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1、Infantile Diarrhea Li zhongyue Dep. Gastroenterology Childrens Hospital , CQMU Dep. Gastroenterology Childrens Hospital, CQMU Content Definition Epidemiology Etiology and Predisposing factor Pathogenesis Clinical manifestation Diagnosis Management Trisodium citrate (C6H5O7Na32H2O:294) Sodium Citrate
2、(mmol)=2.9/2941000=10mmol Na(mmol)= 3citrate (mmol)= 3Sodium Citrate=30mmol ORS H20:1000ml Mechanism of ORS ORS Indications: mild or moderate without vomiting and abdominal distention Methods: mild dehydration: 50-80 ml/kg Moderate dehydration: 80-100 ml/kg 8-12 hr Intravenous infusion: Indications:
3、 Moderate dehydration (serious vomiting) Severe dehydration Volume of fluid in intravenous rehydration types of fluid in intravenous rehydration Speed of intravenous rehydration : First phase: In the first 30min1hr, 20ml/kg of isotonic sodium chloride solution or lactated Ringer solution (total amou
4、nt300ml) need to be replaced. The remainder of deficit should be replaced within 812hours. Second phase: In the following 1216hours, focuses on provision of maintainance fluids (6080ml/kg.d) and replacement of ongoing losses (1040ml/kg.d). Hypernatremia dehydration Determine time for correction base
5、d on initial sodium concentration Na+ 145-157mmol/L: 24hr Na+ 158-170mmol/L: 48hr Na+ 171-183mmol/L: 72hr Na+ 184-194mmol/L: 84hr Control Sodium concentration or rate of IV fluid 60-80ml/kg Correction of acidosis Acidosis may accompany dehydration, and although rehydration will correct this to an ex
6、tent, if it is severe enough to cause air hunger, sodium bicarbonate can be added to the infusion. 5%NaHCO3(ml)=(-BE) 0.5 BW(kg) 5%NaHCO3(ml)=(40-CO2CP) 0.5 BW(kg) Emergency situations : 5% NaHCO3 5ml/kg or 1.4% NaHCO3 20ml/kg serum HCO3 - 5 mmol/ L Correction of hypokalemia Potassium chloride injec
7、tion (10% KCl) needs to be added to the infusion once urine output is established Mild hypokalemia: 200300mg/（ kgd） / 23ml/（ kgd） 10% KCl Severe hypokalemia: 300450mg/（ kgd） /34.5ml/kg.d 10% KCl Concentration of potassium chloride under 0.3% Maintainance: 4-6days Correction of Hypocalcemia 10% Calci
8、um Gluconate 10ml+10% GS 10ml IV Correction of Hypomagnesemia 25% Mg.Sulfas 0.20.4ml/kg deep IM Q6h Remember this girl? The next day Content Definition Epidemiology Etiology and Predisposing factor Pathogenesis Clinical manifestation Diagnosis Management & prevention Fluid therapy Diarrhea Case 1 Fe
9、male,11-month-old, Date of admission: Dec. 8th, 2012 Chief complaint: Diarrhea for two days Present history: Two days ago this baby girl had diarrhea without any inducing factors.The feces was yellow and watery, no mucus and blood, averaged 12 stools daily. Before the diarrhea the baby had a transie
10、nt elevation of temperature, the temp. rose to 38.5 and dropped to normal within 8 hours. The baby develop occasional nausea and vomiting of clear gastric contents in two days. The baby girl had no cough, no breathlessness, no convulsion. She was oral administration smecta three times daily. The dia
11、rrhea was not stopped. The baby was thirsty and drink water generously. Her parents visit the doctor for oliguria and weak today. Since onset,the baby do not sleep well at night and have no appetite for food. Past history: She previously had similar attacks of diarrhea when she was three month old.
12、No history of “measles” or “pertussis” etc and no contact history with T.B or other infective diseases. No allergy history of food and drug. Personal history: Natal: First birth born, uneventfully and on full term with birth weight 3.2 Kg. The state of her at birth was good, no cyanosis, apnea, conv
13、ulsion or bleeding. Development: Able to raise head at second month. The first tooth erupted at 6th month. She began to walk with parents now. Her intelligence was normal. Nutrition: She was only feeded with breast milk before she was 6 months old. Then the additives were added. She was weaned from
14、the breast at 10th month. Immunization: Inoculated on schedule after birth (such as B.C.G, D.P.T and smallpox voccination). Family history: No congenital disease in her family. PE: W 10kg T 37.5 , P 140/min, R 30/min, BP 75/40mmHg. Irritable accompanying with severely sunken eyes and fontanel, no te
15、ars, dry mucous membranes, tenting of the skin, and delayed capillary refill (3 seconds) with cool and pale skin. Negative for heart, lung, nervous system Laboratory Investigation: Blood routine： Hb119g/L WBC 8.0*109/L N: 35% L:65% PLT 155*109/L CRP:7mg/L Stool routine： Yellow, watery, WBC 0-2/HP ,R
16、BC0-1/HP, occult bleeding test is negative Blood gas and Electrolyte analysis： pH7.31, PCO2 40.9mmHg, PO2 126.0mmHg, K+3.0mmol/L, Na+137mmol/L, Cl-108mmol/L, Ca2+1.18mmol/L, Lac1.8mmol/L, HCO3- 11.9mmol/L, SBE -10.8 mmol/L Question: The preliminary diagnosis Futher investigation Management (I.V fluid therpy for first day)
《兒科學(xué)教學(xué)課件》16、infantilediarrhea(上)
