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Tuesday, December 11, 2012

Loose motions "acute gastroenteritis" dehydration dysentery

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Acute DIARRHEAS... WATER LOSS.. DEHYDRATION... DYSENTERY,., QUERIES

All diarrheas are not same…
They are caused by infections and many times without infections.
Causes of diarrhea are different at different ages too.
Apart from causes-- pattern of diarrhea is also important. Some are watery and some with less water. Some are sticky and some with blood. Some do have serious reason under it. Some do cause serious complications.
in summary a common medicine or formula can not be applied to a case of diarrhea without knowing above details.
Often there is a confusion that teething causes diarrhea, winter causes diarrhea.. monsoon causes diarrhea...etc there is scientific logic which needs to modify these beliefs.
Teething Diarrhea
Often parents come with various tonics for dentition available in market...practically teething per say does not cause diarrhea. during teething the important milestone of hand to mouth and biting starts developing. at this phase kids even start chewing clothes, fingers and toys. the germs that get carried along with this; often end up causing gut or throat infections. Both may cause diarrhea.. simple hygeinic measures and controlling cloth/toy chewing may settle this. If there is serious pica associated may need an attention.
Cold/ cough related diarrhea
in nose, throat, ear infections the mucus secretions or pus gets swallowed in small infants and passes through gut undigested and may look like mucus in stools.. but may smell same as nose secretions.
monsoon diarrhea
Often this is due to water/ feed or hand contamination. Though usually rotavirus related in first year of life; there are many other viruses and bacteria that may cause such monsoon diarrheas. bacterial diarrheas and dysenteries predominate in summer and in areas and seasons of water scarcity too. Often such diarrheas are more watery compared to dyentry.
watery diarrheas
diarrhea is often watery. how much water content per stool may decide the level of infection. Infections from small inetstine often cause large watery diarrheas (enteritis). As the infection spreads from small to large intestine; the water content gets lesser and pain or cramps .. and mucus/blood may come in stools.(enterocolitis).when this happens.. the diarrhea is no longer just diarrhea, but is called dysentery. All diarrheas may not go through this phase. There are some viruses that causes redominant gastritis.. some do cause gastroenteritis; some cause only enteritis and some cause entrocolitis; while soem cause colitis.
dysentery
whenever water content of stool is not enough to make the bed "wet", lets call these diarrheas as nonwatery or may be dysentry. dysentery is presence of mucus or blood in stool/poop. dysentery may be associated with spurts of water.. which is often due to inflammation of rectum ( proctocolitis).
Dysentery may be due to amebiasis, bacteria or antibiotic induced.
Viruses often do not cause dysentery.

Commonest cause of loose stools in developing countries liek India are giardiasis (a form of protozoa); and in elderly kids may eb amebiasis.
Commonest cause of watery diarrheas.. in infants in rotavirus related, in seasons. otherwise can be toxin producing e coli bacteria or salmonella bacteria.. Cholera is a serious cause of severe watery diarrhea... and needs specific therapy. In cholera 1 or 2 motions can make a child very sick. The stool has fishy smell and looks like rice water.
Common causes of diarrhea without too much of water loss, are non rotavirus viruses and bacteria..Most bacteria produce a toxin or they may also attack the intestinal skin (epithelium) and may cause infection, bleed or holes in mucosa that may take days to heal.
each bacterial diarrhea my not need antibiotic too, but most need it.
When to stop breast milk in diarrheas ?
Breast milk is best and should not be stopped in diarrheas. feeding is essential component in maintaining feeds and tackling dehydrations.In soem cases, when diarrhea lasts for longer than 4-5 days, the gut epithelium loses its factors required to digest lactose, a domonant sugar in milk. When lactose not digested, it carries water with it in stools and may harm and motions persist. In such cases breast milk or any milk that contains lactose should be promptly stopped for a week and the same phase should be replaced by lactose free formula or feeds for the same duration. Doctor diagnose this condition by looking at stool Ph and reducing substances in stools.

danger signs in diarrhea: any of  these signs if there may  risk life by dehydration or sepsis..they are as below:
1.reducing urine frequency and quantity
2.sleepy child, lethargic
3.child refusing feeds, voomiting not getting controlled
4.cranky or irrtable child , very thirsty child.. but fails to drink or digest
5.perianal rash..nappy rash, diaper rash or skin sores ulcers or redness.. easy to secondarily infected to complicate matters
6.fever not settling despite 72 hours

If any of these danger signs.. prefer the doctor sees the child very often or the child remains under hospital supervision and therapy. Parents cannot feel or assess the severity of diarrhea related issues which child may be going through. A child of 10 kg often needs 1 litre liquid daily to maintain circulation.A motion of hundred ml will compromise it by 10 % aqnd a 5 motions can compromise it by 50%.
be liberal with fluids with children suffering from gastroenteritis.

