(儿科学英文课件)19-infantile-diarrhea

InfantileDiarrheaLizhongyueDep.GastroenterologyChildren’sHospital,CQMUInfantileDiarrheaLizhongyue12012.025thfloorofBuildingNo.62012.025thfloorofBuildingN2ContentDefinitionEpidemiologyEtiologyandPredisposingfactorPathogenesisClinicalmanifestationDiagnosisManagement&preventionFluidtherapyDiarrheaContentDefinitionDiarrhea3(儿科学英文课件)19-infantile-diarrhea4(儿科学英文课件)19-infantile-diarrhea5ConstipationDiarrheaConstipationDiarrhea6(儿科学英文课件)19-infantile-diarrhea7Diarrhea-definitionDiarrheaisdefinedasanincreaseintheFluidity,

Volume,andFrequencyofstools.

Volume＞10ml/kg/dinchildrenor＞200g/dayinadolescentsFluidityDecreaseinconsistency(looseorliquid)Frequency

Bowelmovements≥3per24hoursThesuddenchangeofstoolcharacteristicsismoreimportant!Diarrhea-definitionDiarrheais8ContentDefinitionEpidemiologyEtiologyandPredisposingfactorPathogenesisClinicalmanifestationDiagnosisManagement&preventionFluidtherapyDiarrheaContentDefinitionDiarrhea9Epidemiology

HighincidenceandmortalityEuropean0.5-1.9episodesperpersonperyearEpidemiologyHighincidence10Consumelargeamountsofhealthcarecosts

USA:1-2episodes/child/year1.5Millionmedicalconsultations160,000ERvisits220,000hospitalizations(meanhospitalstay3.4days)$1.8BillionperyearofmedicalcostsMortalityrates:32.2deaths/100,000liveborninAfro-Americans(8.2inwhites)Consumelargeamountsofhealt11DehydrationDeathMalnutritionGrowthretardationImpairedmentaldevelopment

ConsequencesofdiarrheainchildrenAcutestageChronicstageDehydrationConsequencesofd12(儿科学英文课件)19-infantile-diarrhea13(儿科学英文课件)19-infantile-diarrhea14

leadingcausesofdeathinchildrenindevelopingcountries15%malariameaslesHIVPerinataldiseasesothersARTIdiarrhealeadingcausesofdeathinch15MortalityfromdiarrheadiseasesamongchildrenindevelopingcountriesThemortalityofdiarrheaisdecline:DevelopmentofeconomyProgressofMedicineImprovementofmedicalconditionsORSuseBut……

Mortalityfromdiarrheadiseas16PredisposingfactorInfantdigestivesystemisnotwelldeveloped,andthefunctionisimmature:Lackofgastricacidsecretion,-Lowerenzymeactivity,-Rapidgastricemptying(infection&indigestion).Watermetabolismrapidly,thewatertoleranceispoor,oncethewaterlosspronetohumoraldisorder.Thefunctionsofnervesystem,endocrine,circulation,liver,kidneyareinmature,pronetogastrointestinaldysfunction.Morenutritiondemand

Becausechildrenaregrowingrapidly,theyneedmorenutritiontomeettheirrapidgrowth.theburdenofdigestivesystemisheavier.PredisposingfactorInfantdige17WeaknessofdefensesystemLackofgastricacidsecretion,-rapidgastricemptying,-lowerenzymeactivity.Theintrogastricpathogenescannotbekilledthoroughly.ThelevelsofserumIgA,IgMandthesecretoryIgAinintestinaltractarelower,sotheimmunedefenseisinsufficient.Normalintestinalflorahavenotwellestablished

