Remember hypotension late sign of shock in children
Mental status perfusion HR better indicators
24 Back to the case
So we still have to evaluate the 3.5 month old with diarrhea
Onset insidious over past day no recent travel breast fed started daycare the week prior no comorbidity no travel
On PE slightly dry MM normal vital crying tearfully active on exam no rashes
Rest of exam unremarkable
25 Case 1 (cont.)
What is he unlikely to have (based on age time of year exposures type of diarrhea)
What is he likely to have (based on same criteria)
What would your work-up consist of
How would you treat this child
26 Studies for diarrhea
When and why would you get them
Rectal exam Heme testing
Reducing substances etc
Stool ova an parasites (stool op)
C difficile antigen
Eat Drink and Get Better!
Oral Rehydration Therapy
28 Oral Rehydration
Pedialyte Infalyte etc.
Omolarity250 25g of carbs Na 45meq/L K 20meq/L HCO2 30meq/L
Poor electrolyte composition
Osmolar loads gt300mosm/Laggravate diarrhea
29 Oral Rehydration
1 quart clean H2O
½ tsp salt (or ¼ tsp NaCl ¼ tsp baking soda)
4 8 tsp sugar
30 RehydrationIV Fluids
Usually 20cc/kg (if oral rehydration not possible) to start then reassess
NS or LR
Usually not recommended
Only small of infections that require abx
Salmonella pts at risk for bacteremia including infants and immunocompromised
Campylobacter severe cases can be tx with erythromycin or cipro
ETEC consider fluoquinolones
Fallen out of favor due to hypocaloric and low protein content
Protein helps rebuild intestinal lumen
Alter or improve intestinal flora
Active Yogurt CulturesLactobacillus GG
34 Case 2
A 4.4 kg 4 month old former 35 weeker diarrhea all his life started out on Enfamil now on Prosobee. 100 gram wt loss over passed week. Bloody loose stools. How would you proceed
35 Case 3
3 year old girl with bloody diarrhea x 2 days with fever irritability crampy abdominal pain.
36 Case 4
14 month old with 2 month h/o 2-6 foul smelling stools a dayat time with undigested food in feces. Parents have tried multiple dietary changes now eating low fat non-diary lots of fruit juice low protein diet. He has had extensive w/u including negative stool cxs for bacteria/virus o p and parasites no blood.
37 Case 5
7 yo boy with with rapid onset profuse diarrhea this afternoon non-bloody.
38 Case 6
14 yo boy with crampy bloody diarrhea x 2 months.
39 Take Home Message Eat Drink and Get BetterPepto-Bismol is your friend!
PowerShow.com is a leading presentation/slideshow sharing website. Whether your application is business, how-to, education, medicine, school, church, sales, marketing, online training or just for fun, PowerShow.com is a great resource. And, best of all, most of its cool features are free and easy to use.
You can use PowerShow.com to find and download example online PowerPoint ppt presentations on just about any topic you can imagine so you can learn how to improve your own slides and presentations for free. Or use it to find and download high-quality how-to PowerPoint ppt presentations with illustrated or animated slides that will teach you how to do something new, also for free. Or use it to upload your own PowerPoint slides so you can share them with your teachers, class, students, bosses, employees, customers, potential investors or the world. Or use it to create really cool photo slideshows - with 2D and 3D transitions, animation, and your choice of music - that you can share with your Facebook friends or Google+ circles. That's all free as well!
For a small fee you can get the industry's best online privacy or publicly promote your presentations and slide shows with top rankings. But aside from that it's free. We'll even convert your presentations and slide shows into the universal Flash format with all their original multimedia glory, including animation, 2D and 3D transition effects, embedded music or other audio, or even video embedded in slides. All for free. Most of the presentations and slideshows on PowerShow.com are free to view, many are even free to download. (You can choose whether to allow people to download your original PowerPoint presentations and photo slideshows for a fee or free or not at all.) Check out PowerShow.com today - for FREE. There is truly something for everyone!