What Is Pediatric Diarrhea?
Diarrhea in children is a group of diseases mainly caused by diarrhea caused by multiple pathogens and factors. The main features are increased stool frequency and changes in characteristics, which can be accompanied by symptoms such as fever, vomiting, and abdominal pain, and different degrees of water, electrolyte, acid-base balance disorders. Pathogens can include viruses (mainly human rotavirus and other enteroviruses), bacteria (pathogenic E. coli, toxigenic E. coli, hemorrhagic E. coli, invasive E. coli and Salmonella typhimurium, Campylobacter jejuni, Yarrow Bacteria, Staphylococcus aureus, etc.), parasites, fungi, etc. Intestinal infections, intestinal flora disturbances caused by abuse of antibiotics, allergies, improper feeding, and climatic factors can also cause disease. It is a common disease in infants under 2 years of age.
Basic Information
- Visiting department
- Pediatrics
- Multiple groups
- Infants under 2 years
- Common causes
- Viral and bacterial infections
- Common symptoms
- Frequent bowel movements, changes in characteristics, fever, vomiting, abdominal pain, etc.
Pediatric diarrhea classification
1. According to the severity of the disease
(1) Mild diarrhea has gastrointestinal symptoms. Systemic symptoms are not obvious, body temperature is normal or there is low fever. Disorders of anhydrous electrolyte and acid-base balance.
(2) Severe diarrhea In addition to severe gastrointestinal symptoms, this type is also accompanied by severe disturbances of water and electrolyte, acid-base balance, and obvious symptoms of systemic poisoning.
2. According to the course of disease
(1) The course of acute diarrhea is less than 2 weeks.
(2) Duration of persistent diarrhea: 2 weeks to 2 months
(3) The course of chronic diarrhea is > 2 months.
3. Classification by cause
(1) Infectious diarrhea Cholera, dysentery, other infectious diarrhea (caused by bacteria, viruses, parasites, fungi, etc. except Vibrio cholerae and Shigella).
(2) Non-infectious diarrhea, bait diarrhea, symptomatic diarrhea, allergic diarrhea, endocrine diarrhea, congenital or acquired immunodeficiency, inflammatory bowel disease, small intestinal lymphangiectasia, etc.
Causes of diarrhea in children
Infection factor
(1) Intestinal infection
Can be caused by viruses, bacteria, fungi, parasites, both of which were more common in the past, especially viruses.
1) Viral infection 80% of diarrhea in children in cold season is caused by viral infection. The main cause of viral enteritis is rotavirus, followed by norovirus, astrovirus, coxsackie virus, ecovirus, coronavirus and so on.
2) Bacterial infections Escherichia coli causing diarrhea include: pathogenic E. coli, toxic E. coli, invasive E. coli, hemorrhagic E. coli, and adhesion-aggregation E. coli. Campylobacter Campylobacter and Campylobacter related to enteritis include three types: jejunum, colon, and fetus. 95% to 99% of Campylobacter enteritis is caused by Campylobacter fetus and Campylobacter jejuni. Others include Yersinia, Salmonella (mainly typhoid fever and other non-typhoid and paratyphoid), Aeromonas hydrophila, Clostridium difficile, Staphylococcus aureus, Pseudomonas aeruginosa, deformity Bacillus and so on.
3) Fungi that cause diarrhea include Candida, Aspergillus, Mucor and so on. Babies are more common in babies.
4) The parasites are Giardia lamblia, Amoeba and Cryptosporidium.
(2) Extra-intestinal infection
Sometimes cause digestive disorders, can also produce symptoms of diarrhea, that is, symptomatic diarrhea. The younger you are, the more common. The diarrhea is not serious, the stool characteristics are slightly changed, the stool is thin, contains a little mucus, there is no large amount of water and pus and blood, and the frequency of stool is slightly increased. It is common in upper respiratory infections, bronchial pneumonia, otitis media, etc. With the improvement of the original disease, diarrhea The symptoms gradually disappeared.
