Case Manager Interview Presentation Leslie Ryan BSHS 395 June 1 2014.
Ryan Em C. DalmanMD MBA - 070070. Objectives Case Presentation Case Discussion.
-
Upload
marilyn-elliott -
Category
Documents
-
view
215 -
download
0
Transcript of Ryan Em C. DalmanMD MBA - 070070. Objectives Case Presentation Case Discussion.
![Page 1: Ryan Em C. DalmanMD MBA - 070070. Objectives Case Presentation Case Discussion.](https://reader030.fdocuments.us/reader030/viewer/2022032612/56649ec65503460f94bd2963/html5/thumbnails/1.jpg)
Acute Gastroenteritis: A Case Discussion
Ryan Em C. Dalman MD MBA - 070070
![Page 2: Ryan Em C. DalmanMD MBA - 070070. Objectives Case Presentation Case Discussion.](https://reader030.fdocuments.us/reader030/viewer/2022032612/56649ec65503460f94bd2963/html5/thumbnails/2.jpg)
Outline
Objectives Case Presentation Case Discussion
![Page 3: Ryan Em C. DalmanMD MBA - 070070. Objectives Case Presentation Case Discussion.](https://reader030.fdocuments.us/reader030/viewer/2022032612/56649ec65503460f94bd2963/html5/thumbnails/3.jpg)
Objectives
Present a case of Acute Gastroenteritis
Discuss the pathophysiology and management of Acute Gastroenteritis
![Page 4: Ryan Em C. DalmanMD MBA - 070070. Objectives Case Presentation Case Discussion.](https://reader030.fdocuments.us/reader030/viewer/2022032612/56649ec65503460f94bd2963/html5/thumbnails/4.jpg)
Case PresentationPatient History
![Page 5: Ryan Em C. DalmanMD MBA - 070070. Objectives Case Presentation Case Discussion.](https://reader030.fdocuments.us/reader030/viewer/2022032612/56649ec65503460f94bd2963/html5/thumbnails/5.jpg)
General Data
JM 1-year-old born on July 9, 2009 Female Admitted for the first time Roman Catholic Pasig City
![Page 6: Ryan Em C. DalmanMD MBA - 070070. Objectives Case Presentation Case Discussion.](https://reader030.fdocuments.us/reader030/viewer/2022032612/56649ec65503460f94bd2963/html5/thumbnails/6.jpg)
Chief Complaint
Vomiting
![Page 7: Ryan Em C. DalmanMD MBA - 070070. Objectives Case Presentation Case Discussion.](https://reader030.fdocuments.us/reader030/viewer/2022032612/56649ec65503460f94bd2963/html5/thumbnails/7.jpg)
History of Present Illness
Vomiting 1x ingested food Non-projectile Non-bilous Non-bloody
3 days PTA
1 day PTA
Loose bowel movement 3x Watery Non-bloody Non-mucoid Non-foul smelling
No associated symptoms, no medications, no consults
![Page 8: Ryan Em C. DalmanMD MBA - 070070. Objectives Case Presentation Case Discussion.](https://reader030.fdocuments.us/reader030/viewer/2022032612/56649ec65503460f94bd2963/html5/thumbnails/8.jpg)
History of Present Illness
Symptoms persisted 12 hours PTA
Consult at the
ER
Sent home after successful trial feeds
![Page 9: Ryan Em C. DalmanMD MBA - 070070. Objectives Case Presentation Case Discussion.](https://reader030.fdocuments.us/reader030/viewer/2022032612/56649ec65503460f94bd2963/html5/thumbnails/9.jpg)
History of Present Illness
Vomiting 3x ingested food Post-prandial Non-projectile Non-bilous Non-bloody
Few hours PTA
Consult at the
ER
Admitted
![Page 10: Ryan Em C. DalmanMD MBA - 070070. Objectives Case Presentation Case Discussion.](https://reader030.fdocuments.us/reader030/viewer/2022032612/56649ec65503460f94bd2963/html5/thumbnails/10.jpg)
Review of Systems
General: no weight loss, no change in appetite
Cutaneous: no lesions, no pigmentation, no hair loss, no pruritus
HEENT: no rednessno aural dischargeno neck massesno sore throat
