– Acute diarrhea is defined as the transmission of at least 3 loose stools per day for less than 2 weeks.
– Clinically, there are 2 types of acute diarrhea:
• simple diarrhea without blood, caused by viruses in 60% of cases (rotavirus, enterovirus), bacteria (Vibrio cholerae, enterotoxigenic Escherichia coli, Salmonella non-typhi, Yersinia enterocolitica) or parasitic (giardiasis).Other diseases such as malaria, upper respiratory tract infection and low can be accompanied by this type of diarrhea.
• bloody diarrhea or dysentery, caused by bacteria (Shigella in 50% of cases, Campylobacter jejuni, Escherichia colienterotoxigenic and enterohaemorrhagic, Salmonella) and parasites (intestinal amebiasis).
– The transmission of infectious diarrhea is direct (dirty hands) or indirect (ingestion of water or food contaminated).
– Acute dehydration and malnutrition are responsible for the high mortality from diarrhea, even benign. They must be prevented with adequate nutrition and hydration.
Clinical signs:
– Search priority signs of dehydration.
– Then look for other signs:
• profuse and afécales stool (cholera, enterotoxigenic E. coli)
• profuse vomiting (cholera)
• fever (salmonella, viral diarrhea)
• presence of red blood in the stool.
– In cases of severe dehydration quick installation in a more than 5-year patient, suspect cholera.
Treatment:
Basic principles:
– Prevent or treat dehydration: rehydration is to replace water loss and electrolytes, as and when they arise, until the diarrhea stops.
– Supplement with zinc children under 5 years.
– Prevent malnutrition.
– Do not routinely use antibiotics: only certain diarrhoeas require antibiotics.
– Do not use anti-diarrheal or anti-emetic.
Prevent dehydration (outpatient):
Follow Treatment plan A to treat diarrhea at home.
Treatment of dehydration:
Case 1: dehydration is moderate (dispensary)
Follow Treatment Plan B: oral rehydration therapy for moderately dehydrated children.
Case 2: dehydration is severe (in hospital)
Follow C treatment plan for patients with severe dehydration.
– In case of hypovolemic shock or in case of no improvement after one hour: increase the pace of the infusion.
– Beware of fluid overload: palpebral edema is the first sign of overload. Suspend rehydration until disappearance of edema.
– In case of cardiac decompensation sign (laryngeal crackles, dyspnoea and increased respiratory rate, coughing with or without frothy sputum, distress, crackles in both fields, tachycardia etc.), administer IV furosemide immediately renew 1 2 hours after if necessary:
Children: 1 mg / kg / injection
Adult: 40 mg / injection
Special cases:
– Cholera 10 to 15 liters of Ringer’s lactate solution may be necessary on the first day in an adult.
After 24 hours of infusion, especially if the patient is not resupplied, there is a risk of hypokalemia. This deficit can be compensated by adding 1 to 2 g of potassium chloride per liter of Ringer’s lactate (1 to 2 ampoules of 10 ml 10% KCl), subject to clinical assessment and very close monitoring ( if poorly controlled rate, IV potassium exposed to mortal danger).
– Rehydration and severe malnutrition
The principle remains the same but the ORS used and the amounts of liquid to be administered differ from those of healthy children.
Zinc supplementation (in children under 5 years):
Zinc sulfate is used in addition to oral rehydration, in order to reduce the duration and severity of diarrhea and the risk of recurrence within 2 to 3 months after treatment:
PO zinc sulfate
Children under 6 months: 10 mg / day (1/2 tablet) once daily for 10 days
Children from 6 months to 5 years: 20 mg / day (one tablet) once daily for 10 days
Put a 1/2 or 1 tablet in a teaspoon, add a little water to dissolve it, and give the contents of the spoon to the child.
Prevention of malnutrition:
Follow Treatment plan A to treat diarrhea at home.
Etiological treatment of diarrhea
Non-bloody diarrhea:
Most acute diarrhea are caused by viruses which antibiotics have no action. An etiological treatment is initiated in cases of cholera and giardiasis:
– Cholera: rehydration remains the essential element of treatment. In the absence of resistance, antibiotic therapy can best shorten the duration of illness.
doxycycline PO
Children: 100 mg single dose
Adult: 300 mg single dose
Note: doxycycline is usually against-indicated in pregnant women and children under 8 years. However, in the treatment of cholera only (not prevention), administration of a single dose should not induce any adverse effects.Comply with the national protocol.
– Giardiasis: metronidazole or tinidazole.
Bloody diarrhea (dysentery):
– Shigellosis: this is the most frequent dysentery (amebiasis is much rarer).
In the absence of laboratory for confirming amoebiasis, the first-line treatment is for shigellosis.
– Amoebiasis: antiparasitic treatment only if motile E. histolytica amoebae in stools or in case of failure of treatment of shigellosis well conducted.
Prevention of diarrhea:
– Breastfeeding reduces infant morbidity and mortality from diarrhea and the severity of diarrheal episodes.
– At weaning, preparing and preserving food are associated with a risk of contamination by fecal germs discourage the use of bottle; cook food; never keep milk or boiled at room temperature.
– Access to clean water in sufficient quantity and personal hygiene (washing hands with soap and water before preparing or eating meals, after defecation etc.) are effective in reducing the transmission of diarrhea.