Antibiotic-induced diarrhea: chronic, persistent diarrhea. Due to the long-term use of broad-spectrum antibiotics, on the one hand, large numbers of harmful intestinal bacteria, Staphylococcus aureus, Clostridium difficile, and Pseudomonas aeruginosa multiply, and on the other hand, beneficial bacteria such as Bifidobacterium are reduced, and the microecological imbalance When diarrhea occurs, the characteristics of stool are related to the site of bacterial invasion, and the condition can be mild or severe.
2. Non-infectious factors
(1) Improper dietary care is more common in artificially fed children. Irregular feeding, or premature feeding of large amounts of starch or fatty foods, and sudden changes in food variety after weaning can cause mild to moderate diarrhea (indigestion). Sudden changes in the climate, cold bowel movements increase bowel movements; overheated weather reduces digestive juice secretion; as a result of thirst, excessive milk intake increases the burden on the digestive tract, all of which are prone to induce diarrhea. The stool is thin or egg soup-like, without pus, blood, and acid odor. If it is not controlled in time, it is easy to be complicated by intestinal infection.
(2) Allergic diarrhea, such as diarrhea caused by allergy to milk or soy products.
(3) The lack of primary or secondary diglucosidase (mainly lactase) or reduced activity of the intestinal digestion of sugar causes diarrhea.
(4) Climatic factors Sudden changes in climate and increased abdomen peristalsis due to cold weather; reduced digestive juice secretion due to overheating or excessive drinking of milk due to thirst can induce digestive disorders and cause diarrhea.
Clinical manifestations of diarrhea in children
1. Diarrhea is often accompanied by symptoms
(1) Mild onset can be slow or urgent, mainly gastrointestinal symptoms, loss of appetite, occasional galactorrhea or vomiting, increased stool frequency (3-10 times / day), and changes in characteristics; no symptoms of dehydration and systemic acidosis , Mostly recovered within a few days, often due to dietary factors and parenteral infections. In children with rickets or malnutrition, although diarrhea is mild, it is often delayed and other diseases can be secondary. Children may show weakness, paleness, and low appetite. Stool microscopy showed a small amount of white blood cells.
(2) Severe acute onset can also be gradually worsened and changed from mild. In addition to the severe gastrointestinal symptoms, there are more obvious symptoms of dehydration, electrolyte disturbances, and systemic poisoning (fever, irritability, and malaise). , Drowsiness and even coma, shock). Mostly caused by intestinal infections.
1) Gastrointestinal symptoms often include vomiting. In severe cases, vomiting of brown liquid, lack of appetite, frequent diarrhea, stools ten to dozens of times a day, mostly yellow watery or egg-like stools, containing a small amount of mucus, a small number of children also There may be a small amount of blood in the stool.
2) Dehydration Due to vomiting and diarrhea loss of fluid and insufficient intake, the total amount of fluid, especially extracellular fluid, is reduced, resulting in varying degrees of dehydration (see Table 1). This can be caused by the different proportions of water and electrolytes lost in children with diarrhea. Isotonic, hypotonic or hypertonic dehydration (see Table 2), the former two are more common.
3) Metabolic acidosis is generally parallel to the degree of dehydration. Those who are milder have no obvious manifestations, and those who are severe may have gray complexion, red lips, cherry blossoms, deep breathing, apathy, restlessness, and even coma. According to blood C0 2 CP, it was divided into mild (18 to 13 mmol / L), moderate (13 to 9 mmol / L), and severe (<9 mmol / L).
4) Hypokalemia is more common in patients with acute diarrhea after partial dehydration correction, or chronic diarrhea and malnutrition with diarrhea. Clinical manifestations include mental atrophy, decreased muscle tone, weakened tendon reflexes, abdominal distension, weakened bowel sounds, increased heart rate, and dull heart sounds; serum potassium <3.5mmo1 / L; ECG T wave widened, flat, inverted, U Arrhythmia is affected.
