Diarrhoea_in_Children_MBBS student learning

For mbbs student learning

1. Diarrhoea in Children For MBBS Students Dr. Jigar Patel

2. Definition Diarrhoea is the passage of three or more loose or liquid stools per day, or more frequently than is normal for the individual.

3. Classification 1. Acute watery diarrhoea (e.g. cholera) 2. Acute bloody diarrhoea (dysentery) 3. Persistent diarrhoea (lasting >14 days) 4. Chronic diarrhoea (>4 weeks)

4. Epidemiology Common cause of morbidity and mortality in children under 5 years. Major cause of dehydration and malnutrition.

5. Aetiology • Infectious: Rotavirus, E. coli, Shigella, Salmonella, Vibrio cholerae • Non-infectious: Food intolerance, antibiotic-associated diarrhoea

6. Pathophysiology Mechanisms: 1. Osmotic diarrhoea 2. Secretory diarrhoea 3. Exudative diarrhoea 4. Motility-related diarrhoea

7. Risk Factors • Poor sanitation • Contaminated food/water • Malnutrition • Incomplete immunization • Lack of breastfeeding

8. Clinical Features • Frequent watery stools • Vomiting • Dehydration signs: sunken eyes, dry mouth, lethargy • Fever, abdominal pain

9. Assessment of Dehydration Classify as: 1. No dehydration 2. Some dehydration 3. Severe dehydration Based on WHO criteria (e.g. sunken eyes, skin pinch, thirst).

10. Laboratory Investigations • Usually not required for mild cases • Stool microscopy/culture in severe/persistent cases • Electrolytes, renal function in dehydrated children

11. Complications • Dehydration • Electrolyte imbalance (especially hypokalemia) • Metabolic acidosis • Malnutrition • Death if untreated

12. Management Principles 1. Rehydration (ORS or IV fluids) 2. Continue feeding 3. Zinc supplementation 4. Antibiotics only when indicated 5. Education & prevention

13. Oral Rehydration Therapy (ORT) • WHO-ORS formula: sodium 75 mmol/L, glucose 75 mmol/L, total osmolarity 245 mOsm/L • Give 75 mL/kg over 4 hours for some dehydration

14. IV Rehydration Indicated for severe dehydration: • Ringer’s lactate preferred • 100 mL/kg in 3 stages over 3–6 hours

15. Zinc Supplementation • <6 months: 10 mg/day for 14 days • ≥6 months: 20 mg/day for 14 days Reduces duration and recurrence of diarrhoea.

16. Antibiotic Use Only indicated for: • Dysentery (bloody stools) • Cholera • Severe bacterial infection Avoid unnecessary use.

17. Nutrition During Diarrhoea • Continue breastfeeding • Avoid fasting • Provide easily digestible food • Encourage fluid intake

18. Prevention • Hand hygiene • Safe drinking water • Exclusive breastfeeding for 6 months • Rotavirus vaccination • Sanitation improvement

19. WHO Guidelines Summary • Assess dehydration • Rehydrate (ORS/IV) • Continue feeding • Give zinc • Educate caregivers

20. Prognosis Excellent with prompt and adequate management. Delayed treatment can lead to severe dehydration and death.

21. Key Takeaways • Common but preventable cause of childhood illness. • Early recognition and rehydration save lives. • Focus on ORS, zinc, and education.