Weaknessofdefensesystem18(儿科学英文课件)19-infantile-diarrhea19(儿科学英文课件)19-infantile-diarrhea20(儿科学英文课件)19-infantile-diarrhea21Bottle-feeding(orartificialfeeding)Milkor/andbottleispronetocontaminatedwithpathogensduringhandlingMilknutritiondamagedBreastmilkcontainsimmunecomponents:(sIgA,lactoferrin,lysozyme,etc.)Bottle-feeding(orartificial22(儿科学英文课件)19-infantile-diarrhea23E.coliE.coli24ContentDefinitionEpidemiologyEtiologyandPredisposingfactorPathogenesisClinicalmanifestationDiagnosisManagement&preventionFluidtherapyDiarrheaContentDefinitionDiarrhea25EtiologyInfectivefactors(virus,bacteria,fungi,parasites…)NoninfectivefactorsDietaryfactorInappropriatefeedingAllergicDiarrheaDisaccharidaseDeficiencyClimateSymptomaticDiarrheaEtiologyInfectivefactors(vir26EtiologyInfectivefactors(virus,bacteria,fungi,parasites…)NoninfectivefactorsDietaryfactorInappropriatefeedingAllergicDiarrheaDisaccharidaseDeficiencyClimateSymptomaticDiarrheaEtiologyInfectivefactors(vir27Etiology---Infectivefactors

Routeoftransmission:feces-mouthwayEtiology---InfectivefactorsR28PathogensofinfectivefactorsshigellaPathogensofinfectivefactors29(儿科学英文课件)19-infantile-diarrhea30(儿科学英文课件)19-infantile-diarrhea31Etiology---InfectivefactorsViruses:ThemostCommonpathogeninchildrenwithinfecteddiarrhea.

Rotavirus,Astrovirus,Norovirus,Coronavirus,Calicivirus,Entericadenovirus,echovirus,cosackisvirus,andsoon.Usuallyoccursinthecoldseason(Autumn,winter).Rotavirusisthemostsevereentericpathogenofchildhooddiarrhea.Etiology---InfectivefactorsVi32(儿科学英文课件)19-infantile-diarrhea33Etiology---InfectivefactorsBacteria:Thesecondmostcommoncauseinchildrenwithinfectivediarrhea.Etiology---InfectivefactorsBa34Etiology---InfectivefactorsFungi:

Candidaalbicans,aspergillus,mucorEtiology---InfectivefactorsFu35Etiology---InfectivefactorsParasites:

Etiology---InfectivefactorsPa36Etiology---InfectivefactorsThemostimportantinfectivecausesofacutediarrheaindevelopingcountriesinchildrenare:Rotavirus/norovirusEnterotoxigenicEscherichiacoliShigellaCampylobacterjejuniSalmonellatyphimuriumEtiology---InfectivefactorsTh37EtiologyInfectivefactors(virus,bacteria,fungi,parasites…)NoninfectivefactorsDietaryfactorInappropriatefeedingAllergicDiarrheaDisaccharidaseDeficiencyClimateSymptomaticDiarrheaEtiologyInfectivefactors(vir38Etiology---Non-InfectivefactorsDietaryfactorsInappropriatefeeding

(DietaryDiarrhea):OverfeedingIndigestibledietSuddenchangeofformulaInappropriatefeedingforamilk-fedbabyshiftingintosolidfood(toomuch,tooearly,toorapid…)DisaccharidaseDeficiency:LactoseIntolerancePrimarydisaccharidasedeficiencySecondarydisaccharidasedeficiency(Lactasedeficiency)AllergicDiarrheaEtiology---Non-Infectivefacto39AllergiccolitisAllergiccolitis40Etiology---Non-InfectivefactorsClimateSeasonalvariationaffectsthedigestivefunctionofyoungchildren:incidenceofdiarrheaishighestfuringtheearlyrainyseasonColdweathercausesincreasingofenterokinesiaHotweathercausesdecreasingofdigestiveenzymeandmalfunctionofdigestivetractEtiology---Non-Infectivefacto41Etiology---Non-InfectivefactorsSymptomaticDiarrhea:Diarrheaisonlyoneofthesymptomsofprimarydisease.Problemisnotoriginallylocatedinintestinaltract.Respiratorytractinfection,-Otitismedia,-Someinfectiousdiseases,etc.Fever,toxin,antibiotics,localstimulate,etc.Symptomalwaysmild,andrecoverwiththeprimarydiseasegettingbetter.Theyoungerthechildren,themorechancetogetasymptomaticdiarrheaaccompaniedbyotherdiseases.

