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Increased incidence of acute diarrhea may occur in post-disaster situations where access to electricity, clean water, and sanitary facilities are limited. In addition, usual hygiene practices may be disrupted and healthcare seeking behaviors may be altered. The following are general guidelines for healthcare providers for the evaluation and treatment of patients presenting with acute diarrhea in these situations. However, specific patient treatment should be determined based on the healthcare provider’s clinical judgment. Any questions should be directed to the local health department. ChildrenIndications for medical evaluation of infants and toddlers with acute diarrhea
Principles of appropriate treatment for INFANTS AND TODDLERS with diarrhea and dehydration
Older Children and AdultsIndications for medical evaluation of children > 3 years old and adults with acute diarrhea
Principles of appropriate treatment for ADULTS with diarrhea and dehydration
Treatment based on degree of dehydration
|
Degree of dehydration |
Rehydration therapy |
Replacement of ongoing losses |
Nutrition |
---|---|---|---|
Minimal or none |
Not applicable |
<10 kg body wt.: 60-120 mL oral rehydration solution (ORS) for each diarrheal stool or vomiting episode >10 kg body weight: 120-240 mL ORS for each diarrheal stool or vomiting episode |
Continue breast feeding or resume age-appropriat normal diet after initial rehydration, including adequate caloric intake for maintenance |
Mild to moderate |
ORS, 50-100 mL/kg body weight over 3-4 hours |
Same |
Same |
Severe |
Ringers lactate Lactated Ringers solution or normal saline * in 20 mL/kg body weight intravenous amounts until perfusion and mental status improve: then administer 100 mL/kg body weight ORS over 4 hours or 5% dextrose ½ normal saline intravenously at twice maintenance fluid rates |
Same: if unable to drink, administer through nasogastric tube or administer 5% dextrose ¼ normal saline with 20 mEq/L potassium chloride intravenously |
Same |
* In severe dehydrating diarrhea, normal saline is less effective for treatment because it contains no bicarbonate or potassium. Use normal saline only if Ringers lactate solution is not available, and supplement with ORS as soon as the patient can drink. Plain glucose in water is ineffective and should not be used.
NOTE: Restrictive diets should be avoided during acute diarrheal episodes. Breastfed infants should continue to nurse ad libitum even during acute rehydration. Infant too weak to eat can be given breastmilk or formula through nasogastric tube. Lactose-containing formulas are usually well-tolerated. If lactose malabsorption appears clinically substantial, lactose-free formulas can be used. Complex carbohydrates, fresh fruits, lean meats, yogurt, and vegetables are all recommended. Carbonated drinks or commercial juices with a high concentration of simple carbohydrates should be avoided.
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Page last modified August 22, 2004 |
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