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*o Acutediarrhea is defined as a greater number of stools (>3 times in 24 hours) of decreased form from the normal lasting for less than 7 days. If the illness persists for more than 14 days, it is called persistent. If the duration of symptoms is longer than 1 month, it is considered chronic diarrhea.

o Most

cases of acute diarrhea are self-limited, caused by

infectious agents (e.g. viruses, bacteria, parasites), and do not require medication unless the patient is immunocompromised.

*Feces contact before handling food Improper food hygiene Improper food refrigeration

Lack of proper handwashing

Food exposure to flies

Improper disposal of feces

Diarrhea

Consumption of contaminated water or food

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*Caution* Being lethargic and sleepy are not the same. * A lethargic child is not simply asleep ; the childs mental state isdull and cannot be fully awakened ; the child may appear to be drifting into unconsciousness.

* In

some infants and children, the eyes normally appear

somewhat sunken. It is helpful to ask the mother if the childs eye are normal or more sunken than usual.

* The skin pinch is less useful in infants or children with marasmusor kwashiorkor, or obese children.

*oStool cultures are usually unnecessary forimmunocompetent patients who present within 24 hours after the onset of acute, watery diarrhea.

oIt is usually done if there is sign of lactose intolerance and suspect ofamoebiasis.

oWhat to look for ? : Macroscopic :Consistency, Color, Mucus, Blood, Smell

Microscopic : Leukocyte, Erythrocyte, Parasites, Bacteria.

Chemistry : pH, Electrolyte (Na, K, HCO3 ) BloodGas Analysis and Serum Electrolyte if clinically suspect of acid base and electrolyte imbalance.

** Epidemiologicclues to infectious diarrhoea can be found by evaluating the incubation period, history of recent travel, unusual food or eating circumstances, professional risks, recent use of antimicrobials, institutionalization, and HIV infection

risks.

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*

*No signs of dehydration:

* Oral rehydration therapy (ORT) is the administration of fluid by mouthto prevent or correct dehydration that is a consequence of diarrhoea.

* ORT consists of: Rehydration water and electrolytes are administered toreplace losses.

Maintenance fluid therapy (along with appropriate nutrition). 5-10ml/kgBW after every episode of diarrhea or, Depends on age:5 : as needed (fluid other than ORS can be given)

Continue breastfeeding.

* Mild Dehydration 75ml/kgBWof oral rehydration solution within 3 hours and 510ml/kgBW after every episode of diarrhea.

In case of continuous vomiting, parenteral rehydration should begiven : -Ringer Lactate, KaEN 3B or Nacl. -Volume depends on body weight 3-10kg : 200ml/kgBW/day - 10-15kg : 175ml/kgBW/day - >15kg : 135ml/kgBW/day

Patients should be monitored in hospital/Primary Health Centre. Give education to parent about how to do rehydration to theirchildren.

* Severe Dehydration Parenteral rehydration using ringer lactate or ringar acetate :100ml/kgBW.Age 12 months 30ml/kgBW 1 hour 30 minutes 70ml/kgBW 5 hours 2.5 hours

Oral rehydration should be continued when the patient is ableto drink (5ml/kgBW).

**Micronutrientsupplementation supplementation treatment with zinc (20 mg per day until the diarrhea ceases) reduces the duration and severity of diarrheal episodes in children in developing countries.

*Supplementation with zinc sulfate (2 mg per day for 1014 days) reduces the incidence of diarrhea for 23 months.

*It

helps reduce mortality rates among children with persistent diarrheal illness. of zinc sulfate supplements to children suffering from persistent diarrhea is recommended by the WHO.

*Administration

Age