Etiology---Non-Infectivefacto42ContentDefinitionEpidemiologyEtiologyandPredisposingfactorPathogenesisClinicalmanifestationDiagnosisManagement&preventionFluidtherapy

DiarrheaContentDefinitionDiarrhea43PathogenesisofDiarrheaThebasicpathogenesisofdiarrhea:OsmoticDiarrhea(PathogenesisofViralDiarrhea)SecretoryDiarrhea(PathogenesisofEnterotoxigenicDiarrhea)Invasivediarrhea(Exudativediarrhea,Inflammatorydiarrhea)MotilityabnormalitiesPathogenesisofDiarrheaTheba44PathogenesisofDiarrheaThebasicpathogenesisofdiarrhea:OsmoticDiarrhea(PathogenesisofViralDiarrhea)SecretoryDiarrhea(PathogenesisofEnterotoxigenicDiarrhea)Invasivediarrhea(Exudativediarrhea,Inflammatorydiarrhea)MotilityabnormalitiesPathogenesisofDiarrheaTheba45(儿科学英文课件)19-infantile-diarrhea46OsmoticDiarrheaPathogens:VirusGiardia

EAECCharacteristics:WaterystoolStoolWBC(-)StoolRBC(-)DiarrheaimprovedafterfastingOsmoticDiarrheaPathogens:Char47PathogenesisofDiarrheaThebasicpathogenesisofdiarrhea:OsmoticDiarrhea(PathogenesisofViralDiarrhea)SecretoryDiarrhea(PathogenesisofEnterotoxigenicDiarrhea)

Invasivediarrhea(Exudativediarrhea,Inflammatorydiarrhea)MotilityabnormalitiesPathogenesisofDiarrheaTheba48(儿科学英文课件)19-infantile-diarrhea49SecretoryDiarrheaPathogens:Vibriocholerae(cholera)EnterotoxigenicEscherichiaColi(ETEC)StaphylococcusaureusClostridiumdifficileCharacteristics:WaterystoolStoolWBC(-)StoolRBC(-)DiarrheawithoutimprovementafterfastingSecretoryDiarrheaPathogens:Ch50PathogenesisofDiarrheaThebasicpathogenesisofdiarrhea:OsmoticDiarrhea(PathogenesisofViralDiarrhea)SecretoryDiarrhea(PathogenesisofEnterotoxigenicDiarrhea)

Invasivediarrhea(Exudativediarrhea,Inflammatorydiarrhea)

MotilityabnormalitiesPathogenesisofDiarrheaTheba51(儿科学英文课件)19-infantile-diarrhea52InvasiveDiarrheaInvasiveorganisms:ShigellaspeciesEIEC(enteroinvasiveE.coli)CampylobacterjejuniSalmonellatyphimuriumYersiniaenterocoliticaCharacteristics:MucopurulentbloodystoolStoolWBC(+)StoolRBC(+)AbdominalpainTenesmusFeverToxicappearanceInvasiveDiarrheaInvasiveorga53(儿科学英文课件)19-infantile-diarrhea54PathogenesisofDiarrheaPathogenesisofDietaryDiarrheaInappropriatedietOverfeedingIndigestibledietSuddenchangeofformulaInappropriatesolidfoodadding(toomuch,tooearlyortoorapid,andsoon.)

