General condition

Well, alert

“Restless, irritable”

“Lethargic or unconscious”, floppy.

Eyes

Normal

Sunken

Very sunken and dry

Tears

Present

Absent

Absent

Mouth and Tongue

Moist

Dry

Very dry

Thirst

Drinks normally, not thirsty

“Thirsty, drinks eagerly”

“Drinks poorly” or not able to drink

Skinpinch

“Goes back quickly”

“Goes back slowly”

“Goes back very slowly”

Decide dehydration status

The patient has no signs of hydration

If the patient has two or more signs, including one (key) sign, then there is some dehydration

If the patient has two or more signs, including one (key) sign, there is severe dehydration.

Treatment plan

Plan-A

Plan-B

Plan-C

Composition and concentration of WHO/UNICEF recommended oral dehydration salts (ORS)

Ingredients

Composition (Grams/L)

Concentration (mEq/L)

Sodium chloride

3.5

Sodium

90

Potassium chloride

1.5

Chloride

80

Trisodium citrate anhydrous

2.9

Citrate

10

Glucose (anhydrous)

20.0

Glucose Osmolality

111 mmol/L311

Note: Soda bicarb is not recommended now.

Guidelines for replacement of fluid and electrolytes in children with ‘No dehydration’ (Plan-A)*

Age

After each loose stool, offer

< 6 months

Quarter glass or cup (50mL)

7 months - 2 years

Quarter to half glass or cup (50-100 mL)

2 - 5 years

Half to one glass or cup (100-200mL)

Older Children

As much as the child can take.

* Fluids which can be used include ORS, lemon water, butter milk, rice kanji, lentil soup, light tea etc. ORS in Plan-A treatment is optional only.

Deficit fluid therapy for ‘Severe dehydration’ (Plan-C)  (100 mL/kg body weight)

Age

Type of Fluid

Volume of Fluid and Duration

Monitoring

Infants < 1 year

Ringer’s lactate

30 mL/kg body weight within first hour, followed by 70 mL/kg body weight 70 mL/kg body weight over next 5 hours

Reassess after every:
1-2 hours
* if not improving, give IV drip more rapidly.
* encourage oral feeding by giving ORS 5 mL/kg / hour, alongwith IV fluids, as soon as child is able to drink.

Children > 1 year

Ringer’s lactate

30 mL/kg body weight within 1/2 hour, followed by 70 mL/kg/body weight over next 2 1/2 hours.

Reassess hydration status :
* After 6 hours (infants) and 3 hours (older children) assess hydration appropriate plan for hydration (Plan-A, B and C)

Antimicrobials used to treat specific causes of diarrhoea in children

Causes

Drugs of Choice

Doses

Cholera

Tetracycin
Furazolidone
or
Trimethoprim (TMP)-sulfamethoxazole (SMX)

30 mg/day in 4 divided doses x 2-3 days
5 mg/kg/day in 4 divided doses x 3 days

TMP 5mg/kg and SMX 25mg/kg, in 2 divided doses x 3 days

Dysentery

Trimethoprim (TMP)-
sulfamethoxazole (SMX)
or
Nalidixic acid
or
Ampicillin

TMP 5mg/kg and
SMX 25 mg/kg in 2 divided doses x 5 days

15mg/kg 4 times a day x 5 days

25 mg/kg 4 times a days x 5 days

Amebic dysentery

Metronicazole

30 mg/kg/day in 3 divided doses x 5-10 days

Acute giardiasis

Metronidazole

Tinidazole

15mg/kg/day in 3 divided doses x 5 days

10-15mg/kg/day in 3 divided doses x 5 days.