5) Children with hypocalcemia and hypomagnesemia active rickets have convulsions after correction of dehydration acidosis. The possibility of hypocalcemia should be considered. When the use of calcium is not effective, the possibility of hypomagnesemia should be considered. The normal value of blood magnesium is 0.74 0.99mmol / L (1.8 2.4mg / dl), and <0.58mmol / L (1.4mg / dl) may cause convulsions or tetany.
Table 1 Determining the degree of dehydration
Clinical manifestation | Degree of dehydration |
degree | Mild | Moderate | Severe |
Amount of liquid lost (%) | 5 | 5 10 | 10 |
(Ml / kg) | 30 50 | 50 100 | 100 120 |
Urine output | Slightly reduced | Significantly reduced | Very few |
pulse | powerful | Fast and weak | Barely touch |
consciousness | Slightly irritable | Languish, irritable | Blurred, lethargic and even comatose |
Skin elasticity | Good | Worse | Very poor * |
Front | Slightly sunken | More depressed | Extremely depressed |
Eye socket | Normal or slightly sunken | More depressed | Extremely depressed |
Tears | Have tears | Less tears | No tears |
Oral mucosa | Slightly dry | Drier | Extremely dry |
Extremities | warm | cool | Cold, cyanosis |
blood pressure | normal | Normal or slightly lower | Lower shock |
Table 2 Judgment of dehydration properties
Dehydration properties | Serum sodium mmol / L | Incidence% | The main symptoms |
Isotonicity | 130 150 | 40 80 | Severe circulatory disorders |
Hypotonic | <130 | 20 50 | Thirst is not obvious, and circulation disorders are more obvious |
Hypertonic | > 150 | less | Thirst, high fever, prominent neurological symptoms |
2. Clinical characteristics of several common types of enteritis
(1) Rotavirus enteritis is more common in infants from June to 2 years of age. It develops in autumn and winter, often vomiting at the beginning of the disease, diarrhea later, watery or egg soup-like stools, and prone to water and electrolyte disorders. , Often accompanied by fever and upper symptoms, is a self-limiting disease, the course of 3 to 8 days, stool microscopy occasionally with a small amount of white blood cells, stool rotavirus detection (ELISA method) can quickly diagnose.
(2) Pathogenic E. coli enteritis is more common in infants and children under 2 years of age, and most often occur in high temperature seasons, most from May to August. The onset was slow, stools were yellow egg flower soup-like stools, smelly and more mucus, often vomiting, no fever and systemic symptoms, a small amount of white blood cells in the stool microscopy, bacterial culture can confirm the diagnosis.
(3) Invasive E. coli enteritis mainly infects school-age children, with acute onset, frequent diarrhea, pus with bloody pus and blood, often accompanied by vomiting, abdominal pain, and severe acute symptoms. It may have high fever, severe systemic poisoning symptoms, and even shock. It is difficult to distinguish clinical manifestations and bacillary dysentery, and stool culture is required.
(4) Toxigenic Escherichia coli enteritis occurs throughout the year, with September to November as the high incidence season. It can cause an outbreak in the neonatal room and is the main cause of diarrhea in tourists. The disease is transmitted via the fecal-oral route, with an incubation period of 12 to 24 hours. Onset is rapid; stool is 10 to 20 times a day, watery stools, diarrhea with abdominal pain or colic, nausea, vomiting, malaise and fever, severe cases with water, electrolyte and acid-base balance disorders. The course of the disease lasted for several days and was self-limiting.
(5) Hemorrhagic E. coli enteritis occurs in summer and autumn and can occur at all ages, with an incubation period of 2 to 7 days. Sudden onset and severe illness. Fever, nausea, vomiting, abdominal pain, frequent stools, starting with watery stools, and bloody stools, with special odors. Stool microscopy has a lot of red blood cells, often without white blood cells.
(6) The majority of Salmonella typhimuritis is children under 2 years old, which occurs throughout the year and is more common in summer. Pay attention to epidemiological history; the main symptoms are diarrhea, various stool characteristics, indigestible stools, watery stools, and mucus. Symptoms and even pus and bloody stools; the severity of the disease is different, and severe cases can occur shock, DIC; some children show sepsis, a longer heat course. Half of the children will have bacteria in the stool for about 2 weeks, or even longer.
