ADD
Q&A COUNT: 36*
HISTORY:
*Kindly note that the above two questions sound similar, but different answers are expected
Integrated Management of Neonatal and Childhood Illnesses
Q&A COUNT: 36*
HISTORY:
Causes of convulsions in ADD:
- Hyponatremia
- Hypernatremia
- Hypokalemia following bicarbonate therapy for acidosis
- Hypoglycemia
- Cerebral venous thrombosis* (or) Sagittal sinus thrombosis
- Infections (Meningitis/ Encephalitis)
- Febrile seizures
EXAMINATION:
Signs of dehydration
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| This picture is taken from OP Ghai textbook of Paediatrics |
Percentages of fluid loss and dehydration grades:
<3% of loss - No dehydration
3-9% - some
>9% - severe dehydration
>20% - shock
Assessment of Fluid loss using dehydration grades
No Dehydration - <50 ml/kg fluid lost
Some Dehydration - 50-100 ml/kg fluid lost
Severe Dehydration - >100 ml/kg fluid lost
Assessment of Fluid loss using dehydration grades
No Dehydration - <50 ml/kg fluid lost
Some Dehydration - 50-100 ml/kg fluid lost
Severe Dehydration - >100 ml/kg fluid lost
*Kindly note that the above two questions sound similar, but different answers are expected
MANAGEMENT:
What is IMNCI?Integrated Management of Neonatal and Childhood Illnesses
IMNCI module for ADD
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| This picture is taken from OP Ghai textbook of Paediatrics |
Treatment for ADD
1) Oral Rehydration Therapy
Plan A or Plan B or Plan C followed by - Maintenance ORS
2) Antibiotics, only if required
3) Treat SAM, if child is a SAM child
4) Continue Breast feeding*
5) Zinc supplementation
1) Oral Rehydration Therapy
Plan A or Plan B or Plan C followed by - Maintenance ORS
2) Antibiotics, only if required
3) Treat SAM, if child is a SAM child
4) Continue Breast feeding*
5) Zinc supplementation
What is Plan A?
Plan A - ADD with No dehydration
What is Maintenance ORS?
Given after treatment of ADD
For first 10 kg - give 100 ml/kg
For 11-20 kg - 1000 ml + 50 ml/kg for every kilogram above 10 kg
(Example: If child is 15 kg - give 1000 ml + (50*5) ml = 1250 ml)
For >20 kg - 1500 + 20 ml/kg for every kilogram above 20 kg
(Example: If child is 23 kg - give 1500 ml + (20*3) ml = 1560 ml)
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| This picture is taken from OP Ghai textbook of Paediatrics |
What is Plan B?
Plan B - ADD with Some dehydration
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| This picture is taken from OP Ghai textbook of Paediatrics |
Based on body weight: 75 ml/kg
What is Plan C?
What is Plan C?
Plan C - ADD with Severe dehydration
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| This picture is taken from OP Ghai textbook of Paediatrics |
What is Maintenance ORS?
Given after treatment of ADD
For first 10 kg - give 100 ml/kg
For 11-20 kg - 1000 ml + 50 ml/kg for every kilogram above 10 kg
(Example: If child is 15 kg - give 1000 ml + (50*5) ml = 1250 ml)
For >20 kg - 1500 + 20 ml/kg for every kilogram above 20 kg
(Example: If child is 23 kg - give 1500 ml + (20*3) ml = 1560 ml)
Dosage and Role of Zinc in ADD case?
20 mg of elemental zinc per day for 14 days (for children >6 months)
10 mg/day for child <6 months
Zinc reduces severity and duration of Diarrhoea. Zinc reduces risk of persistent diarrhoea.
Zinc fortified ORS can be also used.
What is ORT?
Oral Rehydration Therapy
Given for Acute Diarrhoeal Disease
Note that: ORT can be done either by using ORS or Home available fluids. ORT and ORS are not same terms.
Solutions used for Oral Rehydration Therapy (or) Types of ORS:
1. Reduced Osmolar ORS (WHO ORS)
2. ReSoMal (for SAM baby)
3. Zinc fortified ORS
4. Amino acid fortified ORS
5. Super ORS or Cereal based ORS
6. Super Super ORS
7. Micronutrient fortified ORS
8. Home made ORS
9. Home available fluids
Components of WHO reduced osmolar ORS
10 mg/day for child <6 months
Zinc reduces severity and duration of Diarrhoea. Zinc reduces risk of persistent diarrhoea.