Leave the judgement of medicines to doctors.. as all diarrheas are not same in presentation, severity and treatment response. Commonly a diarrhea starts responding to medicines in 72 hours.. but may last 7 to 10 days.
डॉ कोंडेकर संतोष ,एम .डी,.डी.एन .बी.,डी.सी.एच.,एफ.सी.पी.एस.
विशेष बाल रोग निदान व उपचार केंद्र, ओपिडी नं ११
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 post your free queries at www.kondekar.com 
Part II: managing diarrheas.. awaited..
डॉ कोंडेकर संतोष ,एम .डी,.डी.एन .बी.,डी.सी.एच.,एफ.सी.पी.एस.
सहप्राध्यापक बालरोग विभाग , बाल दमा विभाग 
टोपीवाला राष्ट्रीय वैद्यकीय महाविद्यालय 
बा.य ल नायर धर्मार्थ रुग्णालय मुंबई सेन्ट्रल 

15 comments:

  1. My husband and I took our 14 month old to the ER the other day she had quickly became lethargic; instead of just falling asleep, her eyes were rolling around and head bobbing.
    When she was check into the E.R the doctor came back and told us our daughter had PVC. The heart monitor was going between 170-210. *Monitor would go up when she was crying which was for most the time, due to being poked and prodded. At the end of 12 hrs. came back with that she had Rhino Virus; her heart was fine. They had said that her heart rate was still unsteady and a little high so told us we needed to stay longer for monitoring. By the time she had been finally left alone for an hour her heartrate came down between 130’s- 140’s.
    My question is; If a 14 month old child has “Rhino Virus” a common cold, is teething with molars and scared and upset is it normal for a heart rate to be so high and inconsistent? Between 160-210? 210 crying hard.

    ReplyDelete
  2. To some extent yes. But if it is 180 plus in sleep… needs ECG and further therapy

    ReplyDelete
  3. Hi There,
    we are living in the UK,London.
    I do not trust the Doctors here anymore so I will like to get answer from you.
    Our baby was born mid of October.For first 3 weeks we had no health problems at all.
    But then from 4th week she started having green stool.This was happening for 6 weeks about 8 times a day.We report it to GP,Health Visitor and Midwifes, but they said it is ok for little one, maybe she is just hungry so we have to feed her more.
    6 weeks 8 times a day green stool some of them just green water! and they did not do anything with this just asked us to monitor this.
    She lost some weight as well.
    One day my girlfriend used baby wet towels for the first time and she had very bad reaction to those.Her anal area went crazy red and irritated.
    We told this to Health visitor next day, but she doesn't know what to do so she asked us to give it couple more days and then come back if it is still there.I told her, baby is crying when we even touch her there (to wipe her after she wet herself,or we want to put a powder cream or try to bath her) she haven't do anything for us.Also our little one had horrible discharge from one eye.All doctors here told us she is clearing her self after birth.
    I asked myself even after 9 weeks?
    So we went to Slovakia for Xmas (thats where we are from)
    and we went to see Paediatrician straight from airport.
    She Said the health state of the baby is horrible and asked us where have we been until now.
    There was very bad infection in her eye, o she gave us antibiotics (good after couple of days)
    Also she gave us IMAZOL cream paste and redness from her anal area was gone in couple of days and it was not sore after 8 hrs.
    They gave us some ProBios and some other colic medicine .
    On the Xmas day she did not want to eat,always fall a sleep, very week and lots of watery stools and lost 500 grams of weight.
    So we went to ER and they said she is dehydrated 2 degree and in a risk of life.
    My girlfriend and our baby stayed in the hospital for 5 days,they gave her some drips and did lots of tests.
    They save her life and we had yellow stool for 3 weeks after that.
    But all the test came back negative.
    They asked us to get her test for bilirubin,but we were going back to UK and did not have enough time to do this in Slovakia.
    We came on Sunday and went to see GP here in London on Monday.
    He backup all his colleagues and did not admit any fault.
    Unfortunately littleone has start having green stool from Saturday (day before our flight)
    We told this to GP on Monday.He refused to do any test even bilirubin test as they asked us in slovakia and he ask us to monitor baby for another 2 weeks.Done nothing else!!!
    LAST 5 DAYS:
    -She is having only green stool,sometimes very watery and slimy!
    -very fussy when she is fed
    -sleepy a lot
    -gets tired very quickly
    -not really gaining any weight
    -rash on face
    -kind of hives on her right arm
    -and losing extremely much hair.