(7) Staphylococcus aureus enteritis has a history of long-term application of broad-spectrum antibiotics, yellow-green stool-like water samples, seawater-colored, mucus, and fishy odor; accompanied by symptoms of systemic poisoning to varying degrees; microscopic examination of stool has a large number of pus Clusters of G + cocci are grown with Staphylococcus aureus and are positive for coagulase.
(8) Fungal enteritis is more common in malnourished children or with a history of long-term use of broad-spectrum antibiotics, and children often have thrush; the main symptoms are diarrhea, yellow stools, foamy, fermented, and sometimes tofu-like; stool The fungal spores and mycelia were detected by microscopy, and the fungal culture was confirmed by using Sarcaster medium.
(9) Pseudomembranous enteritis is caused by Clostridium difficile. Except for aminoglycoside antibiotics and vancomycin, which are used externally in the gastrointestinal tract, almost all antibiotics can induce the disease. Symptoms can occur within one week or as early as a few hours after the drug is taken and as late as four to six weeks after the drug is stopped. It is also found in patients with fragility after surgery, intestinal obstruction, intussusception, and megacolon. The bacteria multiply in large numbers and produce two kinds of toxins, namely toxin A (enterotoxin) and toxin B (cytotoxin). The main symptoms are fever, diarrhea, mild stools several times a day, and healed soon after stopping antibiotics; severe diarrhea, yellow-green watery stools, pseudomembranes may be discharged, a few stools with blood, dehydration, electrolyte disorders and Acidosis, toxic megacolon, intestinal perforation. Increased peripheral blood. It is accompanied by symptoms of abdominal pain, bloating and systemic poisoning, and even shock. For suspicious cases, fiber and electronic colonoscopy can be performed. Stool anaerobic culture and tissue culture detection of cytotoxins can help confirm the diagnosis.
Pediatric diarrhea diagnosis
It is easy to make a clinical diagnosis based on the onset season, history, clinical manifestations and stool characteristics. Must determine whether there is dehydration (nature and degree), electrolyte disorders and acid-base imbalance; pay attention to find the cause, the etiology of intestinal infection is difficult to diagnose, from the clinical diagnosis and treatment needs to consider, you can first according to the stool routine with or without white blood cells to diarrhea Divided into two groups:
1. No stool or occasional white blood cells
Diarrhea caused by non-invasive causes (such as viruses, non-invasive bacteria, parasites and other intestinal infections or improper feeding), mostly watery diarrhea, sometimes with symptoms of dehydration, should be identified from the following diseases:
(1) Physiological diarrhea is more common in infants less than 6 months old, mostly breastfeeding, looks fat, often has eczema, and diarrhea occurs shortly after birth, except for increased stool frequency, no other symptoms, good appetite, and does not affect development.
(2) Various diseases causing digestive and absorption disorders of the small intestine, such as lactase deficiency, glucose-galactose malabsorption, chlorine loss diarrhea, primary bile acid malabsorption, and allergic diarrhea.
2. Those with more white blood cells in stool
It shows that there are invasive inflammatory lesions in the colon and the terminal ileum, which are often caused by various invasive bacterial infections (bacterial dysentery, typhoid salmonella enteritis, invasive coliform enteritis, etc.). It is difficult to distinguish based on clinical manifestations only. Stool bacterial culture, bacterial serotype and toxicity testing are performed when necessary. It also needs to be distinguished from necrotizing enterocolitis. Symptoms of severe poisoning are severe, abdominal pain, bloating, frequent vomiting, high fever, bloody stool gradually, often accompanied by shock, abdominal X-rays in the upright and supine position show localized inflated expansion of the small intestine, widened intestinal space, and intestinal gas . If antibiotic treatment is not effective and the duration of diarrhea is longer, it still needs to be distinguished from Crohn's disease, ulcerative colitis, and intestinal polyps.