![Page 11: Ryan Em C. DalmanMD MBA - 070070. Objectives Case Presentation Case Discussion.](https://reader030.fdocuments.us/reader030/viewer/2022032612/56649ec65503460f94bd2963/html5/thumbnails/11.jpg)
Review of Systems
Cardiovascular: no easy fatigability, or fainting spells
Gastrointestinal: no constipationGenitourinary: no genital discharge, no
pruritusno problems in
urinationEndocrine: polydypsia, no heat/cold
intolerance
![Page 12: Ryan Em C. DalmanMD MBA - 070070. Objectives Case Presentation Case Discussion.](https://reader030.fdocuments.us/reader030/viewer/2022032612/56649ec65503460f94bd2963/html5/thumbnails/12.jpg)
Review of Systems
Muskuloskeletal: no joint or muscle swelling, no limitation of movement, no stiffness
Hematopoietic: no easy bruisability, or bleeding
![Page 13: Ryan Em C. DalmanMD MBA - 070070. Objectives Case Presentation Case Discussion.](https://reader030.fdocuments.us/reader030/viewer/2022032612/56649ec65503460f94bd2963/html5/thumbnails/13.jpg)
Maternal and Birth History
Born full term via NSD to a 31 year old G4P3 (3013) by an obstetrician at PCGH
with complete prenatal consults No intake of any medications except
for multivitamins No maternal illnesses No complications at birth
![Page 14: Ryan Em C. DalmanMD MBA - 070070. Objectives Case Presentation Case Discussion.](https://reader030.fdocuments.us/reader030/viewer/2022032612/56649ec65503460f94bd2963/html5/thumbnails/14.jpg)
Nutritional History
Breastfed from birth to 3 months old Bona Supplementary foods were given at
6 month old Current diet
Milk 4-5 bottles a day Rice + (chicken, vegetables, w/ soup) 3x
a day Bread every morning
![Page 15: Ryan Em C. DalmanMD MBA - 070070. Objectives Case Presentation Case Discussion.](https://reader030.fdocuments.us/reader030/viewer/2022032612/56649ec65503460f94bd2963/html5/thumbnails/15.jpg)
Immunizations
BCG – 1 dose DPT – 3 doses Hep B – 3 doses Measles – 1 dose
![Page 16: Ryan Em C. DalmanMD MBA - 070070. Objectives Case Presentation Case Discussion.](https://reader030.fdocuments.us/reader030/viewer/2022032612/56649ec65503460f94bd2963/html5/thumbnails/16.jpg)
Developmental History
Stands alone Throws toys Obeys commands or requests Attempts to use a spoon
![Page 17: Ryan Em C. DalmanMD MBA - 070070. Objectives Case Presentation Case Discussion.](https://reader030.fdocuments.us/reader030/viewer/2022032612/56649ec65503460f94bd2963/html5/thumbnails/17.jpg)
Past Medical History
No Tuberculosis, Asthma, TraumaNo previous surgeriesNo previous hospitalizationsNo Allergies
![Page 18: Ryan Em C. DalmanMD MBA - 070070. Objectives Case Presentation Case Discussion.](https://reader030.fdocuments.us/reader030/viewer/2022032612/56649ec65503460f94bd2963/html5/thumbnails/18.jpg)
Family History
Diabetes, Hypertension – father No heart disease, cancer, stroke,
kidney disease, asthma, or allergies
![Page 19: Ryan Em C. DalmanMD MBA - 070070. Objectives Case Presentation Case Discussion.](https://reader030.fdocuments.us/reader030/viewer/2022032612/56649ec65503460f94bd2963/html5/thumbnails/19.jpg)
Personal and Social History
Father works for Reagent Mother is a housewife Private Subdivision in Pasig City
![Page 20: Ryan Em C. DalmanMD MBA - 070070. Objectives Case Presentation Case Discussion.](https://reader030.fdocuments.us/reader030/viewer/2022032612/56649ec65503460f94bd2963/html5/thumbnails/20.jpg)
Environmental
Not exposed to environmental hazards like chemicals, pollution, cigarette smoking, etc
Generally clean environment Has their own toilet Water comes from Manila Waters