PathogenesisofDiarrheaPathog55(儿科学英文课件)19-infantile-diarrhea56ClinicalfeaturesofDietaryDiarrheaWaterylikediarrheaStoolWBC(-)StoolRBC(-)anorexiaAbdominalpainFeverToxicappearanceDyspepsiaClinicalfeaturesofDietaryD57PathogenesisofDiarrheaThebasicpathogenesisofdiarrhea:OsmoticdiarrheaSecretorydiarrheaExudativediarrhea:Invasivediarrhea,InflammatorydiarrheaMotilityabnormalities

Diarrheaisnotcausedbyasinglemechanism,butoccurinavarietyofmechanisms.PathogenesisofDiarrheaTheb58ContentDefinitionEpidemiologyEtiologyandPredisposingfactorPathogenesisClinicalmanifestationDiagnosisManagement&preventionFluidtherapyDiarrheaContentDefinitionDiarrhea59ClinicalmanifestationsofdiarrheaCommonsymptomsClassificationWater-electrolytedisturbances,acid-baseimbalance(seedetailinnextsection)Clinicalcharacteristicsofdiarrheacausedbyspecialpathogen(rotavirusinfection)Clinicalmanifestationsofdia60ClinicalmanifestationsofdiarrheaCommonsymptomsSiteofaction:smallintestine:Virusenterotoxin-producingorganismsenteroadhesiveorganismslargeintestine:invasiveorganismscytotoxin-producingorganismsenteroadhesiveorganismsClinicalmanifestationsofdia61Gastrointestinalsymptom:Anorexia(Lossofappetite)NauseaVomitDiarrhea(wateryorbloody)withorwithoutabdominalpainGastrointestinalsymptom:62SystemicsymptomFever,paleDebilitation/restlessness/irritabilityLethargy/depression/indisposition,etc.Water-electrolytedisturbances,base-acidimbalance.(seedetailinnextsection)Systemicsymptom63ClinicalmanifestationsofdiarrheaClassificationClinicalmanifestationsofdia64ClinicalmanifestationsofdiarrheaClassificationClinicalmanifestationsofdia65ClinicalmanifestationsofdiarrheaClinicalcharacteristicsofdiarrheacausedbyspecialpathogen---rotavirusClinicalmanifestationsofdia66RotavirusRotavirus67P1-44G1-14A-GgroupP1-44G1-14A-Ggroup68RotavirusVirology:Double-strandedRNAvirusLivesevenmonthsundernormaltemperature,acid-resistance,-20℃canbelong-termpreservationVP6,Rotavirusisdividedintosevengroups:A-GgroupsGroupAisthemostimportantpathogeninchildhooddiarrheaEpidemiology:Peakseason:autumn/winter,“Autumndiarrhea”Contagiousness:fece-mouthwayorspreadbygasoloid.Peakage:6M~2yrsold.RotavirusVirology:Epidemiology69(儿科学英文课件)19-infantile-diarrhea70(儿科学英文课件)19-infantile-diarrhea71(儿科学英文课件)19-infantile-diarrhea72RotavirusMechanisms:PathogenesisofViralDiarrheaNSP4RotavirusMechanisms:73RotavirusRotavirus74ContentDefinitionEpidemiologyEtiologyandPredisposingfactorPathogenesisClinicalmanifestation

DiagnosisManagement&preventionFluidtherapy

DiarrheaContentDefinitionDiarrhea75DiagnosisofdiarrheaTheinitialclinicalevaluationofthepatientshouldfocuson:

AssessingtheseverityoftheillnessandtheneedforrehydrationIdentifyinglikelycausesonthebasisofthehistoryandclinicalfindingsDiagnosisofdiarrheaTheinit76PhysicalexaminationHistoryAssessdehydrationEvaluationofacutediarrheapatientOnset,frequency,quantityCharacter-bile,blood,mucusVomitingPastmedicalhistoryUnderlyingmedicalconditionsEpidemiologicalcluesBodyweightTemperatureHartrateRespiratoryrateBloodpressureGeneralappearance,alertnessPulseandbloodpressurePosturehypotensionMucosaandtearsSunkeneyes,skinturgorCapillaryrefill,jugularvenouspressureSunkenfontanellePhysicalexaminationHistoryAs77CanstoolanalysisdifferentiateaBacterialfromaNonbacterialAgent?