Pediatric diarrhea treatment
Principles of treatment: reasonable diet and maintenance of nutrition; rapid correction of water and electrolyte balance disorders; control of infections inside and outside the intestine; symptomatic treatment to strengthen care and prevent complications; avoid abuse of antibiotics.
1. Treatment of acute diarrhea
(1) Diet therapy
1) Continue breastfeeding and encourage eating.
2) Artificial feeding infants 6 months of age should give a daily diet (such as porridge, noodles, rotten rice, etc., can give some fresh fruit juice or fruits to supplement potassium), to avoid difficult to digest food.
3) Those with severe diarrhea or severe vomiting may temporarily fast for 4 to 6 hours, but should not fasten. Fasting time 6 hours, diet should be resumed as soon as possible.
(2) Fluid therapy
1) Prevention of dehydration: From the beginning of the child's diarrhea, give enough fluids orally to prevent dehydration. Breastfeeding infants should continue breastfeeding, and increase the frequency of feeding and extend the duration of single feeding; infants who are fed mixed should be given ORS or other clean drinking water on the basis of breastfeeding; artificial feeding infants should choose ORS or food-based rehydration Such as soup, rice soup and yogurt drinks or clean drinking water. It is recommended to add a certain amount of liquid after each loose stool (<6 months, 50ml; 6 months to 2 years, 100ml; 2 to 10 years, 150ml; how much can children drink over 10 years old) ) Until diarrhea stops.
2) Those with mild to moderate dehydration: oral rehydration salts (ORS) can be given, the dosage (ml) = body weight (kg) × (50 to 75). Completed within 4 hours; closely observe the condition of the child, and counsel the mother to give the child ORS solution.
The following conditions suggest that oral rehydration may fail: persistent, frequent, and massive diarrhea [> 10-20ml / (kg · h)], insufficient dose of ORS solution, frequent and severe vomiting; if it is near 4 hours, the child still has dehydration Performance, to adjust the fluid replacement program. After 4 hours, the child's dehydration was reassessed, and then the appropriate regimen was selected.
3) People with moderate to severe dehydration: need to be hospitalized for intravenous fluid replacement. The total amount of fluid replacement in the first 24 hours includes three parts: cumulative loss, continued loss, and physiological maintenance.
Supplementary cumulative losses:
Liquid volume: according to the degree of dehydration, mild 30 50ml / kg; moderate 50 100m1 / kg; severe 100 120m1 / kg. Liquid type: according to the nature of dehydration, isotonic supplement 1/3 1/2 sheets, hypotonic supplement 2/3 sheets, hypertonic supplement 1/3 1/5 sheets. Please refer to Table 3 for specific schemes .
Patients with mild dehydration and moderate dehydration who are not associated with circulatory disorders must administer intravenous fluids if they have severe vomiting and diarrhea. The infusion rate should be replenished within 8 to 12 hours.
Patients with moderate dehydration with circulatory disturbance and severe dehydration should be divided into two steps: Give 2 1 isotonic solution during the expansion phase, and quickly inject within 30 to 60 minutes at 20ml / kg, which is suitable for any child with dehydration nature. Replenish the cumulative loss, choose different liquids according to the nature of dehydration after expansion, and deduct the intravenous drip after expansion, and replenish within 7 to 11 hours.
Table 3 Different degrees of dehydration fluid replacement scheme
degree | Cumulative loss | Continued losses | Physiological maintenance |
Mild dehydration | Amount: 30 50ml / kg Speed: replenishment within 8 to 12 hours Type: 1/2 sheet or ORS | How much to throw up or 30ml / kg daily Replenish 1/2 sheet within 12 ~ 16 hours 3 2 1 liquid or ORS (after dilution) | 60 80ml / kg daily or infusion 12 to 16 hours 1/5 sheets, 4 1 fluid |
Moderate dehydration | Amount: 50 100ml / kg Speed: replenishment within 8 to 12 hours Type: 1/2 sheet or ORS | Ibid | Ibid |
Severe dehydration | Volume expansion: volume 20ml / kg; speed: 30-60 minutes; type: isotonic solution (2 1 isotonic solution); volume 100-120ml / kg (less volume expansion); speed, type: same as dehydration intravenous rehydration | Ibid | Ibid |
Supplement continued loss: Supplement based on the amount of water lost during diarrhea or vomiting. The principle is how much to lose and how much to make up, usually 10 to 40 ml / kg per day. Give 1/2 to 1/3 of the liquid and replenish it within 12 to 16 hours.
