Diarrhea | Medical Science Optional Notes for UPSC PDF Download

Diarrhea Management in Young Infants (Less Than 2 Months)

Assessment

• Ask about Dehydration:
  • If the infant has diarrhea, assess for signs of dehydration.
  • If two or more signs are present (lethargy, sunken eyes, slow skin pinch), classify as Severe Dehydration and urgently refer to the hospital.
  • If signs are not severe, proceed to further assessment.
• Look and Feel:
  • Observe the infant's general condition.
  • If lethargic or unconscious, or restless and irritable, check for sunken eyes and perform a skin pinch test.

Classification

• Some Dehydration:
  • If there are changes in stool frequency or consistency but not severe, advise the mother to continue breastfeeding.
  • Provide guidance on keeping the infant warm if referral to the hospital is not required.
• No Dehydration:
  • If no signs of dehydration, encourage breastfeeding.
  • Provide advice on keeping the infant warm for hospital visits if necessary.
  • If there are signs of dehydration but not severe, offer fluid for rehydration (Plan B) and provide follow-up instructions.

Persistent Diarrhea

• For 14 Days or More:
  • Administer the first dose of intramuscular ampicillin and gentamicin.
  • If severe persistent diarrhea or other classifications, treat for low blood sugar and advise on keeping the infant warm on the way to the hospital.
  • Refer to the hospital for further management.
• Severe Dysentery (Blood in Stool):
  • Administer the first dose of intramuscular ampicillin and gentamicin.
  • Treat for low blood sugar.
  • Advise on keeping the infant warm and refer urgently to the hospital.

IMNCI-Diarrhea (2 months- 5 years)

Plan A: Treatment of No Dehydration at Home

• Oral Rehydration Therapy (ORS) administered at home.
• Dosage based on age:
• Age <24 months: 50 to 100 ml after each stool
• Age 2-10 years: 100 to 200 ml after each stool
• Age >10 years: Liberal usage
• Observation for danger signs:
• Continuing diarrhea beyond 3 days
• Increased volume/frequency of stools, repeated vomiting, increasing thirst
• Refusal to feed, fever, or blood in stools.

Plan B: Treatment of Some Dehydration at the Hospital

• Daily fluid requirements calculated based on weight.
• Deficit replacement or rehydration therapy with 75 ml/kg of ORS over 4 hours.
• Nasogastric tube used if ORS cannot be taken orally.
• Maintenance fluid therapy initiated after dehydration signs disappear, usually within 4 hours.
• Administer ORS in volumes equal to diarrheal losses, up to a maximum of 10 ml/kg per stool.

Plan C: Treatment of Severe Dehydration at the Hospital

• Immediate initiation of intravenous fluids (Ringer lactate with 5% dextrose).
• Total of 100 ml/kg of fluid given over 6 hours (<12 months) or 3 hours (>12 months).
• Simultaneous start of ORS if the child can take it orally.
• If IV fluids cannot be given, nasogastric feeding at 20 ml/kg/hr for 6 hours.
• Reassessment every 1-2 hours; adjust oral or nasogastric fluids based on vomiting or distension.
• If no improvement after 3 hours, initiate IV fluids as early as possible.
• Reassess every 15-30 minutes for pulses and hydration status after the first bolus.

Plan A, Plan B, and Plan C Outcomes

• Persistence of severe dehydration: Repeat intravenous infusion.
• Improved hydration but some dehydration present: Discontinue IV fluids; administer ORS over 4 hours.
• No dehydration: Discontinue IV fluids; consider home treatment with education on feeding and danger signs for the mother/caregiver.

Diarrheal disorders-Repeats

Q1: What are the definition, etiology and importance of Dysentery in young children? What are the clinical features and complications of Dysentery in children? How will you manage a child brought with Dysentery? (2009)

Q2: A 9 month old baby is brought with complains of 3 episodes of diarrhea since his mother stopped breast-feeding at the age of 6-months and started cow's milk along with other food. The current episode of diarrhea began 18 days ago. The baby still takes cow's milk but his mother has reduced his intake of solid food since the diarrhea began. There is no blood in the stool. He weighs 6 kg.
(i) How will you classify his illness?
(ii) What will you look for during examination of this baby?
(iii) How will you manage this baby? (2009)

Q3: Discuss the management of a 2-year-old child presenting with diarrhea for 10 days. The child weighs 5 kg, looks moribund and has low volume peripheral pulses. (2010) 

Q4: A 25 day old baby presented with fever, loose stools, vomiting and refusal to accept feeds. C.R.P. was positive. Discuss the diagnosis and management. (2011) 

Q5: An 8-month-old child, weighing 8 kg, is brought with loose motions 6 per day, mixed with blood, for last 2 days. There is no history of vomiting. Enumerate the 4 most important signs you will look/feel for to assess the severity of dehydration .Assessment of dehydration reveals some dehydration. Write the initial Prescription for appropriate management of this child. (2013)

Q6: Define "persistent diarrhoea" in under-five children. How is it different from "chronic diarrhoea"? Discuss the dietary management of persistent diarrhoea. Enumerate few common causes of chronic diarrhoea. (2016)

Q7: A 13-month-old boy was brought by his mother with six episodes of loose stools and persistent vomiting to the emergency ward. He was found to be lethargic and his pulse rate was 160 per minute. What was the danger signs you would ask for and look for in this child to assess the severity of his illness? If you find severe dehydration, how will you treat the child? If the child is fit to be discharged, yet has 2—3 episodes of loose stools, what advice would you give to the mother? (2018)