Fecalmarker?Stoolculturesareusuallyunnecessaryforimmunocompetentpatientswhopresentwithin24hoursaftertheonsetofacute,waterydiarrhea.Microbiologicinvestigationisindicatedinpatientswhoaredehydratedorfebrileorhavebloodorpusintheirstool.Howaboutlab.findings?Canstoolanalysisdifferentia78(儿科学英文课件)19-infantile-diarrhea79CanstoolanalysisdifferentiateaBacterialfromaNonbacterialAgent?

Fecalmarker?Stoolculturesareusuallyunnecessaryforimmunocompetentpatientswhopresentwithin24hoursaftertheonsetofacute,waterydiarrhea.Microbiologicinvestigationisindicatedinpatientswhoaredehydratedorfebrileorhavebloodorpusintheirstool.Howaboutlab.findings?Canstoolanalysisdifferentia80Electrolytesshouldbemeasured:InmoderatelydehydratedchildrenwhosehistoryandphysicalexaminationfindingsareinconsistentwithastraightdiarrhealdiseaseAllseverelydehydratedchildren(Va,D).Inallchildrenstartingintravenous(IV)therapy,andduringtherapybecausehyper-orhyponatremiawillaltertherateatwhichIVrehydrationfluidswillbegiven(Va,D).Electrolytesshouldbemeasure81ContentDefinitionEpidemiologyEtiologyandPredisposingfactorPathogenesisClinicalmanifestationDiagnosisManagement&preventionFluidtherapy

DiarrheaContentDefinitionDiarrhea82DoWeKnowHowtoTreatIt?DiarrheaDoWeKnowHowtoTreatIt?Dia83ManagementofdiarrheaManagementofdiarrhea84ManagementofdiarrheaFluidtherapyDietandNutritiontherapyDrugtherapyManagementofdiarrheaFluidth85(儿科学英文课件)19-infantile-diarrhea86(儿科学英文课件)19-infantile-diarrhea87Drugtherapy

Antimicrobialtherapy

Adsorbents

ProbioticsSupplementalzinctherapy,multivitamins,andminerals

Antiemetics

Antidiarrhealtreatment

Antisecretoryagents

Drugtherapy88(儿科学英文课件)19-infantile-diarrhea89(儿科学英文课件)19-infantile-diarrhea90(儿科学英文课件)19-infantile-diarrhea91(儿科学英文课件)19-infantile-diarrhea92Supplementalzinctherapy,multivitamins,andminerals

＞6M:20mgzincfor14days(WHO&UNICEF).＜6M:10mgzincfor14days(WHO&UNICEF).AntiemeticsSuggestthatantiemeticsshouldnotberoutinelyusedtotreatvomitingduringAGEinchildren(II,B).Ondansetron(5-hydroxytryptamineserotoninantagonist)

Metoclopramide(adopamineantagonist)Supplementalzinctherapy,mul93AntidiarrhealtreatmentNonspecificantidiarrhealtreatmentAntimotility:Antisecretoryagents:

Antidiarrhealtreatment94(儿科学英文课件)19-infantile-diarrhea95(儿科学英文课件)19-infantile-diarrhea96PreventionWater,sanitation,andhygiene:

SafewaterSanitation:housefliescantransferbacterialpathogensHygiene:handwashingSafefood:

CookingeliminatesmostpathogensfromfoodsExclusivebreastfeedingforinfantsWeaningfoodsarevehiclesofentericinfectionToavoidmisuseofantibioticsMicronutrientsupplementation:

dependsonthechild’soverallimmunologicandnutritionalstatefurtherresearchisneededPreventionWater,sanitation,a97Vaccines:Salmonellatyphi:

Shigellaorganisms:V.cholerae:ETECvaccines:

Rotavirus:

RotaTeq™(Merck)Rotarix™(GSK)

Measlesimmunization:Vaccines:98ContentDefinitionEpidemiologyEtiologyandPredisposingfactorPathogenesisClinicalmanifestationDiagnosisManagement&preventionFluidtherapyDiarrheaContentDefinitionDiarrhea99FluidtherapyThecharacteristicsofchildren'swater-electrolytesbalanceDisturbancesofwaterandelectrolytesCommonSolutionoffluidTherapyIntravenousinfusionFluidtherapyThecharacteristi100FliudtherapyThecharacteristicsofchildren'swater-electrolytesbalanceVolumeanddistributionofbodyfluid

