Diarrhea is a change in normal bowel movements characterized by increase in frequency, water content or volume of stools. The usual stool output is 10 g/kg/day.
Acute diarrhea lasts ≤14 days while chronic diarrhea lasts >14 days.
Infectious diarrhea is usually associated with symptoms of nausea and vomiting and abdominal cramps.

Supportive Therapy

  • Dehydration is the primary cause of morbidity & mortality
  • Oral rehydration therapy (ORT) encompasses 2 phases of treatment:
    • Rehydration phase
      • Electrolytes & water are administered as oral rehydration solution (ORS) to replenish fluid losses
      • Should be performed rapidly within 3-4 hours
    • Maintenance phase
      • Restoration of ongoing fluid & electrolyte losses, & adequate dietary intake
  • Age-appropriate diet (including solids) for rapid realimentation is recommended once adequate degree of hydration is attained
  • Breastfeeding should be continued especially for breastfed patients
  • Changes in formula milk are not necessary

Oral Rehydration Solutions (ORS)

  • The formula recommended by the World Health Organization (WHO)
    • Concentration of: 75 mEq/L sodium, 75 mmol/L glucose with total osmolarity of 245 mOsm/L
    • Lower osmolarity that is proportionally reduced sodium & glucose concentrations
    • The formulation has been shown to reduce vomiting & the need for IV fluids
  • As effective as IV fluids in rehydrating patients with mild to moderate dehydration
  • Severe vomiting, abdominal ileus & in state of hemodynamic shock are contraindications to oral rehydration solutions

Intravenous (IV) Fluids or Nasogastric (NG) Oral Rehydration Solutions (ORS)

  • Given for 4-6 hours or until adequate hydration is achieved
  • Recommended in the following patients:
    • Severely dehydrated
    • In whom oral hydration has failed due to severe vomiting
    • Patients w/ intestinal ileus or intestinal obstruction
  • Nasogastric feeding allows continuous oral rehydration solutions administration at a slow & steady amount

Minimal or No Dehydration

  • Replace fluid losses by giving 60-120 mL of ORS for each diarrheal stool or vomiting episode in patients who weigh <10 kg
  • For a patient with body weight of >10 kg, administer 120-240 mL of oral rehydration solutions for each episode of fluid loss
  • Continue breastfeeding or resume age-appropriate feeding

Mild to Moderate Dehydration

  • Administer 50-100 mL of ORS/kg body weight over 3-4 hours to replace estimated fluid deficit
  • Give additional oral rehydration solutions to restore ongoing fluid loss; may use the recommended amount as with minimal dehydration
  • Several trials support the use of nasogastric oral rehydration solutions feeding even in patients with continuous vomiting or with presence of oral ulcers
  • IV hydration may also be administered

Severe Dehydration

  • Start patient on rapid IV rehydration
  • Administer 20 mL/kg body weight of IV lactated Ringer’s solution or normal saline solution (0.9% NaCl) until pulse, perfusion & mental status return to normal, followed by 100 mL/kg body weight of oral rehydration solution for 4 hours or 5% dextrose ½ normal saline IV at 2x maintenance fluid rates
    • Alternatively, give 100 mL/kg body weight. Then, for infants <1 year give 30 mL/kg/body weight within the 1st hour, followed by 70 mL/kg/body weight within 5 hours. For children >1 year, 30 mL/kg/body weight IV fluid may be given within the 1st 30 minutes, followed by 70 mL/kg/body weight within 2.5 hours
    • Administration of oral rehydration solutions may encourage early resumption of feeding
    • Study shows that giving of oral rehydration solutions may lead to rapid resolution of acidosis compared to IV fluid
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