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DEHYDRATION
DONE BY: MOHAMMED A. SYAM
Learning Objective
Definition of diarrhea
Classification of diarrhea
Mechanism of diarrhea
Approach
Management
Dehydration
GENERAL INFORMATION
Diarrhea is one of the leading causes of mortality (infectious).
One of the preventable causes of neonatal mortality.
Diagnosis depends on the history in the first place, then on
medical tests to detect the origin of the problem
There are many causes for diarrhea, these include:
Infective causes.
Non-infective causes.
Endocrine.
Factitious.
DIARRHEA
DIARRHEA
Organic diarrhea
Stool weight of more than 250 mg/day.
Functional diarrhea
Is diarrhea in the absence of any abnormalities
regarding digestion and absorption of nutrients,
fluids and electrolytes , and without any structural
abnormalities.
Diarrhea Classification
Watery
Acute
<2weeks
Diarrhea
Chronic
>2weeks
Bloody
(Dysentery)
Chronic
without
infection
Persistent
with infection
Amebic
Entamoeba
histolytica
Bloody
Bacillary
Shigella,
Salmonella
Not always bloody
Mechanisms of
Diarrhea
Osmotic
Secretory
Exudative
Motility disorders
Osmotic:
due to: presence of high concentration of non -absorbed
hypertonic Substances in intestine which will attract fluid
from the blood to Intestine
Digestive enzyme deficiencies
Ingestion of unabsorbable solute
Viral infection
Secretory:
Defect:
Increased secretion
Decreased absorption
Examples:
Cholera
Toxinogenic E.coli
Comments:
Exudative Diarrhea:
Defects:
Inflammation
Decreased colonic reabsorption
Increased motility
Examples:
Bacterial enteritis
Comments:
Increased motility:
Defect:
Example:
MECHANISMS OF
DIARRHEA
Acute Diarrhea
3. Travellers Diarrhoea
4. Drugs / medications
Chronic Diarrhea
Chronic Diarrhea
Persistent
diarrhea
Acute onset
Prolonged for >2wk
Mostly infection related
Young <1year old
chronic
diarrhea
Insidious onset
Duration wks to months
Any age group
Mostly not infection
related
Infection
HIV
Infection
Severe watery stools that contains fat (floats, shiny and smells
very bad)
Malabsorption
1. Lactose Intolerance
Symptoms may include abdominal pain, bloating, diarrhea, gas, and nausea. These
typically start between half and two hours after drinking milk
Malabsorption
2. Coeliac Disease
A mucosal defect with permanent inability to tolerate gluten (wheat & rye)
Most present before age of 2 years with failure to thrive, irritability, anorexia,
vomiting and diarrhea.
Signs include wasted muscles, abdominal distention and pallor due to iron
deficiency anemia
Coeliac antibodies levels are raised (TG & endomysial)+in villus atrophy
Malabsorption
3. Cystic Fibrosis
Pale fatty stools that float with foul smelling and mucus.
(steatorrhea)
Inflammation
Inflammatory
1) Crhons disease
2) Ulcerative Colitis
Endocrine
1.
Hyperthyroidism
2.
Adrenal insufficiency
3.
Hypoparathyrodism
4.
Diabetes Mellitus
Cont
No nocturnal diarrhea
No blood in stools
Complications of Diarrhea
Dehydration
Electrolyte deficiency
Malnutrition
Paralytic ileus
Irritation to anus due to frequent passage of watery stool containing irritating substances
Degree of Dehydration
Isotonic Dehydration
When proportionally more water than sodium is lost from the body, the extracellular
fluid has increased concentration of sodium and becomes hypertonic regarding the
intracellular fluid and therefore attracts water from the cells. This results in the cell
shrinkage, which may cause brain shrinkage, Itisaparticularlydangerous
formofdehydration,
mayleadtojittery
movements, increased
muscletone, withhyperreflexia,altered consciousness, seizures and
multiple, small cerebral haemorrhages. Transienthyperglycaemia
occursinsomepatientswithhypernatraemic dehydration; it is
selfcorrecting anddoesnotrequireinsulin
Types of dehydration
Infants,< 6monthsofageorthosebornwithlowbirthweight.
Iftheyhavepassed 6diarrhoealstoolsintheprevious24h
Iftheyhavevomitedthreeormoretimesintheprevious24h
Iftheyhavebeenunabletotolerate(ornotbeenofered)extra
fluids
Iftheyhavemalnutrition.
Infantsareatparticularriskof
dehydrationbecause:
Theyhaveagreatersurfaceareatoweightratio
thanolder children,
Immaturerenaltubularreabsorption.
Theyareunabletoobtainfluidsforthemselves
whenthirsty
APPROACH
Detailed history.
Is
it
actually
diarrhea?
Stool volume.
Frequency.
Consistency.
Travel history.
Smell
Color
Family history
Type of food
Physical examination.
Assessment of dehydration.
Weight loss.
Extra-intestinal symptoms.
Abdominal examination.
Rectal examination.
Investigations:
Stool specimens should be examined for mucus, blood, and leukocytes, if + think
about colitis in response to bacteria that difusely invade the colonic mucosa, such
as Shigella, Salmonella, C. jejuni,and invasive E. coli.
Stool cultures are recommended for patients with fever, profuse diarrhea, and
dehydration
If the stool test result is negative for blood and leukocytes, and there is no history
to suggest contaminated food ingestion, a viral etiology is most likely.
fecal immunoassays are the diagnostic tests of choice for Girdia
TREATMENT
Most infectious causes of diarrhea in children are self-limited.
Management of viral and most bacterial causes of diarrhea is primarily supportive and
consists of:
correcting dehydration and ongoing fluid and electrolyte deficits and
managing secondary complications resulting from mucosal injury.
RESOURCES
Literature:
Tom Lissauer, Graham Clayden, Illustrated textbook of
pediatrics, 4th edition,(Mosby Elsevier, 2012).
Robert M. Kliegman, Bonita F. Stanton, nelson textbook of
pediatrics, 19th edition, (Elsevier Saunders, 2011).
Parveen Kumar, Michael Clark, Kumar and Clark's clinical
medicine, 8th edition, (saunders Elsevier, 2012).