Zinc fortified ORS can be also used.
What is ORT?
Oral Rehydration Therapy
Given for Acute Diarrhoeal Disease
Note that: ORT can be done either by using ORS or Home available fluids. ORT and ORS are not same terms.
Solutions used for Oral Rehydration Therapy (or) Types of ORS:
1. Reduced Osmolar ORS (WHO ORS)
2. ReSoMal (for SAM baby)
3. Zinc fortified ORS
4. Amino acid fortified ORS
5. Super ORS or Cereal based ORS
6. Super Super ORS
7. Micronutrient fortified ORS
8. Home made ORS
9. Home available fluids
Components of WHO reduced osmolar ORS
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| This picture is taken from OP Ghai textbook of Paediatrics |
How to prepare ORS?
1 packet of ORS powder is mixed in 1 litre of water and mixed well in a clean container. This solution can be given to ADD child as much as they wish to drink
ORS solution needs to be used within 24 hours of preparing it
ORS solution needs to be used within 24 hours of preparing it
Why you cannot push fluids fast in a SAM child with diarrhoea?
Risk of water and sodium retention
Oral Fluids for SAM + Diarrhoea:
- Low osmolar ORS (less NaCl and less sugar)
- RESOMAL
What is the Ideal ORAL fluid for Malnutrition?
RESOMAL
Why normal ORS cannot be given in SAM baby? (or) Why WHO reduced osmolality of ORS solution?
If there is ADD with malnutrition, there will be Villi mucosa atrophy due to adaptation. Now, by giving osmolar solution like normal ORS can cause osmotic diarrhoea - aggravating existing diarrhoea resulting in dehydration and death.
If there is ADD with malnutrition, there will be Villi mucosa atrophy due to adaptation. Now, by giving osmolar solution like normal ORS can cause osmotic diarrhoea - aggravating existing diarrhoea resulting in dehydration and death.
What is ReSoMal? Its contents?
RE - Rehydration
SO - Solution for
MAL - Malnutrition
SAM baby has Potassium deficiency but high level of sodium. SAM baby also has magnesium, zinc and copper deficiency. So this special ORS solution contains 40 mEq/L of potassium with 45 mEq/L of sodium with Magnesium, zinc and copper.
Recommended by WHO for SAM babies
SO - Solution for
MAL - Malnutrition
SAM baby has Potassium deficiency but high level of sodium. SAM baby also has magnesium, zinc and copper deficiency. So this special ORS solution contains 40 mEq/L of potassium with 45 mEq/L of sodium with Magnesium, zinc and copper.
Recommended by WHO for SAM babies
What is Super ORS?
Super ORS is an ORS effective in Cholera; Here, instead of mono sugar, rice powder is added.
Also called as Cereal based or Rice based ORS
Advantages:
Decreased purge and slow release of glucose from starch**
Super ORS is an ORS effective in Cholera; Here, instead of mono sugar, rice powder is added.
Also called as Cereal based or Rice based ORS
Advantages:
Decreased purge and slow release of glucose from starch**
What is Super Super ORS?
Super ORS + Zinc
Super ORS + Zinc
What is home made ORS?
It is a sugar salt solution
4 g salt + 40 g sugar in 1 Litre of water
Home available Fluids used for Oral Rehydration Therapy
Using home made fluids for management of acute Diarrhoea
It is a sugar salt solution
4 g salt + 40 g sugar in 1 Litre of water
Home available Fluids used for Oral Rehydration Therapy
Using home made fluids for management of acute Diarrhoea
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| This picture is taken from OP Ghai textbook of Paediatrics |
Kindly note that Home made ORS and Home available fluids are different**
What is ORT corner?
Oral Rehydration Therapy Corner is a room in hospital which provides readymade ORS fluid solution for ADD babies.
What is Parenteral Diarrhoea?