Supplement the physiological maintenance amount: the liquid is 60 80ml / kg daily. Oral as much as possible, if not enough, 1/5 physiological maintenance solution is given intravenously. Replenish within 12 to 16 hours.
4) Correction of acidosis: mild and moderate acidosis need not be corrected separately. Severe acidosis or the degree of acidosis more severe than dehydration can be corrected according to the blood gas BE value or CO 2 CP. The calculation formula: the required number of mmoles of 5% sodium bicarbonate = (BE-3) × 0.3 × body weight (kg) or ( 22CO 2 CP) × 0.5 × weight (kg). 5% sodium carbonate 1ml = 0.6mmol. After being diluted 3.5 times into an isotonic solution, the static point can be obtained; if blood gas or CO 2 CP is checked unconditionally, 5% sodium bicarbonate 5 ml / kg can be used to increase CO 2 CP 5 mmol.
5) Potassium supplementation: daily requirement is 3 ~ 5mmol / kg. Urinary potassium supplementation should be seen. Intravenous infusion concentration <0.3%, evenly infused for 24 hours. Special attention should be paid to potassium supplementation in malnourished children, children with chronic diarrhea and severe dehydration.
6) Correction of low calcium and low magnesium: Routine supplementation is generally not required, but attention should be paid when malnutrition and rickets are combined. If convulsions occur in the fluid, 10% calcium gluconate can be given 5 to 10 ml each time by intravenous intravenous infusion. , 2 to 3 times a day, if there is no effect to consider the possibility of low magnesium, you can give 25% magnesium sulfate 0.1ml / kg each time, deep intramuscular injection, 3 to 4 times a day. Stop after symptomatic relief.
7) Rehydration on the second day: The main supplement is the amount of continued loss, physiological maintenance, potassium and heat supply, and oral administration as much as possible.
(3) Controlling infection
Viral enteritis does not require antibiotics. Bacterial enteritis is based on the pathogen, antibiotic selection, or adjustment based on the results of the drug sensitivity test. Escherichia coli selected ampicillin, gentamicin oral tablets, polymyxin E, and third-generation cephalosporins for severe cases. Salmonella typhimurium was administered orally with ampicillin, and third-generation cephalosporins were used severely. Campylobacter jejuni uses macrolides. Staphylococcus aureus enteritis was treated with neocyanine and vancomycin. Antibiotics are discontinued for fungal enteritis, and nystatin is administered orally.
(4) symptomatic treatment
1) Antidiarrheal: montmorillonite powder, 1 g each time less than 1 year old, 2 g 2 years old, 3 g 2 years old, 20 ~ 50 ml flush water, orally three times a day.
2) Improve the intestinal micro-ecological environment: micro-ecological preparations such as lactobacillus, streptococcus faecalis, and bacillus cereus can be applied.
3) Others: Aid digestion: available gastric enzyme mixture, multi-enzyme tablets, etc. Antiemetic: Morphine, three times a day. Relieve abdominal distension: Symptomatic treatment should be performed after clearing the cause, and anal canal exhaustion can be used; abdominal distension caused by toxic intestinal paralysis can be treated with phentolamine, intravenous injection, and can be reused every 4 to 6 hours.