Drinking water mineral water
![Page 21: Ryan Em C. DalmanMD MBA - 070070. Objectives Case Presentation Case Discussion.](https://reader030.fdocuments.us/reader030/viewer/2022032612/56649ec65503460f94bd2963/html5/thumbnails/21.jpg)
Case PresentationPhysical Exam
![Page 22: Ryan Em C. DalmanMD MBA - 070070. Objectives Case Presentation Case Discussion.](https://reader030.fdocuments.us/reader030/viewer/2022032612/56649ec65503460f94bd2963/html5/thumbnails/22.jpg)
General Survey
awake, active, with good cry but consolable
Not in cardiorespiratory distress
![Page 23: Ryan Em C. DalmanMD MBA - 070070. Objectives Case Presentation Case Discussion.](https://reader030.fdocuments.us/reader030/viewer/2022032612/56649ec65503460f94bd2963/html5/thumbnails/23.jpg)
Vital Signs/ Anthropometrics
Vital signsTemperature – 36.5oCCR – 112 (70-110) RR – 28
(20-30)
Weight: 10.4 kg (50-75th) Length: 75cm (50th) HC: 45.5cm (50-75th) CC: 45 cmAC: 42 cm
![Page 24: Ryan Em C. DalmanMD MBA - 070070. Objectives Case Presentation Case Discussion.](https://reader030.fdocuments.us/reader030/viewer/2022032612/56649ec65503460f94bd2963/html5/thumbnails/24.jpg)
Skin
Light brown No rashes, hemorrhages, scars Moistgood skin turgorCRT 1-2 seconds
![Page 25: Ryan Em C. DalmanMD MBA - 070070. Objectives Case Presentation Case Discussion.](https://reader030.fdocuments.us/reader030/viewer/2022032612/56649ec65503460f94bd2963/html5/thumbnails/25.jpg)
HEENT
Headnormocephalicno lesions, fontanels closed
Eyesanicteric sclerae, pink palpebral conjunctiva, not sunkenpupils 2-3mm
Earscone of light present inferomedially on both earsno discharge noted
Noseseptum medline, moist mucosa
Throatmouth and tongue moistno TPC
![Page 26: Ryan Em C. DalmanMD MBA - 070070. Objectives Case Presentation Case Discussion.](https://reader030.fdocuments.us/reader030/viewer/2022032612/56649ec65503460f94bd2963/html5/thumbnails/26.jpg)
Chest and Lungs
Neck no cervical lymphadonapathySupple
Chestadynamic precordiumno heaves, thrills, or lifts, PMI at 4th ICS MCLslightly tachycardic, normal rhythm, distinct S1 and S2no murmurs
Lungssymmetrical chest expansion, no retractionsEqual vocal fremitiClearbreath sounds
![Page 27: Ryan Em C. DalmanMD MBA - 070070. Objectives Case Presentation Case Discussion.](https://reader030.fdocuments.us/reader030/viewer/2022032612/56649ec65503460f94bd2963/html5/thumbnails/27.jpg)
Abdomen/ Perineum
AbdomenDistended, no scars, no lesionsHyperactive bowel soundstympanitic on all quadrantsno tenderness on all quadrantsno masses, no organomegallyliver edge palpatedkidneys and spleen not appreciated
![Page 28: Ryan Em C. DalmanMD MBA - 070070. Objectives Case Presentation Case Discussion.](https://reader030.fdocuments.us/reader030/viewer/2022032612/56649ec65503460f94bd2963/html5/thumbnails/28.jpg)
Neurologic Examination
Glasgow Coma Scaleverbal response: 5eye opening: 4motor response: 6
total: 15Cerebrum
awake and active
Cerebellumno nystagmus, tremors, or abnormal movements
![Page 29: Ryan Em C. DalmanMD MBA - 070070. Objectives Case Presentation Case Discussion.](https://reader030.fdocuments.us/reader030/viewer/2022032612/56649ec65503460f94bd2963/html5/thumbnails/29.jpg)
Neurologic Examination
Sensoryresponds to pain
MotorSymmetrical general movement with good activity
DTR++ on all extremities
![Page 30: Ryan Em C. DalmanMD MBA - 070070. Objectives Case Presentation Case Discussion.](https://reader030.fdocuments.us/reader030/viewer/2022032612/56649ec65503460f94bd2963/html5/thumbnails/30.jpg)