FliudtherapyThecharacterist101(儿科学英文课件)19-infantile-diarrhea102Compositionofelectrolyteinbodyfluids

Compositionofelectrolytein103ThecharacteristicsofwatermetabolisminchildrenLargewaterrequirements,highwaterexchangerateHighmetabolism,needmorewater.Insensiblelossofwaterloss(doubleadult’samount).Infant’swaterexchangeamountis1/2ofECF,theadult’sisonly1/7.Immatureofbodyfluidregulatingfunction(concentration-dilutionfunction)Thecharacteristicsofwaterm104(儿科学英文课件)19-infantile-diarrhea105(儿科学英文课件)19-infantile-diarrhea106(儿科学英文课件)19-infantile-diarrhea107DisturbancesofwaterandelectrolytesDehydrationHypokalemiaMetabolicacidosisHypocalcemiaHypomagnesemiaDisturbancesofwaterandelec108DehydrationAssessmentofdehydrationMildModerateSevereThetypesofdehydrationHypotonicdehydrationIsotonicdehydrationHypertonicdehydrationDehydration109eyeseyes110(儿科学英文课件)19-infantile-diarrhea111(儿科学英文课件)19-infantile-diarrhea112(儿科学英文课件)19-infantile-diarrhea113IsotonicHypertonicHypotonicIsotonicHypertonicHypotonic114NormalInterstitialfluidIntracellularfluidPlasmaHypotonicdehydrationSodium＞waterOsmoticpressureofECF＜ICFWaterwillshiftfromECFtoICFICF

ECF↓↓↓Celledemacirculatoryfailure+++NormalInterstitialfluidIntrac115IsotonicdehydrationNormalInterstitialfluidIntracellularfluidPlasmaSodium=waterOsmoticpressureofECF=ICFNowatershiftbetweenECFandICFICF-

ECF↓↓NormalCellshapecirculatoryfailure++IsotonicdehydrationNormalInte116HypertonicdehydrationNormalInterstitialfluidIntracellularfluidPlasmaSodium＜waterOsmoticpressureofECF＞ICFWaterwillshiftfromICFtoECFICF

ECF↓Celldehydrationcirculatoryfailure+HypertonicdehydrationNormalIn117HypokalemiaSerum[K+]<3.5mmol/LPathogenesisintakeinsufficientLossofkaliumfromkidneysorgastrointestinaltractAbnormalkaliumdistribution(K＋

shiftsintothecells).alkalosis,insulintherapy、periodicparalysis）Burn,dialysis,etc.

Hypokalemia118(儿科学英文课件)19-infantile-diarrhea119Hypokalemia---ClinicalmanifestationsNervoussystemdepressedMuscleMusculartensiondecreased，Abdominaldistension，Respiratorymuscleparalysis.CardiovascularsystemTachycardia,lowerheartsound,arrhythmia,Bradycardia，atrioventricularblock,Adams-Stokessyndrome,ElectrocardiogramshowsUwaveappearing，U≥T，flattenTwave.ProlongedQ-Tperiod,depressedS-TKidneyconcentratingfunctiondecreased,urinevolumeincreased(polyuria)Hypokalemia---Clinicalmanif120(儿科学英文课件)19-infantile-diarrhea121MetabolicacidosisSerum[pH]<7.35PathogenesisTheloseoflargeamountofbasicsubstances（fromgastrointestinaltract,kidneys）ToomuchAcidmetabolites（becauseofhungriness,diabetes,renalfailure,hypoxia）Toomuchacidsubstanceintake（longtimetotakecalciumchloride,ammoniumchloride,aminoacid.）

