Therapeutic methods for diarrhea in children

Table 1 Assessment of diarrhoea patients for dehydration

1. Look at:	Conditiona	Well, alert	Restless, irritable	*Lethargic or unconscious; floppy*
	Eyesb	Normal	Sunken	Very sunken and dry
	Tears	Present	Absent	Absent
	Mouth and tonguec	Moist	Dry	Very dry
	Thirst	Drinks normally, not thristy	*Thirsty, drinks eagerly*	*Drinks poorly, or not able to drink*
2. Feel:	Skin pinchd	Goes back quickly	*Goes back slowly	**Goes back very slowly*
3. Decide:		The patient has no signs of	If the patient has two or more signs, including	If the patient has two or more signs,
		dehydration	at least one *sign*, there is some dehydration	including at least one *sign* , there is
			severe dehydration
4. Treat:		Use Treatment Plan A	Weigh the patient, if possible, and use	Weigh the patient and use Treatment
			Treatment Plan B	Plan C urgently

^aBeing lethargic and sleepy are not the same. A lethargic child is not simply asleep: the child’s mental state is dull and the child cannot be fully awa kened; the child may appear to be drifting into unconsciousness.

^bIn some infants and children the eyes normally appear somewhat sunken. It is helpful to ask the mother if the child’s eyes are normal or more sunken th an usual.

^cIt is necessary to look inside the child’s mouth. The mouth may be dry in a child who habitually breaths through the mouth. The mouth may be wet in a dehydrated child owing to recent vomiting or drinking.

^dThe skin pinch is less useful in infants or children with marasmus or kw ashiorkor, or obese children.

Table 2 Guidelines for treating children and adults with some dehydration

Approximate amount of ORS solution to give in the first 4 h
Agea	Less than 4 months	4-11 months	12-23 months	2-4 years	5-14 years
Weight:	Less than 5 kg	5-7.9 kg	8-10.9 kg	11-15.9 kg	16-29.9 kg
In mL	200-400	400-600	600-800	800-1200	1200-2200
In local measure

^aUse the patient’s age only when you do not know the weight. The ap proximate amount of ORS required (in mL) can also be calculated by multiplying the patient’s weight in kg by 75. ·If the patient wants more ORS than shown, give more. ·Encourage the mother to continue breastfeeding her child. ·For infants under 6 months who are not breast fed, also give 100-200 mL clean water during this period.NOTE: During the initial stages of therapy, while still dehydrated, adults can consume up to 750 mL per h, if necessary, and children up to 20 mL per kg body weight per h.

Table 3 Guidelines for intravenous treatment of children and adults with sever e dehydration

·Start IV fluids immediately. If the patient can drink, give ORS by mouth until the drip is set up. Give 100 mL/kg Ringer’s Lactate Solutiona divided as follows:
Age	Fisst give 30 mL/kg in:	Then give 70 mL/kg in:
Infants (under 12 months)	1 hb	5 h
Older	30 minb	2.5 h
·Reassess the patient every hour. If hydration is not improving, give the IV drip more rapidly.
·After 6 h (infants) or three hours (older patients), evaluate the patient using the assessment chart. Then choose the appropriate Treatment Plan (A,B or C) to continue treatment.

^aIf Ringer’s Lactate Solution is not available, normal saline may be used.

^bRepeat once if radial pulse is still very weak or not detectable.