Neurologic Examination
Cranial NervesI: not elicited II: 2-3mm pupils, equally reactive to
lightIII,IV,VI: EOM’s intactV: corneal reflex present
V1, V2, V3 intact (responds to touch)VII: no facial asymmetry VIII: turns to soundIX, X: gag reflex presentXI: turns head from side to sideXII: tongue midline
![Page 31: Ryan Em C. DalmanMD MBA - 070070. Objectives Case Presentation Case Discussion.](https://reader030.fdocuments.us/reader030/viewer/2022032612/56649ec65503460f94bd2963/html5/thumbnails/31.jpg)
Case PresentationSalient Features, Admitting Impression, Differentials, Course in the Ward
![Page 32: Ryan Em C. DalmanMD MBA - 070070. Objectives Case Presentation Case Discussion.](https://reader030.fdocuments.us/reader030/viewer/2022032612/56649ec65503460f94bd2963/html5/thumbnails/32.jpg)
Salient Features
1 year month old, female Vomiting Acute Loose watery stools
Non-bloody, non-mucoid, non-foul smelling
Distended abdomen Skin – good turgor, CRT 1-2 sec Eyes not sunken Moist oral mucosa Hyperactive bowel sounds
![Page 33: Ryan Em C. DalmanMD MBA - 070070. Objectives Case Presentation Case Discussion.](https://reader030.fdocuments.us/reader030/viewer/2022032612/56649ec65503460f94bd2963/html5/thumbnails/33.jpg)
Admitting Impression
Acute Gastroenteritis, probably viral, with no signs of dehydration
![Page 34: Ryan Em C. DalmanMD MBA - 070070. Objectives Case Presentation Case Discussion.](https://reader030.fdocuments.us/reader030/viewer/2022032612/56649ec65503460f94bd2963/html5/thumbnails/34.jpg)
Differential Diagnosis
Viral AGE
1 year old +
Vomiting +
Loose watery stools +
Acute +
Bloody stool -
Mucoid stool -
Foul smelling -
Hyperactive bowel sounds +
Abdominal distention +/-
Enterotoxigenic E. coli
+
+
+
+
-
-
-
+
+/-
![Page 35: Ryan Em C. DalmanMD MBA - 070070. Objectives Case Presentation Case Discussion.](https://reader030.fdocuments.us/reader030/viewer/2022032612/56649ec65503460f94bd2963/html5/thumbnails/35.jpg)
Differential Diagnosis
Viral AGE Giardia lamblia
1 year old + +
Vomiting + +
Loose watery stools + +
Acute + +
Bloody stool - -
Mucoid stool - +
Foul smelling - +
Hyperactive bowel sounds + +
Abdominal distention +/- +/-
Oily stoolExplosive
fever
![Page 36: Ryan Em C. DalmanMD MBA - 070070. Objectives Case Presentation Case Discussion.](https://reader030.fdocuments.us/reader030/viewer/2022032612/56649ec65503460f94bd2963/html5/thumbnails/36.jpg)
Differential Diagnosis
Viral AGE Fecal impaction
1 year old + +
Vomiting + +
Loose watery stools + +
Acute + -
Bloody stool - -
Mucoid stool - -
Foul smelling - -
Hyperactive bowel sounds + +
Abdominal distention +/- +
- With Hx of constipation
-Vomitus with fecal material
![Page 37: Ryan Em C. DalmanMD MBA - 070070. Objectives Case Presentation Case Discussion.](https://reader030.fdocuments.us/reader030/viewer/2022032612/56649ec65503460f94bd2963/html5/thumbnails/37.jpg)
Differential Diagnosis
Viral AGE Food Allergy
1 year old + +
Vomiting + +
Loose watery stools + +
Bloody stool - +/-
Mucoid stool - -
Foul smelling - -
Hyperactive bowel sounds + +
Abdominal distention +/- +/-
Associated with other symptoms
![Page 38: Ryan Em C. DalmanMD MBA - 070070. Objectives Case Presentation Case Discussion.](https://reader030.fdocuments.us/reader030/viewer/2022032612/56649ec65503460f94bd2963/html5/thumbnails/38.jpg)
Differential Diagnosis
Viral AGE Shigellosis
1 year old + +
Vomiting + +
Loose watery stools + +
Acute + -
