CASE REPORT

DIARRHEA

Adviser by :
dr. Alfred, Sp. A

Writen by:
Meylinda (1261050133)
LITERATURE REVIEW

Introduction
• Diarrhea is an increase in the frequency and looseness of
stool.
• It results when some factors impair the ability of the
intestine to absorb water from stool.
Classification
According to:
1. Mechanism
• Osmotic
• Secretory
• Motility

2. Origin
• Acute
• Chronic
Classification According to Mechanism
• Osmotic diarrhea:
• when non absorbable solute pulls excess
water into the intestinal tract.
• Secretory diarrhea:
• When the intestinal wall is damaged,
increased secretions rather than absorption of
electrolytes in the intestinal tract.
• Motility disorder:
• Decreased contact time of fecal mass with the
intestinal wall
Classification According to Origin
• Acute: (2-3 days and may last up to 2 weeks)
Due to:
• Infection
• Virus (Rota)
• Bacteria
• Protozoa (Giardia lambila,entamoeba histolytica).
• Diet
• Food allergy
• High fiber diet
• Large amount of caffeine

• Chronic: (more than 2 weeks).

Due to:
• Protozoal infection
• IBS
• Malabsorption syndrome
• Pancreatic disease
Risk factors
• Occurrence – First 2 years of life (6 – 11 months)
• Low socio-economic status
• Non breast fed babies
• Associated with measles, severe malnutrition,
immunodeficiency
Etiology
• Common - Rotavirus, Enterotoxigenic Escherichia coli
(ETEC), Enteropathogenic Escherichia coli (EPEC),
Shigella, Campylobacter jejuni

• Vibrio cholerae (in epidemics)Dysentery – shigella,

Campylobacter jejuni, enteroinvasive E coli, Salmonella
dysenteriae

• Drugs – Ampicillin, Cotrimoxazole, Amoxicillin,

Chloramphenicol
Clinical features
Based on the mechanism -
• Secretory diarrhea – ETEC, Vibrio Cholerae. Toxins cause Na pump failure.
Ac watery diarrhea with profound losses of water and elect. Risk - rapid
water & elect imbalance.

• Invasive diarrhea (Dysentery)- Shigella. Intestinal mucosa invaded by

enteropathogens>> inflammatory reaction >>blood & mucus in stools.
Complications – Intestinal perforation, toxic megacolon, rectal prolapse,
encephalopathy, septicemia, hemolytic uremic syndrome

• Osmotic diarrhea – Carbonated soft drinks, ORS with high sugar content.
Injury to enterocytes >>epithelial destruction >> <ed mucosal disaccharidse
activity. Passage of large, frothy, explosive and acidic stools. Dehydration,
hypernatremia.
Consequences of diarrhea

• Dehydration – Most common and life

threatening. Young children more susceptible.
Depletion of ECF vol, elect imbalance (< Na
& K). First symptom at loss of 5% body wt. At
loss of 10% body wt – shock…

• Malnutrition – Low intake of food, <ed nutrient

absorption, >ed req due to infection.
Repeated & prolonged –serious effects,
growth failure, intercurrent infections
Assessment of dehydration
Clinical signs No dehydration Some Severe
dehydration dehydration
General condition Well, alert Restless, irritable Lethargic/
unconscious/
floppy
Eyes Normal Sunken Very sunken, dry
Tears Present Absent Absent
Mouth & tongue Moist Dry Very dry
Thirst Drinks normally, Thirst, drinks Drinks poorly, not
not thirsty eagerly able to drink
Skin pinch Goes back quickly Goes back slowly Goes back very
slowly
Dehydration status No signs 2/ more signs + 1 2/ more signs + 1
key sign key sign
Treatment plan Plan A Plan B Plan C
Management of ‘No’ dehydration – Plan A
• Objective – Prevent dehydration & malnutrition
• By Mother/ caretaker (advice)
Give more fluids than normal
Continue feeding
Bring to hosp after 2 days, or earlier (if thirst, high fever, high pulse
rte, excessive vomiting, visible blood in stool, abd.al distension,
poor intake or lethargy)
Guidelines for fluid & electrolytes replacement - Plan
A

Age After each loose stool, offer-

< 6 months Quarter glass or cup (50 ml)
7 months – 1 year Quarter – half glass or cup (50 – 100 ml)
2 – 5 years Half – one glass or cup (100 – 200 ml)
Older children As much as child can take
Choice of fluds – ORS, lemon water, butter milk, rice kanji, lentil
soup, light tea etc.
Management of ‘some’ dehydration - Plan B
• Objective – Treat dehydration & elect imbalance and
continue feeding
• Rehydrated with ORS under supervision of a health
facility
• Correction of dehydration –
50 – 100ml/kg body wt (av 75 ml/kg) ORS over a period of 4 hrs.
Give more if child wants, continue br feed
Infants <6 months not on br feed – 100 – 200 ml plain water in
addition to ORS
Older children – Free access to plain water
Monitor closely – Acceptance of ORS, vomiting , stools, fever
• Reassess after 4 hrs –
If still dehydrated, repeat ‘deficit therapy’ and start to other milk/
food.
 If rehydrated, treat as in Plan A
If ORT not successful, treat as ‘severe dehydration’ with IV fluids
by Plan C
Management of ‘severe’ dehydration – Plan C
• Objective – Quickly rehydrate in hospital with IV fluids
• Preferred solution – Ringer’s lactate
• If RL not available- N Saline and half strength Darrow’s
solution may be used
Deficit fluid therapy -Plan C for severe dehydration

Age Type of Vol of fluid & duration Monitoring

fluid
Infants Ringer’s 30 ml/kg wt in first hr, Reassess after 1 – 2 hrs
< 1year lactate followed by 70ml/kg wt -If no improvement – IV drip
over next 5 hrs more rapidly
Children Ringer’s 30 ml/kg wt within ½ hr, -ORS 5ml/kg/hr, along with IV

< 1year lactate followed by 70ml/kg wt fluids as soon as baby can

over next 2½ hrs drink
Reassess hydration status
After 6 hrs (infants) & 3 hrs
(older children)
Choose appropriate plan – A,B
and C
Thank You