TO MANAGE dehydration caused by diarrhea, doctors recommend hydration therapy with oral rehydration solution (ORS), the continuation of an age-appropriate diet, and the practice of proper food and water handling.
Diarrhea is the leading cause of death among children under five years old, according to the World Health Organization (WHO).
Acute diarrhea is the passage of three or more loose, watery, or bloody stools in a 24-hour period, with a duration of less than 14 days. Acute infectious diarrhea, meanwhile, is acute diarrhea caused by infectious agents. Symptoms for the latter include nausea, vomiting, abdominal pain, and fever.
Evaluate the child from time to time during rehydration to ensure that the ORS is being taken satisfactorily and that the signs of the dehydration are not worsening, said Dr. Jennifer A. Olay, a pediatrician, in a Jan. 3 webinar organized by the Adventist Medical Center Manila.
“For breastfed infants, breastfeeding should be continued in addition to hydration therapy,” she told the webinar audience. She added that a restrictive diet such as BRAT (or banana, rice, apple, tea) increases the risk of malnutrition.
WHO said nutrition-related factors contribute to about 45% of deaths in children under 5 years.
“The resumption of the usual, age-appropriate diet is recommended during or immediately after the rehydration process is completed,” said Dr. Olay.
Telltale signs indicating dehydration in children with acute infectious diarrhea are a rapid heart rate, an abnormal respiration pattern, sunken eyes, decreased or absent tears, poor skin turgor, and a decreased urine output.
The fluid deficit is 5-10% in an infant, and 6% in a child, for mild to moderate dehydration. In severe dehydration, the fluid deficit increases to more than 10% in an infant, and 9% in a child.
Children with severe dehydration are lethargic, have no tears, breathe in a deep and rapid manner, and have a skin pinch that goes back very slowly. A trip to the emergency room is necessary for the rapid intravenous rehydration of fluids.
Meanwhile, children with mild to moderate dehydration are advised to drink ORS to replace fluid losses.
Dr. Olay said the amount of ORS after each loose stool is 50–100 ml for children less than two years old, and 100 ml for children between 2–10 years old. Those more than 10 years old may take as much fluids as they want.
“The change in stool consistency is more important than the change in stool frequency in assessing patients with diarrhea,” added Dr. Olay. “The frequent, semi-solid stools in breastfed infants, [however,] is normal and is not considered diarrhea.”
A homemade ORS (or 4–5 teaspoons of sugar and a teaspoon of salt in one liter of clean drinking water) may be given in lieu of a commercial ORS if the latter is not available.
Antiemetics (medicines that are used to treat nausea and vomiting) are unsuitable for children with diarrhea who are vomiting because of safety concerns.
“The most common antiemetic given is metoclopramide,” Dr. Olay said. “The problem is that the allowance between the therapeutic dose and the toxic dose is very narrow.”
Another common remedy to be avoided are caffeinated drinks, as these have diuretic and purgative effects that may only worsen the diarrhea.
To prevent acute infectious diarrhea, Dr. Olay advised hand hygiene, water safety interventions, proper food handling, rotavirus vaccine administration, vitamin A supplementation, and exclusive breastfeeding during the first six months of life.
“Keep food clean, cook food thoroughly, and store food at safe temperatures,” she said. “Separate raw and cooked food too.”
The US Food and Drug Administration suggests keeping refrigerator and freezer temperatures at 4° C and -18° C, respectively. It also recommended sticking to the two-hour rule for leaving items needing refrigeration out at room temperature. — Patricia B. Mirasol