Definition

Acute diarrhea is passage of loose stools

lasting for 3- 7 days, but also can last for
10 – 14 days.
Signs of Dehydration
Classification of Dehydration
ORS - Reduced Osmolarity
Content Grams / litre

Sodium chloride 2.6

Glucose, anhydrous 13.5

Potassium chloride 1.5

Trisodium citrate, dihydrate 2.9

Total weight 20.5

Zinc Supplementation
Reduces the episode’s duration and severity
If given for 10 – 14 days, it lowers the incidence
of diarrhoea in the following 2 – 3 months
Dosage: 10 mg for children below 6 months, 20
mg for above 6 months
Plan A : Treat Diarrhoea at Home
Counsel the mother on the three rules of home treatment:
Give extra fluids, continue feeding, return if child worsens
Give extra fluids as much as the child will take
If exclusively breast fed, breast feed frequently and for longer at each
feed.
If passing frequent watery stools: For less than 6 months age, give
ORS and clean water in addition to breast milk. If 6 months or older,
give one or more of the home fluids in addition to breast milk.
If the child is not exclusively breast fed: give one or more of the
following home fluids: ORS solution, yoghurt drink, milk, lemon drink,
rice or pulse based drink, vegetable soup, green coconut water or
plain clean water.
Approximate amount of ORS solution to be given in the first 4
hours ( 75 ml/kg BW)
Age Weight (kg) ORS solution (ml)
< 4 months <5 200 – 400
4 – 11 months 5 – 7.9 400 – 600
12 – 23 months 8 – 10.9 600 – 800
2 – 4 years 11 – 15.9 800 – 1200
5 – 14 years 16 – 29.9 1200 – 2200
≥ 15 years ≥ 30 2200 – 4000
Plan C:
In case of patient with severe dehydration
lethargic
unconscious or floppy
unable to drink water
his radial pulse is weak
skin pinch goes back very slowly
Start intravenous rehydration
Refer the patient to a higher centre to treat as per plan
C

Give IV ringer lactate or if not available give normal

saline

100ml/kg in 3 hour period ( in 6 hours for children less

than 1 year)

Start rapidly (30 ml/kg within 30 minutes) and then slow

down

Age First give 30 ml/kg Then give 70 ml/kg

Total amount per day:200ml/kg during first 24 hours
Infants 1 hr 5 hr
Older 30 min 2 ½ hr
Kiran is 5 months old and weighs 6 Kgs
His mother breast feeds him
He started having diarrhea the previous night and has
had a number of very watery stools associated with
vomiting
His mother said there was no blood in the stools.
As the health worker examines Kiran, he seems alert
but the skin pinch goes back slowly and the eyes are a
little sunken
There are tears in his eyes
But his mouth and tongue are dry and he drinks eagerly.
1. Does Kiran have signs of dehydration? If yes, describe
them.

Kiran has signs of dehydration.

Because:

His eyes are a little sunken

His mouth and tongue are dry
Skin pinch retracts slowly
He is thirsty and drinks eagerly
b. Which treatment plan should the health worker select and
follow?

Health worker selects and follows the plan for some

dehydration – Plan B

c. What should be done if Kiran vomits while on treatment?

If the child vomits, wait for 10 mins.
Then again try to give the ORS solution, but more slowly
For ex: a spoonful every 2 – 3 mins
Also continue breast feeding
 1. How much ORS solution should be given to Kiran in the
first four hours?
Patient weighs 6 kg.
Since exact amount of fluid loss is impractical to calculate,
75 ml/ kg is taken as approximate amount of fluid loss
Hence infant requires:
75 x 6 = 450 ml of ORS solution in the first 4 hours
e. When should Kiran be reassessed?

Child should be reassessed for signs of dehydration again

at the end of 4 hours
f. When the health worker reassesses Kiran, she finds that his
skin pinch goes back quickly and his mouth is moist.
Kiran has passed several watery stools while being treated.
Describe the treatment to be given now.

The signs indicate that the child is adequately rehydrated as he

has no signs of dehydration
Thereafter, maintenance therapy with ORS should be started,
with ORS administered in volume equal to the amount of stool
loss, till diarrhea stops
g. Describe the prevention and control measures
Breast feeding should be continued along with oral
rehydration therapy
Health education should be given to the mother
Immunization against measles and Rota virus vaccine
should be given at the right age
Promotion of breast feeding
Flies breeding in association with human or animal
excreta should be controlled
1. Sham is a two year old brought to the PHC with
complaints of diarrhoea for the last two days.
On examination, he is found to be active and
alert.
His lips and tongue are moist.
And when he cries, there are tears.
His skin pinch reverts quickly.
1. What kind of dehydration does Sham have?
2. Which plan of treatment will you follow?
3. After four hours Sham‘s lips and tongue are moist and
he is sleeping comfortably . His skin pinch goes back
quickly. Frequency of loose stools has also decreased.
How will you manage him now?
4. What advice will you give to prevent such attacks in the
future?