Diarrhea and Dehydration: A Case - Based Approach



Diarrhea and Dehydration: A Case - Based Approach

Pharmacy 456 October 21, 2004

Allison Dekker, BSP, RPh

A dad and his 18 month old son, Joshua, arrive in your pharmacy. Dad tells you they have just been to Joshua's pediatrician regarding the diarrhea Joshua has been having for the last three days. The pediatrician recommended "ORS" and suggested Dad pick it up at your pharmacy. Dad is unsure what this "ORS stuff" is and certainly doesn't know which product to choose or how to use it. He has come to you for assistance.

Assess Urgency

- undesirable symptom is diarrhea, but the most important issue is the potential for dehydration

- infants and children with diarrhea are at higher risk for the development of dehydration than adults because they have a greater percentage of body water and smaller body mass

- assess urgency by determining the degree of dehydration

Clinical Signs of Dehydration in Children

|Mild |• increased thirst |

|potentially serious; |• slightly dry mucous membranes |

|can be treated as outpatient | |

|Moderate |• thirst, restlessness, lethargy |

|requires MD assessment |• tachycardia, normal blood pressure |

| |• decreased skin turgor, dry mucous membranes, sunken eyes and |

| |fontanelle |

| |• decreased urine output |

| |• lack of tears |

|Severe |the above signs and: |

|medical emergency |• looks sick, circulatory collapse, cold extremities |

| |decreased skin turgor, very dry mucous membranes |

|requires IV rehydration |• no urine output |

| |• apathy, somnolence |

| |• shock, acidosis, death |

- the most accurate way of assessing dehydration is to determine the amount of weight the child has lost

mild dehydration: < 5% weight loss

moderate dehydration: > or = 5 but < 10% weight loss

severe dehydration: > or = 10% weight loss

Joshua did weigh 11 kg. Now he weighs 10.5 kg

(11 kg - 10.5 kg) ÷ 11 kg x 100 = 4.5

Joshua has lost 4.5% of his body weight. He is mildly dehydrated.

Causes of Diarrhea in Children

a) infectious

i) viruses

- 70 - 80% of cases

- rotavirus (most common ~ 50%), adenovirus, astrovirus, torovirus, Norwalk

ii) bacteria

- 10 - 20% of cases

- commonly presents with a high fever; may have bloody stools

- Clostridium difficile, Escherichia coli, Salmonella sp., Campylobacter sp., Shigella sp.,

Yersinia

iii) parasites

- ................
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