(5) Supplement zinc
Children with acute diarrheal disease can be treated with zinc supplementation after eating. Children older than 6 months will be supplemented with 20 mg of elemental zinc per day, and children younger than 6 months will be supplemented with 10 mg of elemental zinc per day for a total of 10 to 14 days. 20 mg of elemental zinc is equivalent to 100 mg of zinc sulfate and 140 mg of zinc gluconate.
2. Treatment of persistent and chronic diarrhea
Due to persistent and chronic diarrhea often accompanied by malnutrition and other complications, the condition is more complicated, and comprehensive treatment measures must be taken:
(1) Etiology treatment: Avoid abuse of antibiotics and avoid intestinal flora imbalance.
(2) Prevention and treatment of dehydration: Correct electrolyte and acid-base balance disorders.
(3) Active nutrition supply
1) Continue breastfeeding
2) The diet of artificial feeding infants should be adjusted: infants less than 6 months old should be diluted with milk plus equal amount of rice soup or water, or fermented milk (ie, yogurt), or a milk-cereal mixture can be fed 6 times a day to ensure sufficient calories . Babies older than 6 months can use the usual diet, such as thick porridge and noodles with a small amount of cooked vegetable oil, vegetables, minced fish or minced meat, from little to more, from thin to thick.
3) Carbohydrate intolerance (also known as glycogenic diarrhea): Use a disaccharide-free diet. Soymilk (add 5-10g glucose per 100ml of fresh soybean milk), yogurt, or low-lactose or lactose-free milk powder.
4) Allergic diarrhea: When diarrhea does not improve after using a disaccharide-free diet in some children, the possibility of protein allergy (such as milk or soy protein allergy) needs to be considered, and other diets should be used instead.
5) Factor diet: It is the most ideal diet for children with intestinal mucosa damage. It consists of amino acids, glucose, medium chain triglycerides, multivitamins and trace elements. Can be absorbed and tolerated even in the case of severe intestinal mucosal damage and digestive enzyme deficiency. The application concentration and amount depend on the clinical status of the child.
6) Intravenous nutrition: A few severe children who cannot tolerate oral administration can use intravenous nutrition. Recommended solution: Fat milk 2 3g / kg daily, compound amino acid 2 2.5g / kg daily, glucose 12 15g / kg daily, proper amount of electrolytes and trace elements, liquid daily 120 150ml / kg, heat card Daily 209 376J / kg (50 90cal / kg). Input via peripheral vein (preferably to use an infusion pump to control the infusion rate), and then change to oral after improvement.
Prognosis of diarrhea in children
Depends on the nutritional status of the cause, and sooner or later. Drug resistance, diarrhea caused by pathogenic Escherichia coli or fungi have a poor prognosis; viral enteritis has a good prognosis, and children with malnutrition and rickets develop diarrhea. Poor prognosis, severe illness, and late treatment due to poor body regulation 2. Patients with severe complications, such as acute renal failure or severe secondary infection, have a poor prognosis.
Pediatric diarrhea prevention
Reasonable feeding, pay attention to health management, cultivate good sanitary habits, pay attention to disinfection and isolation in the epidemic season, pay attention to climate change, and prevent abuse of antibiotics.
Pediatric diarrhea care
Infectious diarrhea should be isolated to prevent cross-infection; pay attention to the amount of input and output (feces, urination and vomiting), and timely and accurately record; pay attention to the speed of intravenous fluid replacement; pay attention to hip care, prevent diaper rash and hip infection ; Give water and oral rehydration salts on time and give parents guidance.
references:
[1] Wu Xiru, Qin Jiong. Pediatrics. Beijing: Peking University Medical Press, 2003: 377-388.
[2] Xue Xindong. Pediatrics. 2nd Edition. Beijing: People's Medical Publishing House, 2010: 250-258.
[3] Chinese Medical Association Pediatrics Branch, Consumer Chemistry Group, Chinese Medical Association Pediatrics Branch Infection Group, "Chinese Journal of Pediatrics" Editorial Board. Expert consensus on the principles of diagnosis and treatment of pediatric diarrhea. Chinese Journal of Pediatrics, 2009, 47 (8 ): 634-636.
