Acute Gastroenteritis - Treatment & Management - PDF

ACUTE GASTROENTERITIS DEHYRATION ORAL REHYDRATION Dr. Deniz ERTEM Marmara University School of Medicine Dept. Of Pediatrics, Div. Of Pediatric Gastroenterology  Lecture Outline Definition of acute gastroenteritis (AGE) Etiology Assessment and...

ACUTE GASTROENTERITIS DEHYRATION ORAL REHYDRATION Dr. Deniz ERTEM Marmara University School of Medicine Dept. Of Pediatrics, Div. Of Pediatric Gastroenterology  Lecture Outline Definition of acute gastroenteritis (AGE) Etiology Assessment and classification of dehydration Complication of AGE Treatment of dehydration  Definition Acute Gastroenteritis (AGE) - passage of excessively liquid and/or frequent stools for a few days, up to one week (diarrhea > 3 weeks is NO LONGER ACUTE!!) - AGE may be accompanied by vomiting episodes, fever, cramping abdominal pain, loss of appetite, diaper rash in small children Worldwide prevalence of AGE (WHO estimate) ❑ 3-5 billion cases of acute gastroenteritis, ❑ nearly 1.6 million deaths occur each year in children under 5 years King CK et al. Centers for Disease Control and Prevention. Managing acute gastroenteritis among children. MMWR Recomm Rep 2003;52(RR16):1-16. ❑ Annual hospital admission rate ~ 7/1.000 children. Elliott E, Dalby-Payne J. Gastroenteritis in children. Clin Evid 2006;15:1-7. ❑ Children with poor nutrition are at increased risk of complications  ETIOLOGY OF ACUTE GASTROENTERITIS IN CHILDREN ❑ VIRUSES (~70%) Rotaviruses Noroviruses (Norwalk-like viruses) Enteric adenoviruses Caliciviruses Astroviruses Rotavirus Enteroviruses ❑ PROTOZOA (9% of body weight) exists ❑ Mild or moderately dehydrated child plus… ❑ difficulties exist in administrating ORS ❑ caregiver can not provide adequate care at home ❑ intractable vomiting ❑ ORS refusal ❑ inadequate ORS intake ❑ worsening diarrhea or dehydration despite adequate ORT ❑ If dehydrated child has factors such as: ❑ young age (< 6 months) ❑ unusual irritability or drowsiness ❑ progressive course of symptoms ❑ uncertainty of diagnosis exist that might indicate a need for close observation Frequent Complications of Acute Gastroenteritis ❑ Dehydration ❑ Electrolyte disturbance (hypernatraemia, hyponatraemia, hypokalaemia) ❑ Metabolic acidosis ❑ Carbohydrate (lactose, glucose) intolerance ❑ Secondary lactase deficiency ❑ Malnutrition --- susceptibility to reinfection  Diet and Drugs during Acute Diarrhea ❑ Breastfeding / formula should continue infants should be continued immediately upon rehydration ❑ Probiotics can be used as an adjunct to ORT (decreases the duration of AGE in Rota virus) ❑ Early reintroduction of solid foods and complex carbohydrates recommended ❑ Antibiotics are not indicated in viral or uncomplicated bacterial AGE non-typhoid Salmonella infection -- antibiotics increase the risk of prolonged carriage and disease relapse Shiga toxin producing E.coli ---- antibiotics may increase the risk of haemolytic uraemic syndrome ❑ Antibiotics are required for bacterial AGE if complicated by septicaemia and in cholera, shigellosis, amoebiasis, giardiasis, and enteric fever Antidiarrheal, anti motility agents are not recommended Some antiemetics with no extrapyramidal side effect may reduce the duration and frequency of vomiting