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Evaluation and Treatment of Diarrhoea
Assessment of dehydration in a patient with diarrhoea

        Clinical signs
General condition Well, alert “Restless, irritable” “Lethargic or unconscious”, floppy.
Eyes Normal Sunken Very sunken and dry
Tears Present Absent Absent
Mouth and Tongue Moist Dry Very dry
Thirst

Drinks normally, not thirsty

 “Thirsty, drinks eagerly” “Drinks poorly” or not able to drink
Skinpinch “Goes back quickly” “Goes back slowly” “Goes back very slowly”
Decide dehydration status The patient has no signs of hydration If the patient has two or more signs, including one (key) sign, then there is some dehydration If the patient has two or more signs, including one (key) sign, there is severe dehydration.
Treatment plan Plan-A Plan-B Plan-C


Composition and concentration of WHO/UNICEF recommended oral dehydration salts (ORS)
Ingredients Composition (Grams/L) Concentration (mEq/L)  
Sodium chloride 3.5 Sodium 90
Potassium chloride 1.5 Chloride 80
Trisodium citrate anhydrous 2.9 Citrate 10
Glucose (anhydrous) 20.0 Glucose Osmolality 111 mmol/L311
Note: Soda bicarb is not recommended now.


Guidelines for replacement of fluid and electrolytes in children with ‘No dehydration’ (Plan-A)*
Age After each loose stool, offer
< 6 months Quarter glass or cup (50mL)
7 months - 2 years Quarter to half glass or cup (50-100 mL)
2 - 5 years Half to one glass or cup (100-200mL)
Older Children As much as the child can take.
* Fluids which can be used include ORS, lemon water, butter milk, rice kanji, lentil soup, light tea etc. ORS in Plan-A treatment is optional only.


Deficit fluid therapy for ‘Severe dehydration’ (Plan-C)  (100 mL/kg body weight)
Age Type of Fluid Volume of Fluid and Duration Monitoring
Infants < 1 year Ringer’s lactate 30 mL/kg body weight within first hour, followed by 70 mL/kg body weight 70 mL/kg body weight over next 5 hours Reassess after every:
1-2 hours
* if not improving, give IV drip more rapidly.
* encourage oral feeding by giving ORS 5 mL/kg / hour, alongwith IV fluids, as soon as child is able to drink.
Children > 1 year Ringer’s lactate 30 mL/kg body weight within 1/2 hour, followed by 70 mL/kg/body weight over next 2 1/2 hours. Reassess hydration status :
* After 6 hours (infants) and 3 hours (older children) assess hydration appropriate plan for hydration (Plan-A, B and C)


Antimicrobials used to treat specific causes of diarrhoea in children
Causes Drugs of Choice Doses
Cholera Tetracycin
Furazolidone
or
Trimethoprim (TMP)-sulfamethoxazole (SMX)		 30 mg/day in 4 divided doses x 2-3 days
5 mg/kg/day in 4 divided doses x 3 days

TMP 5mg/kg and SMX 25mg/kg, in 2 divided doses x 3 days
Dysentery Trimethoprim (TMP)-
sulfamethoxazole (SMX)
or
Nalidixic acid
or
Ampicillin		 TMP 5mg/kg and
SMX 25 mg/kg in 2 divided doses x 5 days

15mg/kg 4 times a day x 5 days

25 mg/kg 4 times a days x 5 days
Amebic dysentery Metronicazole 30 mg/kg/day in 3 divided doses x 5-10 days
Acute giardiasis Metronidazole

Tinidazole		 15mg/kg/day in 3 divided doses x 5 days

10-15mg/kg/day in 3 divided doses x 5 days.


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