Metabolicacidosis122DegreesofacidosisDegreesofacidosis123Clinicalfeatures:Mildacidosis:symptomsisnotobvious,onlyfasterbreathingSereveacidosis:depressed,irritable,lethary,coma,deepandfastbreathing,(kussmaulsbreathing),breathwithketonesmell,redlipnauseaandvomitingClinicalfeatures:124HypocalcemiaNormalserumCa2+:2.2~2.7mmol/L(9~11mg/dl)Ca2+﹤1.75mmol/L(7mg/dl)HypocalcemiaHypomagnesemiaNormalserumMg2+:0.8~1.2mmol/L(2.0-3.0mg/dl)Mg2+﹤0.6mmol/L(1.5mg/dl)HypomagnesemiaHypocalcemia125CommonSolutionoffluidTherapyNon-electrolytesolution:5％glucose10％glucoseElectrolytesolution:0.9％NaCl,Ringer’ssolution1.4％NaHCO3,5％NaHCO310％KClMixedsolutions:ORSCommonSolutionoffluidThera126(儿科学英文课件)19-infantile-diarrhea127ORSCompositionofORSORS128Molarconcentration?mol=w(g)/MWmmol=w(g)/MW·1000NaCl(mmol)=2.6/58.5·1000=44mmol=Na(mmol)=Cl(mmol)SodiumCitrate;Trisodiumcitrate(C6H5O7Na3·2H2O:294)SodiumCitrate(mmol)=2.9/294·1000=10mmolNa(mmol)=3citrate(mmol)=3SodiumCitrate=30mmolORSH20:1000mlMolarconcentration?mol=w(g)/M129(儿科学英文课件)19-infantile-diarrhea130MechanismofORSMechanismofORS131ORS

Indications:

mildormoderatewithoutvomitingandabdominaldistentionMethods:

milddehydration:50-80ml/kgModeratedehydration:80-100ml/kg8-12hr(4-6hr)ORS132Intravenousinfusion:Indications:Moderatedehydration(seriousvomiting)Severedehydration

Intravenousinfusion:133VolumeoffluidinintravenousrehydrationVolumeoffluidinintravenous134

typesoffluidinintravenousrehydrationtypesoffluidinintravenous135(儿科学英文课件)19-infantile-diarrhea136Speedofintravenousrehydration:Firstphase:Inthefirst30min~1hr,20ml/kgofisotonicsodiumchloridesolutionorlactatedRingersolution(totalamount≤300ml)needtobereplaced.Theremainderofdeficitshouldbereplacedwithin8~12hours(4-6hr).Secondphase:

Inthefollowing12~16hours,focusesonprovisionofmaintainancefluids(60~80ml/kg.d)andreplacementofongoinglosses(10~40ml/kg.d).Speedofintravenousrehydrati137HypernatremiadehydrationDeterminetimeforcorrectionbasedoninitialsodiumconcentrationNa+145-157mmol/L:24hrNa+158-170mmol/L:48hrNa+171-183mmol/L:72hrNa+184-194mmol/L:84hrControlSodiumconcentrationorrateofIVfluidHypernatremiadehydration13860-80ml/kg60-80ml/kg139CorrectionofacidosisAcidosismayaccompanydehydration,andalthoughrehydrationwillcorrectthistoanextent,ifitissevereenoughtocauseairhunger,sodiumbicarbonatecanbeaddedtotheinfusion.5%NaHCO3(ml)=(-BE)×0.5×BW(kg)5%NaHCO3(ml)=(40-CO2CP)0.5BW(kg)Emergencysituations:5%NaHCO3

5ml/kgor1.4%NaHCO320ml/kg

serum〔HCO3-〕5mmol/LCorrectionofacidosis140Correctionofhypokalemia

Potassiumchlorideinjection(10%KCl)needstobeaddedtotheinfusiononceurineoutputisestablishedMildhypokalemia:200~300mg/（kg·d）/2~3ml/（kg·d）10%KClSeverehypokalemia:300~450mg/（kg·d）/3~4.5ml/kg.d10%KClConcentrationofpotassiumchlorideunder0.3%Maintainance:4-6daysCorrectionofhypokalemia141CorrectionofHypocalcemia