Diarrhoea due to systemic infection
Causes:
1. Sepsis
2. ASOM
3. UTI
What is HANGING DROP TEST? (just for knowledge sake; this question will not be asked)
It is a microscopic lab test done in cases of ADD
Principle:
Hanging drop of sample will make MOTILE bacteria to move to the edges of the sample drop
Diagnostic of - Vibrio cholerae
Procedure:
1. Collect a sample of stool (mixed with peptone water or any transport media like VR medium)
2. Put a drop of stool over a cover slip
3. Take a glass slide with concave depression in its centre.
4. Place the glass slide over cover slip, such that concavity of glass slide covers the drop. (here - glass slide is above and cover slip is below)
5. Now flip it!! (so that glass slide is below and cover slip is above) - the sample will "hang like a drop" from above
6. This hanging drop will make the "MOTILE" bacteria to move to the edges of drop
7. Now visualize drop under microscopy*
Oral Rehydration Therapy Corner is a room in hospital which provides readymade ORS fluid solution for ADD babies.
INDICATIONS FOR ANTIBIOTICS in ADD case:
- Dysentery
- Cholera
- Shigella
- Amoebiasis
EMPIRICAL ANTIBIOTIC USED IN ADD CASES (SYNDROMIC APPROACH)
Classify ADD as ADD with no fever & ADD with fever
Any ADD with no fever - DOXYCYCLINE (cholera presents as ADD + no fever)
Any ADD with fever - METRONIDAZOLE
Other drugs in ADD:
- Paracetamol for fever
- Anti emetic for vomiting
- Probiotics for ADD
DISCUSSION:
Types of Diarrhoea
1. Acute Diarrhoea - less than 7 days, but can persist upto 14 days
2. Chronic Diarrhoea - more than 14 days, non infective origin
3. Persistent Diarrhoea - more than 14 days, infective origin
4. Protracted Diarrhoea - more than 14 days, due to malnutrition
What is Protracted Diarrhoea?
Diarrhoea more than 14 days, due to malnutrition
Complications of ADD:
Types of Diarrhoea
1. Acute Diarrhoea - less than 7 days, but can persist upto 14 days
2. Chronic Diarrhoea - more than 14 days, non infective origin
3. Persistent Diarrhoea - more than 14 days, infective origin
4. Protracted Diarrhoea - more than 14 days, due to malnutrition
What is Protracted Diarrhoea?
Diarrhoea more than 14 days, due to malnutrition
Definition for Diarrhoea and Dysentery
Diarrhoea - Change in consistency (watery or semi-solid) and frequency of stools (>3 times a day)
Dysentery - Change in consistency (watery or semi-solid) and frequency of stools (>3 times a day), associated with BLOOD IN STOOLS
Differences between Diarrhoea and Dysentery
1. Dysentery - blood in stools +ve, Diarrhoea - no blood in stools
2. Dysentery is always associated with cramping abdominal pain, weakness, vomiting (meanwhile diarrhoea may or may not have these symptoms)
3. Causes - E.Coli, Shigella, Salmonella, Amoebiasis (for dysentery) (For Diarrhoea - E.Coli, Shigella, Salmonella, V.cholerae, Campylobacter, Rotavirus, Giardia, Cyclosporidium etc.)
4. Site involved - Small intestine (Diarrhoea) and Large intestine (dysentery)
5. Complications - Dehydration (both), Ulceration of colon (only dysentery)
6. Antibiotics are indicated in dysentery, not indicated in diarrhoea
Complications of ADD:
- Dehydration
- Electrolyte imbalance (Hyponatremia and Hypokalemia)
- Cerebral venous thrombosis
- Metabolic acidosis
Diarrhoea due to systemic infection
Causes:
1. Sepsis
2. ASOM
3. UTI
What is HANGING DROP TEST? (just for knowledge sake; this question will not be asked)
It is a microscopic lab test done in cases of ADD
Principle:
Hanging drop of sample will make MOTILE bacteria to move to the edges of the sample drop
Diagnostic of - Vibrio cholerae
Procedure:
1. Collect a sample of stool (mixed with peptone water or any transport media like VR medium)
2. Put a drop of stool over a cover slip
3. Take a glass slide with concave depression in its centre.
4. Place the glass slide over cover slip, such that concavity of glass slide covers the drop. (here - glass slide is above and cover slip is below)
5. Now flip it!! (so that glass slide is below and cover slip is above) - the sample will "hang like a drop" from above
6. This hanging drop will make the "MOTILE" bacteria to move to the edges of drop
7. Now visualize drop under microscopy*