A 1-year old infant presents with 10-12 episodes of watery stools per day for the last 9 days. Along with zinc supplementation, what else should be prescribed to the child?
Ans. b. ORS only (Ref: Ghai 8/e p293-294. 296)The infant is suffering from acute diarrhea and treatment includes oral rehydration therapy, zinc supplementation and continued breastfeeding.Low lactose diet is required in management of persistent diarrhea. Antibiotics are required in management of dysentery, i.e. blood in stools."Routine use to probiotics in acute diarrhea is not recommended. It was recommended till the previous edition of the book, but the latest data shows no added advantage of probiotics in children."-- Ghai 8/e p296Acute Diarrhea ManagementThe cornerstone of acute diarrhea management is rehydration by using oral rehydration solutions (ORS).Principles of Acute Diarrhea ManagementCorrection of dehydration, electrolytes & hypoglycemiaQEvaluation for infections using appropriate investigations and their managementQNutritional therapyQPhysiological Basis for Oral Rehydration TherapyIn most cases of acute diarrhea, sodium & chloride are actively secreted from the gut mucosa due to pathogen- induced dysfunction of several actively functioning absorption pumps.However, glucose dependent sodium pump remains intact and functional transporting one molecule of glucose and dragging along a molecule of sodium and one of water across intestinal mucosa resulting in repletion of sodium and water losses.The glucose dependent sodium & water absorption is the principle behind replacing glucose and sodium in 1:1 molar ratio in the WHO oral rehydration solution (ORS)Q.Use of low osmolality ORS causes reduction of stool output, decrease in vomiting and decrease in the use of unscheduled IY fluids without increasing the risk of hyponatremia.For this reason, the recommendation for use of standard WHO ORS (having osmolarity of 311 mmol/I) was changed to low osmolarity WHO ORS (having osmolality of 245 mmoI/l)QHome available fluids for Acute DiarrheaFluids that contain salt (preferable)* Oral rehydration solution* Salted drinks (e.g. Salted rice water or salted yoghurt drink)* Vegetable or chicken soup with saltFluids that do not contain salt (acceptable)* Plain water, water in which a cereal has been cooked (e.g. unsalted rice water), unsalted soup, yoghurt drinks without salt, green coconut water, weak unsweetened tea, unsweetened fresh fruit juiceUnsuitable home available fluids* Commercial carbonated beverages, commercial fruit juices, sweetened teaZinc SupplementationIt is helpful in decreasing severity & duration of diarrhea and also risk of persistent diarrheaQ.Zinc is recommended to be supplemented as sulphate, acetate or gluconate formulation, at a dose of 20 mg of elemental zinc per day for children >6 months for a period of 14 daysQ.Composition of WHO Recommended ORSConstituentg/IOsmole or ionmmol/ISodium chloride2.6Sodium75QGlucose, anhydrous13.5Chloride65Potassium chloride1.5Glucose, anhydrous75Trisodium citrate, dihydrate2.9Potassium20Q Citrate10Total osmolanty 245Q Standard ORS solutionLow Osmolar ORS solutionGlucose11175Sodium9075Chloride8065Potassium2020Citrate1010Total osmolarity311Q245Q
ORS with antibiotics
ORS only
ORS with low-lactose diet
ORS with low-lactose diet and probiotics
Fluid and Electrolyte Treatment of Specific Disorders