10%CalciumGluconate10ml+10%GS10mlIVCorrectionofHypomagnesemia25%Mg.Sulfas0.2~0.4ml/kgdeepIMQ6hCorrectionofHypocalcemia142Rememberthisgirl?Rememberthisgirl?143(儿科学英文课件)19-infantile-diarrhea144Thenextday……Thenextday……145ContentDefinitionEpidemiologyEtiologyandPredisposingfactorPathogenesisClinicalmanifestation

DiagnosisManagement&preventionFluidtherapy

DiarrheaContentDefinitionDiarrhea146wearedone!wearedone!147InfantileDiarrheaLizhongyueDep.GastroenterologyChildren’sHospital,CQMUInfantileDiarrheaLizhongyue1482012.025thfloorofBuildingNo.62012.025thfloorofBuildingN149ContentDefinitionEpidemiologyEtiologyandPredisposingfactorPathogenesisClinicalmanifestationDiagnosisManagement&preventionFluidtherapyDiarrheaContentDefinitionDiarrhea150(儿科学英文课件)19-infantile-diarrhea151(儿科学英文课件)19-infantile-diarrhea152ConstipationDiarrheaConstipationDiarrhea153(儿科学英文课件)19-infantile-diarrhea154Diarrhea-definitionDiarrheaisdefinedasanincreaseintheFluidity,

Volume,andFrequencyofstools.

Volume＞10ml/kg/dinchildrenor＞200g/dayinadolescentsFluidityDecreaseinconsistency(looseorliquid)Frequency

Bowelmovements≥3per24hoursThesuddenchangeofstoolcharacteristicsismoreimportant!Diarrhea-definitionDiarrheais155ContentDefinitionEpidemiologyEtiologyandPredisposingfactorPathogenesisClinicalmanifestationDiagnosisManagement&preventionFluidtherapyDiarrheaContentDefinitionDiarrhea156Epidemiology

HighincidenceandmortalityEuropean0.5-1.9episodesperpersonperyearEpidemiologyHighincidence157Consumelargeamountsofhealthcarecosts

USA:1-2episodes/child/year1.5Millionmedicalconsultations160,000ERvisits220,000hospitalizations(meanhospitalstay3.4days)$1.8BillionperyearofmedicalcostsMortalityrates:32.2deaths/100,000liveborninAfro-Americans(8.2inwhites)Consumelargeamountsofhealt158DehydrationDeathMalnutritionGrowthretardationImpairedmentaldevelopment

ConsequencesofdiarrheainchildrenAcutestageChronicstageDehydrationConsequencesofd159(儿科学英文课件)19-infantile-diarrhea160(儿科学英文课件)19-infantile-diarrhea161

leadingcausesofdeathinchildrenindevelopingcountries15%malariameaslesHIVPerinataldiseasesothersARTIdiarrhealeadingcausesofdeathinch162MortalityfromdiarrheadiseasesamongchildrenindevelopingcountriesThemortalityofdiarrheaisdecline:DevelopmentofeconomyProgressofMedicineImprovementofmedicalconditionsORSuseBut……

Mortalityfromdiarrheadiseas163PredisposingfactorInfantdigestivesystemisnotwelldeveloped,andthefunctionisimmature:Lackofgastricacidsecretion,-Lowerenzymeactivity,-Rapidgastricemptying(infection&indigestion).Watermetabolismrapidly,thewatertoleranceispoor,oncethewaterlosspronetohumoraldisorder.Thefunctionsofnervesystem,endocrine,circulation,liver,kidneyareinmature,pronetogastrointestinaldysfunction.Morenutritiondemand

Becausechildrenaregrowingrapidly,theyneedmorenutritiontomeettheirrapidgrowth.theburdenofdigestivesystemisheavier.PredisposingfactorInfantdige164WeaknessofdefensesystemLackofgastricacidsecretion,-rapidgastricemptying,-lowerenzymeactivity.Theintrogastricpathogenescannotbekilledthoroughly.ThelevelsofserumIgA,IgMandthesecretoryIgAinintestinaltractarelower,sotheimmunedefenseisinsufficient.Normalintes