Zusammenfassung der Ressource
Gastroenteritis- ix & mx contd
- Ix
- usually none indicated
- stool culture
- if child appears septic
- if blood or mucus in stools
- if immunocompromised
- if recent foreign travel
- if diarrhoea hasn't improved by day 7
- if diag uncertain
- if iv fluids needed or
features suggestive of
hypernatraemia
- U&E
- glucose
- if Abx started
- blood cultures
- Mx
- fluid management of dehydration
- see doc
- hypernatraemic dehydration
- ORS
- to rehydrate kids w/ clinical dehydration
- if iv fluids needed
- a rapid decrease in plasma [Na+] and osmolality will ->
- water moving into cerebral cells->
- seizures
- cerebral oedema
- reduction in plasma [Na+] should be slow
- replace fluid deficit over at least 48 h & measure plasma Na+ regularly
- aim to reduce plasma Na+ at < 0.5 mmol/L/hr
- NO ROLE FOR
ANTI-DIARRHOEALS &
ANTIEMETICS
- ineffective
- prolong excretion of bacteria in stools
- can be assoc w/ s/es
- add unnecessarily to cost
- take focus away from ORS
- Abx
- not routinely required
- even if bacterial cause
- indications
- suspected/confirmed sepsis
- extra-intestinal spread of bacterial infection
- Salmonella gastritis in <6 months old
- malnourished kids
- immunocompromised
- specific bacterial or protozoal infections
- bacteria
- C diff assoc pseudomembranous colitis
- cholera
- shigellosis
- protozoa
- giardiasis
- Mx
- nutrition
- multiple episodes of diarrhoea predispose
to developing malnutrition
- in developing countries
- increase nutritional
intake ff diarrhoea
- zinc supplementation in acute diarrhoea & prophylaxis
- diarrhoea can be assoc w/ zinc def