Regarding dehydration in children with diarrheal disease, don’t rush to stop the diarrhea, focus on preventing and treating dehydration
During diarrhea, water and electrolytes (sodium, chloride, potassium and bicarbonate) are lost through watery stools, vomiting, sweat, urine and breathing. Without adequate replacement, dehydration can occur and water and electrolyte deficiencies can progress. Dehydration is the leading cause of death from diarrhea. The presence and extent of dehydration can be estimated by observing the child’s clinical signs, such as the child’s consciousness, spirit, skin elasticity, the presence or absence of sunken front chimney eyes, body temperature and urine output.
1.Early stage of dehydration: no signs or symptoms.
2.Mild to moderate dehydration: signs and symptoms gradually appear. Initially, the signs are thirst, irritability or irritability, less frequent urination than usual (for infants, less than 6 wet diapers per day indicates reduced urine output), decreased skin elasticity, sunken eye sockets and sunken fontanel (for infants).
3. Severe dehydration: the above signs and symptoms worsen, irritability or obvious drowsiness; obvious sunken eye sockets and fontanelle; cold hands and feet; urine decreases to only 1~2 times a day. If rehydration is not timely, death occurs quickly.
About the main treatment measures for diarrhea
1. Proper rehydration to prevent and treat dehydration (most important): Oral rehydration salt III is a hypotonic oral rehydration salt recommended by the World Health Organization, which is absorbed in the small intestine and replenishes water and electrolytes lost with feces. Oral rehydration salts III should be given from the beginning of diarrhea to prevent dehydration. It not only prevents and treats mild to moderate dehydration, but also reduces stool volume by 20%, vomiting by 30%, and intravenous rehydration by 33%, and the WHO requires that more than 90% of children with diarrhea be given oral rehydration salts III.
When giving oral rehydration salts III to children, it is important to follow the principle of small amounts, preferably 10 – 20 ml every 2 – 3 minutes. This will give the child 150 – 300 ml of fluid every hour. For smaller infants and children, spoon, dropper or small cups can be used frequently until the required dose is given. If the child vomits, stop for 10 minutes and then feed slowly.
Patients with diarrhea need to determine the dosage to be taken according to the degree of dehydration and age and weight
①No dehydration symptoms: The general principle is: take a dose of oral rehydration salts III after each loose stool according to the patient’s age until the diarrhea stops. The details are as follows.
Example: For a child with diarrhea around 1 year old, who has diarrhea 5 times a day and does not show obvious symptoms of dehydration, 100 ml should be fed after each diarrhea, for a total of 100 ml/time x 5 times a day = 500 ml (i.e. 2 bags).
②Mild to moderate dehydration: dose (ml) = (50~75) ml × body weight (kg), to be taken within 4 hours for children. If the dehydration is corrected after 4 hours, take the same amount as in case one to prevent dehydration until the diarrhea stops.
Example: For an 18-month-old child with diarrhea, weighing 10 kg and having mild dehydration, use the dose = 50 ml/kg × 10 kg = 500 ml (i.e., 2 bags), i.e., finish feeding 500 ml within 4 hours, and if the dehydration is corrected at this time, then take the dose according to the situation with no dehydration symptoms, i.e., 100 ml after each dilute stool until the diarrhea stops.
③ Severe dehydration: Patients with severe dehydration need to be immediately sent to the hospital for emergency treatment, first take intravenous rehydration, take intravenous rehydration while giving oral rehydration salt III as long as the patient can take it orally; after severe dehydration is corrected, it can be completely changed to oral rehydration salt III until diarrhea stops.
2, feeding during diarrhea: if there is no violent vomiting should continue to feed (or increase breastfeeding), the child to a small number of times feeding than a large number of less times feeding better tolerability.
Breastfed infants, regardless of age, should be nursed on demand. Mothers are encouraged to increase the frequency and duration of breastfeeding. Infants who are not breastfed should be fed at least every 3 hours (or infant formula), using a cup whenever possible. Mixed-feeding infants under 6 months of age
Infants under 6 months of age should be breastfed more frequently. As the child improves and breastfeeding increases, other foods should be reduced (liquids other than mother’s milk should be given, and cups should be used instead of bottles).
After the diarrhea has stopped, energy-rich foods should continue to be given and the child should eat more often than usual each day for at least two weeks. If the child is malnourished, additional meals should always be given until the child’s height and weight return to normal.
Zinc supplementation: Zinc supplementation can reduce the duration of diarrhea by 25% and the amount of stool by 30%. 10mg/day for babies under 6 months old and 20mg/day for babies over 6 months old, for 10-14 days.
4. Care: Wash with warm water promptly after stool, apply some greasy ointment after washing to prevent red buttocks, and change diapers promptly to avoid breakage.
Etiological treatment: If it is a bacterial infection, antibiotics can be applied to treat it. If it is a viral infection such as rotavirus, there is no need to apply antiviral treatment such as ribavirin, and there is no need to apply antibiotics.
When to go to the hospital
1. Violent diarrhea, frequent stools or large amount of diarrhea or inability to eat anything at all; obvious signs of dehydration: urine is significantly reduced, possibly only 1-2 times a day; spirit becomes depressed or very irritable; skin is dry and loose, pinching up and rebounding very slowly; hands and feet are cold and wet, etc.
2. Persistent vomiting for more than 12-24 hours; (It can easily cause dehydration and electrolyte disorders. Persistent vomiting means that the child is unable to eat anything between vomiting and it lasts for a longer period of time. In many cases children with diarrhea or acute gastritis may experience frequent vomiting for several hours and not be able to eat, but the vomiting symptoms can usually be gradually relieved after a period of rest).
3, vomit contains fecal residue, more blood or coffee grounds-like material, vomit looks yellowish-green or smells like feces (this is often a sign of intestinal obstruction); feces with blood, or feces with jam-like (there is a possibility of complications of intestinal entrapment and other aggressive diseases).
4. Fever: age < 6 months, prematurity, history of chronic disease or comorbidities.
The main measures to prevent diarrhea are
1. access to safe water; use of improved sanitation facilities; hand washing with soap; good personal hygiene practices and food sanitation; exclusive breastfeeding of infants for the first six months
2. health education on how the infection is transmitted
3. vaccination against rotavirus.