DIARRHEA AND DEHYDRATION

Diarrhea is an infectious disease characteriszed by an abnormal liquidity and frequency (3 times or mor in a day) of fecal discharges, causing 18% of the deaths that occurred among under-fives in Indonesia in 2005.

Causes
Diarrhea is caused by infections of illnesses that either lead to excess production of fluids or prevent absorption of fluids, due to bacteria (E. coli, Shigella, Salmonella, Vibrio virus, Adenovirus) or parasite (Ameba, Giardia lambli). It can also be caused by :

• Lactose intolerance,
• Carbohydrate intolerance,
• Carbohydrate, fat, and protein malabsorpstion,
• Food poisoning by chemistry substances poison, toxin microorganism, Clostridium perfringens, Staphylococcus,
• Immunedericiency.

Complications and prevention
Complications to diarrhea may occur : dehydration, disturbance of bases acid balances, disturbance of electrolyte balance, nutrition disorder, and anemia.

Proper hygiene and food handling techniques can prevent many cases of diarrhea. the most important action is to prevent the complications of dehydration, a loss of water and salts that are essential for normal body function.

Therapy A : Diarrhea without dehydration (to treat the diarrhea at home)

1. Give the child more liquid than usual to prevent dehydration: use recommeded home's liquid such as Oral Rehydration Solution (ORS), liquid food (soup, thick water) until the child's diarrhea stpos. For the baby under 6 months is better to give ORS and cooked water than liquefy food.
2. Feed the child to prevent under nutrition: continue breastfeeding (breastfeeding) or milk as usual. For children over 6 months give adequate feeding: Porridge or other flours mixture, if possible mixed with vegetables, meet or fish. Sore fresh fruit or soft banana to increase kalium. Fresh food, cook and soft it. Encourage the child to eat at least 6 times/day. Give the same food after the diarrhea stopped, and give additional food every day for 2 weeks.
3. Bring the child to the health facility if the child do not get better in 3 days or suffer: Pass stool is diluted and frequently. Repeated Vomitig. Very thirsty, Eat or drink a little. Fever. Bloody stools

Therapy B : diarrhea with mild to medium dehydration
The amount of ORS given in the first 3 hours = patient's weight (kgs) x 75 mL or if the weight is unknown : Age (year) <> 5 give ORS (mL) 1200, Adult give ORS (mL) 2400.

• Give more ORS if the child wants to. Show the ways to give it : one tea spoon in every 1 - 2 minutes to the children <2>
• Encourage the mother to continue breastfeeding.
  
• For the baby <6>
• Check time to time if there is a problem.
• If the children vomit, wait until 10 minutes and than continue to give ORS, but slowly example one spoon in every 3-4 minutes.
• If child's eyelid is swollen, stop to give the ORS and give the cooked water or breast milk. Give ORS accordance to plan therapy A if the swollen done.

After 3 - 4 hours, rexam the children by using examination draft, then choose plan therapy A, B, or C to continue therapy. If the signs still show mild/medium dehydration, repeat the plan therapy B but offer food, milk, and sore fruit as plan therapy A.

Glossary
Acute diarrhea : less than 2 weeks
Persistent d : diarrhea lasting more than 2 weeks.
Dysenteric d : diarrhea with muccous and bloddy stools
Choleraic d : acute diarrhea with serous stools, acampained by circulatory.
Collapse d : thus resembling cholera.

Good To Know
Gelatin water may be subtituted for electrolyte replacement solutions if an ORS is unavailable it is made by diluting a 3 oz package in a quart of water or by adding one-fourth teaspoon of salt and a tablespoon of sugar to a print of water.

Therapy C : diarrhea with severe dehydration
Start to give IV liquid soon. If the patient can drink give ORS when IV liquid is started. Give 100 mL/kg RL/NaCl, divides as follows : Age : Baby<1>

Exam again the patient in every 1 -2 hours. if no sign of rehydration make fast IV drops.

Also give ORS (5mL/kg/hour) if the patient can drink, usually after 3 - 4 hours (baby) or 1 - 2 hours (child), after 6 hours (baby) or 3 hours (child). Exam again the patient by using examination table. then plan therapy as necessary.

Send the patient for the IV therapy

If the patient can drink, provide ORS to the mother and show how to give it during travel

Start rehydration per oral with ORS. Give 20 mL/kgbb/hours for 6 hours (total 120 mL/kgbb)

Exam the patient every 1 -2 hours

If vomiting or the stomach puffing give the liquid slowly

If no sign of rehydration within 3 hours, refer the patinet to IV therapy

Afer 6 hours exam again the patient and give a plan.

Sources : General Coordinator, Zul habibi, Atjeh Student's Of health Orgnization ASHO, Health Massenger