Clinical Presentation on child
with Accute diarrhoeal disease
Sreedevi . T suresh
2nd year M.S.c
PROFILE OF THE CHILD
HISTORY OF THE CHILD
PHYSICAL
EXAMINATION
GROWTH AND
DEVELOPMENT
ANATOMY AND PHYSIOLOGY
Acute Diarrhoeal Disease
Stool weight in excess of 200 gm/day
3 or more loose or watery stools/day
Alteration in normal bowel movement
characterized by decreased
consistency and increased frequency
Less than 14 days in duration
EPIDIOMOLOGY
1.2-1.9 episodes per person annually in the
general population
2.4 episodes per child <3 years old
annually
5 episodes per year for children <3
years old and in daycare
ETIOLOGY
Viral: 70-80% of infectious diarrhea in
developed countries
Bacterial: 10-20% of infectious
diarrhea but responsible for most
cases of severe diarrhea
Protozoan: less than 10%
VIRAL DIARRHOEA
Rotavirus
Norovirus (Norwalk-like)
Enteric Adenovirus
Astrovirus
Rotavirus
Leading cause of hospitalization for diarrhea in
children
Most prevalent during winter season Fecal-oral
transmission: viral shedding can persist for 21
days
Acute onset of fever followed by watery
diarrhea (10-20 BM/day) and
Norovirus
Most common cause of diarrheal outbreaks/epidemics
Multiple modes of fecal-oral transmission
Acute onset of nausea and vomiting,
watery diarrhea with abdominal
cramps and can persist for 1-3 days
Enteric Adenovirus
Primarily affects children < 4 years old
Fecal-oral transmission
Clinical picture similar to rotavirus (fever and
watery diarrhea)
Astrovirus
Primarily affects children < 4 years old and
immunocompromised
Seasonal peak in the winter
Fecal-oral transmission: viral shedding can occur for
several weeks
Fever, nausea and vomiting, abdominal
pain, and diarrhea lasting up to a week
Bacterial Diarrhea
Campylobacter
Salmonella
Shigella
Enterohemorrhagic Escherichia coli
Campylobacter
Most common bacterial pathogen Transmitted through
ingestion of contaminated food or by direct contact with
fecal material
Symptoms include diarrhea (+/- blood),
abdominal cramps (can be severe), malaise, fever
Usually self-limited and does not require antibiotics
Salmonella
Most common in children <4 years old and a
peak in the first few months of life
Transmitted via ingestion of contaminated
food and contact with infected animals
Symptoms include fever, diarrhea, and
abdominal cramping
Antimicrobial therapy can prolong fecal
shedding
Shigella
Fecal-oral transmission Symptoms include
fever, abdominal
cramps, tenesmus, and mucoid stools with or
without blood Can lead to serious
complications
Antimicrobial treatment shorten duration of
illness and limits fecal shedding
E. Coli
Transmission via contaminated food and
Water Symptoms include bloody diarrhea,
severe abdominal pain, and sometimes fever Can lead to
serious complications
Antibiotics have no proven benefit and may increase the
risk of complications
Physical Exam
Vitals
Abdominal exam
Presence of occult blood
Signs of dehydration
Laboratory Evaluation
Unnecessary for patients who present within 1
day from onset of diarrhea
Warning signs/symptoms: bloody
diarrhea, high fever, severe abd pain, dehydration.
Fecal leukocytes followed by bacterial
culture, ova & parasites, viral antigens
CBC, chemistries
Treatment
Fluid replacement
– Fluids or Oral Rehydration Solutions (ORS)
– Parenteral rehydration
Early refeeding
Symptomatic Treatment
– Oral bismuth
– Loperamide
Antibiotics
Fluid Replacement
ORS: Infalyte, Pedialyte, Naturalyte and
Rehydralyte
Must be used or thrown out 24 hours
after opening/mixing
AAP Guidelines
Diarrhea with no dehydration – normal
diet and supplemental ORS with each diarrheal episode.
Diarrhea with some dehydration –
seek medical care, give ORS in the doctor's
office, and cont. ORS and normal diet at home.
Moderate - severe dehydration –
consider intravenous hydration, especially if patient is
also vomiting
Early Refeeding
Luminal contents help promote growth of
new enterocytes and facilitatemucosal repair
Can shorten duration of the disease
Lactose restriction is not necessary except in
severe disease
Symptomatic Treatment
Only in patients who are afebrile and have
nonbloody diarrhea
Loperamide – inhibits peristalsis and has
antisecretory properties
Bismuth subsalicylate – may help with
nausea, vomiting, and abdominal pain,as
well as shorten duration of illness
Antibiotics
antibiotic therapy generally not beneficial
and can be harmful
Those with more than eight
stools/day,diarrhea >1 wk, volume depletion,
immunosuppresion, or warning signs
Fluoroquinolone or Azithromyzin
Specific Antibiotic
Therapy
Viral – of course not!
Campylobacter – only if severe
Salmonella – can prolong fecal shedding, only prescribe
if severe
Shigella – proven beneficial
E. Coli O157:H7 – can be harmful
Zinc Supplementation in
AD
Responsible for > 200 enzymes in body.
Improves the immune function & absorption.
Supplementation in AD and PD helpful in 20-
30% reduction in diarrhea.
42% lower rate of treatment failure or death.
Cont….
Dosages
Infants 10mg daily x 2 weeks.
Older children 20mg daily x 2 weeks.
Persistent diarrhea 20mg x 4 weeks
Home Available
Fluidson…
Recommended
Salt sugar solution
Lemon water(Sikanjabi)
Rice water / Kanjee
Soups
Dal water
Lassi
Coconut water
Plain water
Cont…
Not recommended
Simple sugar solution
Glucose solution
Carbonated soft drinks
Fruit juices-tinned or fresh
Fluids for athletes
Gelatin desserts
Tea/Coffee
NURSING DIAGNOSIS
Hyperthermia
Fluid volume deficit
Ineffective tissue perfusion
Interrupted breast feeding
Risk for complication
Risk for impaired parent neonatal attachment
NURSING
MANAGEMENT
Restoring fluid and electrolyte balance by ORS and
IV therapy.
Prevention of spread of infection by good hand
washing practices, hygienic
disposal of stools, care of diapers,general cleanliness
and universal precautions.
Cont..
Preventing skin breakdown by frequent change of
diaper, keeping the perineal area dry and clean
Providing adequate nutritional intake by
appropriate dietary management
Reducing fear and anxiety by explanation,
reassurance, answering questions and providing
necessary informations.
Cont…
Giving health education for prevention of diarrhea, home
management of diarrheal diseases, importance of ORS,
dietary management etc..
HEALTH EDUCATION
CONCLUSION
