Principles of Management of Acute Diarrhea

The important principle of management of diarrhea is to determine the severity of dehydration and treat diarrhea according to the severity of dehydration. Severity of dehydration can be assessed clinically. The severity of dehydration is actually due to loss of fluid and electrolytes and the more the loss of fluid and electrolytes the severe is dehydration. Whenever there is loss of fluid by gastrointestinal route (vomiting or diarrhea or loose motion) there is always accompanying loss of electrolytes.

Dehydration is divided into mild, moderate and severe dehydration. The treatment of diarrhea generally depends on the severity of diarrhea. The severe the dehydration, the vigorous is the treatment.

Mild dehydration:

If the loss of fluid (and accompanying loss of electrolytes) is less than 5%-7.5% of body weight, it is mild diarrhea. For example, if body weight of a child is 10 kg, than loss of 500-750 ml or less of fluid constitutes mild dehydration.

Treatment of diarrhea causing mild dehydration is generally replacement of fluid alone. Electrolyte replacement is generally not required if started at early stage of diarrhea/dehydration.

Moderate dehydration:

If the fluid loss (and accompanying loss of electrolytes) is 7.5%-10% of body weight, it is called moderate dehydration. For example, loss of 750-1000 ml of body fluid along with accompanying loss of electrolytes, in a child of 10 kg constitute moderate dehydration.

Treatment of diarrhea causing moderate dehydration is generally done by replacement of fluid and electrolytes by ORS (oral re-hydration salts). The quantity of fluid that need to be replaced is at least the same or little more than fluid loss, within 4 hours. Intravenous fluid is rarely, if ever required in moderate dehydration.

Severe dehydration:

If loss of fluid and accompanying electrolytes is more than 10% of body weight, it is called severe dehydration. For example, loss of more than one liter (1000 ml) of body fluid along with accompanying loss of electrolytes, in a child of 10 kg constitute severe dehydration.

In most of the cases of severe dehydration, intravenous fluid and electrolyte replacement is required, and for this Ringer Lactate is the intravenous fluid of choice which can replace electrolytes adequately. The lost fluid should be replaced within 4 hours. ORS generally can not correct severe dehydration adequately and quickly.

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