Background:

While diarrhea in adults can be inconvenient and briefly debilitating, in children it can be fatal.  Globally, diarrheal diseases are the second leading cause of death for children under five.

• Approximately 760,000 children under five die each year from diarrhea
  • Kills 2,200 children daily- more than AIDS, malaria and measles combined
• Most of the diarrhea can be prevented
  • Safe drinking water
  • Adequate sanitation and hygiene
• Diarrhea is also a leading cause of malnutrition

 

Clinical types of Diarrhea (with common infectious causes):

• Acute watery diarrhea lasting hours or days (e.g. rotavirus, norovirus, Vibrio cholerae)
• Acute bloody diarrhea, a.k.a. dysentery (e.g. Entamoeba histolytica, Shigella, Salmonella, Campylobacter, E. coli)
• Persistent diarrhea lasting longer than 14 days (e.g. parasites, C. difficile)

 

Clinical assessment:

• Early dehydration- no signs or symptoms
• Moderate dehydration
  • Thirst
  • Irritability/tiredness/lightheadedness
  • Dry mucous membranes/decreased tears
  • Decreased urine output/dark (concentrated) urine
  • Sunken eyes
  • Decreased capillary refill (2-4 sec)*
  • Decreased skin turgor*
  • Increased respiratory rate*
• Severe dehydration
  • Decreased mental status
  • Shock (rapid heart rate, low blood pressure)
  • Minimal or no urine output
  • Very sunken eyes/no tears
  • Parched/cracked mucous membranes
  • Marked decreased capillary refill (> 4 sec)*
  • Skin tenting*
  • Markedly increased respiratory rate*

 

*Best indicators of hydration status

 

Next week: Prevention and Treatment

 

 

References

http://www.who.int/mediacentre/factsheets/fs330/en/

http://www.cdc.gov/healthywater/global/diarrhea-burden.html

http://emedicine.medscape.com/article/906999-clinical#a0217