    I forget to tell you that my girlfriend is Breastfeeding only.

    As I did some research online,this looks like diarrhoea and because she poops so much she get dehydrated.Doctor said if She gets worst to go to ER.
    I do not want her to get worst I want to solve the problem before it gets worst.
    Can you help me,Please.
    We want to see GP tomorrow and ask him one more time to do something.
    Should We ask him to send us to paediatrician,do allergy test,test for bilirubin,
    test for Lactose intolerant,exame blood or stool,check for yeast?
    Could she be lactose int? Or have a prob's with liver?
    Can you help me and advice me what should we do,Please.

    Many Thanks

    Dusan

    ReplyDelete
  4. I have a 7 year old daughter. i missed booster 2 dose in vaccination due in the fifth year. what is to be done now.

    Thank you

    ReplyDelete
    Replies
    1. you may take it now at earliest. download immunisation schedule pdf page for print at www.kondekar.com

      Delete
  5. Hi!I want to talk about the leg weakness in my sister.She is just 15 years olds but her legs sweat much and bend to inside from knees to the down below.I think this is Orthopaedy illness.What do you think about its cure?Please help her to get health.Thanks.

    ReplyDelete
    Replies
    1. if she can run without deformity or gait disturbance as a 16 year old, i may not worry about bit. You may report back with her vitamin D levels.

      Delete
  6. HELLO
    I HAVE A DAUGHTER SHE IS 5 YEARS OLD
    ABOUT 5 6 DAYS AGO SHE STARTED WITH A BLISSTER ON EACH SIDE OF HER MOUTH (OUTSIDE (LIP AREA)), ABOUT 2 DAYS AGO I STARTED NOTICING A FEW LITTLE RED DOTS ON HER CHIN AND AROUND HER CHEECKS CLOSE TO HER LIPS, NOW SHE HAS ABOUT 20 OF THEM. YESTERDAY I STARTED APPLYING SOME BACITRACIN OINTMENT ON THE AFFECTED AREA BUT NOTHING SEEM TO WORK.
    IM REALLY WORRIED.
    THANK YOU

    ReplyDelete
    Replies
    1. hi there
      its always a guesswork unless i see the rash or whatever. a blister `felt/seen by u may be small but i may not get exact idea of how small is it. often blisters are caused by viral sores like herpes, but at times by cold as cold sores.
      red dots though often seen with fungal infection, can be a pattern of allergy. May be you can be more specific. or send image.

      Delete
  7. Hello Sir,
    I have baby girl of 4 months old .
    we have given her vaccinations of Hep B2,Rotavirus,DPT and IPV on 1-FEB-2013 .
    then she had a fever which last for four days.
    so did urine test and PUS CELL Count is : 55-60 HPF .
    Doctor prescribed Curam Oral suspension (Amoxycillin & potassium clavulanate) for six days.
    did again urine test and PUS CELL count is :15-20 HPF
    again we continue for 12 days same medicine and then also PUS cell count coming lie 140-160.
    then we did urine culture and got bactrarial infection cause by
    (1)kelbsiella oxytoca
    (2)pseudomonas aerugineosa.
    so given amikacin for 7 days injection.
    after three days we did urine test again and still PUS cell count is : 8-10 .

    can you please help here why this PUS cell coming every time?
    other than that baby doen not have any fever,vomiting ,feeding is also good .

    ReplyDelete
    Replies
    1. she needs further tests to understand infection in background disease / anomaly of urinary system

      Delete
  8. Sir,
    can you please tell me which test should i conduct ?

    ReplyDelete
    Replies
    1. ultrasound of kidney ureter bladder, blood tests BUN and Cr with CBC. May need urinary contrast studies to assess any anatomical block like urinary valves, duplications etc.

      Delete

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डॉं कोंडेकर संतोष वेंकटरमण@मुंबई