Diarrhea and Dehydration in Children

Diarrhea and Dehydration in Children

• Diarrhea and dehydration are life-threatening emergencies.
• Several factors can cause diarrhea and dehydration in children.
• Diarrhea is a symptom resulting from various disorders.
• Dehydration is classified as mild, moderate, or severe, depending on fluid loss.

Characteristics of Diarrhea

• Increased frequency of bowel movements.
• Change in consistency of stool; more fluid content.
• Stool may be greenish, contain mucus, or blood.

Factors Predisposing to Diarrhea

• Age
• Socioeconomic status
• Overcrowding
• Environmental sanitation
• Nutrition
• Personal hygiene
• Parent's education
• Chronic conditions
• Emotional distress

Why Children are More Susceptible to Dehydration

• Infants and young children's electrolyte systems are less adaptable to fluid and electrolyte imbalances.
• 50% of extracellular fluids are lost in children under two years of age, causing rapid loss.
• Children commonly lose 60% extracellular and 40% intracellular fluids during dehydration.
• Higher basal metabolic rate (BMR) in children leads to increased heat production, requiring more water.
• Kidneys in children are immature and less able to regulate urine concentration.

Causes of Diarrhea

• Infections (central nervous system (CNS), gastrointestinal (GI))
• Gastroenteritis
• Obstruction
• Hepatitis
• Intussusception
• Pyloric stenosis
• Toxicity (ingestion, overdose, drug effects)
• Endocrine disorders (diabetic ketoacidosis)
• Renal disorders (infection, renal failure)
• Fluid losses from vomiting or diarrhea

Consequences of Diarrheal Diseases in Children

• Severity of illness
• Cause of diarrhea
• Type of diarrhea
• Duration of diarrhea
• Associated symptoms
• Child's age
• Child's nutritional status

Types of Diarrhea

Acute Diarrhea

• A significant cause of illness in children under 5 years old.
• Dehydration is a life-threatening complication.
• Commonly self-limiting.
• Can stem from microorganisms invading the GI tract, communicable diseases, antibiotic misuse, or food poisoning.

Chronic Diarrhea

• Loose stools with increased frequency, lasting more than 2 weeks.
• Related to infant formula problems, overfeeding, imbalanced diets, malabsorption problems, intestinal obstructions, anatomical defects, and allergic reactions (food or drug).

Signs and Symptoms of Diarrhea

Mild Diarrhea

• Altered bowel habits (2-5 bowel movements per day with fluid consistency)
• 3%-5% weight loss.
• Low-grade fever, possible vomiting
• Irritability, disturbed sleep

Moderate Diarrhea

• 6-9 bowel movements per day
• 6%-9% weight loss
• Moderate fever.
• Drowsiness, reduced tearing, dry skin, decreased urination

Severe Diarrhea

• More than 10 bowel movements per day.
• Over 10% weight loss.
• Altered mental status.
• Rapid pulse, delayed capillary refill, rapid respiration.

Nursing Management of Diarrhea

Nursing Assessment

• Measuring weight and vital signs.
• Assessing diarrhea and dehydration level.
• Stool characteristics (frequency, color, odor, consistency, mucus, blood).
• Presence of vomiting, thirst, fever, or other symptoms (cough, ear infection).
• Last urination, feeding habits before and during illness, and previous treatment.

Nursing Interventions

• Monitoring vital signs, weight, diarrhea characteristics, volume, and frequency.

• Monitoring fluid intake and output.

• Educating parents on hygienic strategies.

• Applying meticulous hygiene.

• Monitoring for dehydration symptoms.

• Promoting breast-feeding for infants.

• Teaching parents to provide appropriate and balanced nutrition.

• Supplying fluids – broths, rice, water, potatoes, and other easily digestible foods.

• Avoiding high-fat, junk, and spicy foods and carbonated beverages with high sugar and glucose content, during diarrhea.

Dehydration

• A common body fluid and electrolyte disturbance in infants and children.
• Occurs when fluid output exceeds fluid intake, regardless of the underlying cause.
• Can result from diarrhea, vomiting and other fluid losses.

Causes of Dehydration

• Excessive fluid loss (GI tract, urinary tract, skin, respiratory tract).
• Insufficient fluid intake
• Repeated vomiting
• Burns

Types of Dehydration

• Isotonic: Loss of water and electrolytes; potentially fatal
• Hypotonic: Water loss exceeds electrolyte loss
• Hypertonic: Electrolyte loss exceeds water loss;

Signs and Symptoms of Dehydration

• Sunken eyes, lack of tears
• Decreased/absent fontanel, flat.
• Reduced consciousness, dry mucous membranes
• Reduced skin turgor, tachypnea, oliguria
• Tachycardia, hypotension, peripheral vasoconstriction
• Sudden weight loss

Diagnostic Evaluation

• Detailed history (frequency, consistency, color, odor) and physical exam
• Stool specimens (culture, presence of mucus/blood)
• Urine specific gravity (if suspected dehydration)
• CBC, serum electrolytes, creatinine, and urea (for severe cases)

Treatment

• Intravenous fluids (for moderate to severe dehydration).
• Hospitalization may be necessary for moderate to severe dehydration.
• Determining the underlying cause.
• Maintenance fluids based on body weight.
• Oral rehydration therapy (for mild dehydration)

Prevention of Diarrhea

• Breast-feeding promotion.
• Improved weaning practices
• Proper water usage and hygiene
• Proper stool disposal for young children

Prevention of Dehydration

• Monitoring fluid intake and output in susceptible populations
• Avoiding potential dehydration causes (excessive heat, poor hygiene, improper food handling)