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By ULY CLINIC staff

 

Acute watery diarrhea in children (AWD)

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Introduction

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AWD is diarrhea that lasts less than 14 days. Based on the degree of dehydration there are three categories, acute watery diarrhea with no signs of dehydration, acute watery diarrhea with some dehydration and cute watery diarrhea with severe dehydration.

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In this page you will learn about

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First, check for emergency signs (the ABCD), and then check for signs of dehydration.​

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Assessment of Dehydration

AWD

Note:


Lethargy means; mental state is dull and the child cannot be fully awakened, the child may appear to be drifting into unconsciousness. Assessment for dehydration in SAM click here

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Acute watery diarrhoea with no signs of dehydration


Diagnostic Criteria

 

  • Diarrhoea and no signs of dehydration

 

Investigations

 

  • No specific investigation

 

Treatment

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  • Treatment Plan A

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Diarrhoea Treatment Plan A

AWD-no dehydration

Acute watery diarrhea with some dehydration

 

Diagnostic Criteria

 

Diarrhoea and at least two signs in column B above

 

Investigations

 

  • Serum electrolytes

 

Treatment Plan B:

 

  • Oral rehydration therapy for children with some dehydration.

  • Give low osmolar ORS solution and Zinc supplementation to children with some dehydration in a health facility (Treatment Plan B) as described below.

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DIARRHOEA TREATMENT PLAN B GIVE RECOMMENDED AMOUNT OF ORS IN CLINIC OVER A 4 – HOUR PERIOD

AWD some dehydration

* use the child’s age only when you do not know the weight. Amount of ORS required in ml can be calculated as 75ml/Kg

 

  • If the child wants more ORS than shown, give more

 

Show the mother how to give ORS solution

 

  • Give frequent small sips from a cup

  • If the child vomits, wait 10minutes. Then continue , but more slowly

  • Continue breastfeeding whenever the child

 

 After 4 hours

  • Reassess the child and classify the child for dehydration

  • Select the appropriate plan to continue treatment

 

If the mother must leave before completing treatment

 

  • Show her how to prepare ORS solution at home

  • Show her how much ORS to give to finish 4 – hour treatment at home

  • Give her enough ORS packets to complete rehydration. Also give her 2 packets as recommended in Plan A

 

Explain the four rules of Home Treatment

 

  1. Give extra fluid

  2. Give zinc supplements

  3. Continue feeding

  4. When to return

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Note:

 

Oedematous (puffy) eye lids are a sign of over hydration. If this occurs, stop giving ORS solution, but give breast milk or plain water, and food. Do not give a diuretic

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Acute watery diarrhea with severe dehydration

 

Diagnostic Criteria

 

Diarrhoea and at least two signs in column C above

 

Investigations

 

  • Serum electrolytes

  • Serum creatinine

  • Blood Urea Nitrogen

  • FBP

 

Treatment Plan C

 

IV rehydration therapy for children with severe dehydration. Follow the chart below.​

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DIARRHOEA TREATMENT PLAN C


TREAT SEVERE DEHYDRATION QUICKLY

AWD-severe dehydration
Diarrhoea treatment plan C- ulyclinic

Note:

 

If possible, observe the child for at least 6 hours after rehydration to be sure the mother can maintain hydration giving the child ORS solution by mouth

 

 

Treatment of Complications of Acute watery diarrhea

 

Hypernatraemia (serum Na >150 mmol/L)

 

  • Give ORS solution 75ml/Kg slowly in a period of 24hrs.

 

Hyponatraemia (serum Na+ <130 mmol/l)

 

  • Mild/Moderate (Na 120- 130mmol/l), give ORS solution according to the treatment plan A or B depending on the level o dehydration.

 

  • Severe hyponatraemia (Na < 120 mmol/l) give 3% NaCl 4 ml/kg IV bolus over 15 minutes.

 

Hypokalaemia (serum K+ <3 mmol/l)

 

 

Mild/Moderate (Serum K+ 2.5 – 3mmol/l)

 

  • Give Oral potassium (Potassium chloride - Slow K) 1- 4 mmol/kg/day

 

Severe Hypokalaemia (serum K + <2.5 mmol/l)

 

  • Give 7.5% potassium Chloride 0.2- 0.4 mmol/kg/hr (1ml =1mmol) diluted

  • 25- 50 times in Ringers Lactate to run for three hours.

  • Give food rich in potassium (e.g. Ripe banana, green coconut water (Madafu), tomatoes etc) during diarrhoea and after it has stopped.

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Note:


Severe hypokalemia should be managed where serum electrolytes can be monitored closely as overdose can cause sudden cardiac arrest

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Before giving IV Potassium - ensure the child is passing urine, never give bolus or
flush. 1 tablet of slow K has 600 mg=8 mmol

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Last updated on 06.09.2020

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References​

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  1. Tanzanian Standard treatment guideline for children 2017 edition page 67-72

  2. Healthlinefor disease. Diarrhoea treatment plan C. http://helid.digicollection.org/en/d/Jwho89e/11.1.2.html. Accessed on 06.09.2020

AWD treatment
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