Acute Diarrhea Disease Recommendations
Diarrhea refers to a condition with increased loose stools, occurring three or more times per day, or in cases where stool volume can be measured, exceeding 10 grams/day in infants or young children, or exceeding 200 grams/day in older children and adults.
Causes of Acute Diarrhea in Children
It is mostly caused by infections, including viruses, bacteria, and protozoa. A smaller portion is caused by other factors such as antibiotics (antibiotic-associated diarrhea), adverse drug reactions, or consumption of certain foods.
These infections can be transmitted directly from person to person, through contaminated food or drinking water, or via the fecal route. Factors that increase the risk of infection include poor hygiene, immunodeficiency, immunosuppressive therapy, malnutrition, infants under 6 months old, infants not breastfed in early life, and social environments that increase exposure to pathogens, such as living in crowded communities.
Dehydration
- Dehydration Assessment
Dehydration is the main cause of death in acute diarrhea. Therefore, assessing dehydration is crucial. If the patient is dehydrated, adequate and timely oral rehydration should be provided. If moderate or severe dehydration is present, medical attention should be sought immediately, especially if the following symptoms are observed:
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- Frequent vomiting or diarrhea combined with low fluid intake
- Severe thirst
- Weakness, restlessness
- Sunken eyes, decreased tears, dry mouth
- Cold hands and feet
- Decreased urine output
- Dehydration Correction and Prevention
Correction and prevention of dehydration are key in children with acute diarrhea. Oral rehydration solution (ORS) is the first choice for patients with mild to moderate dehydration due to its effectiveness, low cost, and easy availability or preparation.
It is recommended to use ORS to replace 10 ml/kg per episode of watery diarrhea (maximum 240 ml per episode) to prevent new dehydration episodes.
Risk factors and prevention
- Handwashing and Drinking Clean Water
Washing hands before and after handling food, after defecation or contact with feces, and drinking clean water help reduce the incidence and mortality of diarrhea. Handwashing with soap can reduce diarrhea incidence in children under 5 years by 42-64%. Using antibacterial soap is similarly effective as regular soap. Drinking clean water reduces diarrhea incidence by 44%.
- Breastfeeding
Breastfeeding for at least 6 months reduces the risk of intestinal infections, severity of diarrhea, and rotavirus infection in infants.
- Rotavirus Vaccination (in infants under 6 months)
Rotavirus vaccination helps prevent diarrhea caused by rotavirus infection, reducing hospital admissions and mortality from rotavirus diarrhea in children under 2 years old.
Nutrition
- Breastfeeding
In children who are breastfed during dehydration treatment with ORS, the frequency and volume of stools are reduced compared to those receiving ORS alone.
- Lactose-free formula milk (in cases of severe watery diarrhea suspected of lactose intolerance)
Lactase enzyme deficiency in acute diarrhea is usually mild and self-limiting. However, in non-breastfed children, lactose-free formula may help reduce illness duration and treatment failure.