Bloody stool - +
Mucoid stool - +/-
Foul smelling - +
Hyperactive bowel sounds + +
Abdominal distention +/- +/-
![Page 39: Ryan Em C. DalmanMD MBA - 070070. Objectives Case Presentation Case Discussion.](https://reader030.fdocuments.us/reader030/viewer/2022032612/56649ec65503460f94bd2963/html5/thumbnails/39.jpg)
Diagnostic and Therapeutic Plan Diagnostic
CBC with platelet count Blood chemistry (sodium and potassium) Urinalysis Fecalysis
Therapeutic IV for Hydration Increased oral hydration Antipyretics Zinc supplementation Probiotics
![Page 40: Ryan Em C. DalmanMD MBA - 070070. Objectives Case Presentation Case Discussion.](https://reader030.fdocuments.us/reader030/viewer/2022032612/56649ec65503460f94bd2963/html5/thumbnails/40.jpg)
Course in the Ward
1st Hospital DayS O A P
Poor suckComfortableNo vomiting3 BM-2x watery with some formed-soft
T: 36oC CR: 104 RR: 30-U/O: 1.84 cc/hr-Awake, with good cry-Good activity-Eyeballs not sunken-With tears-Clear breath sounds-Regular cardiac rate with normal rhythm-Normoactive bowel sounds-Soft and non-tender abdomen
![Page 41: Ryan Em C. DalmanMD MBA - 070070. Objectives Case Presentation Case Discussion.](https://reader030.fdocuments.us/reader030/viewer/2022032612/56649ec65503460f94bd2963/html5/thumbnails/41.jpg)
Course in the Ward
1st Hospital DayS O A P
Poor suckComfortableNo vomiting3 BM-2x watery with some formed-soft
Fecalysis-negative
Blood Chemistry-Normal Na and K+
Urinalysis -normal
CBC-normal
Acute gastroenteritis with no signs of dehydration-resolving
IVF D5LR 1L 42-43ml/hr-Small frequent feeding-avoid oily and fatty food-encourage apples and bananas-continue hydration-monitor input and output
![Page 42: Ryan Em C. DalmanMD MBA - 070070. Objectives Case Presentation Case Discussion.](https://reader030.fdocuments.us/reader030/viewer/2022032612/56649ec65503460f94bd2963/html5/thumbnails/42.jpg)
Course in the Ward
2nd Hospital DayS O A P
Good suckComfortableNo vomiting1 BM, soft
T: 36.7oC CR: 103 RR: 28-U/O: 1.77 cc/hr-Awake, with good cry-Good activity-Eyeballs not sunken-With tears-Clear breath sounds-Regular cardiac rate with normal rhythm-Normoactive bowel sounds-Soft and non-tender abdomen
Acute Gastroenteritis with no signs of dehydration-resolved
-May go home tomorrow-consume IVF then switch to oral hydration-home medications:Zinc sulfite syrupProbiotics
![Page 43: Ryan Em C. DalmanMD MBA - 070070. Objectives Case Presentation Case Discussion.](https://reader030.fdocuments.us/reader030/viewer/2022032612/56649ec65503460f94bd2963/html5/thumbnails/43.jpg)
Case Discussion
![Page 44: Ryan Em C. DalmanMD MBA - 070070. Objectives Case Presentation Case Discussion.](https://reader030.fdocuments.us/reader030/viewer/2022032612/56649ec65503460f94bd2963/html5/thumbnails/44.jpg)
Definition
Infections of the gastrointestinal tract caused by bacterial, viral, or parasitic pathogens
Diarrheal disorders Term used in public health setting
Diarrhea 3 or more unusually watery stools
passed in 24 hours
WHO – Treatment of Diarrhea
![Page 45: Ryan Em C. DalmanMD MBA - 070070. Objectives Case Presentation Case Discussion.](https://reader030.fdocuments.us/reader030/viewer/2022032612/56649ec65503460f94bd2963/html5/thumbnails/45.jpg)
Etiology
> 3 years old Viral
Rotavirus Enteric adenovirus Astrovirus Norovirus Calicivirus
E. coli, Salmonella
![Page 46: Ryan Em C. DalmanMD MBA - 070070. Objectives Case Presentation Case Discussion.](https://reader030.fdocuments.us/reader030/viewer/2022032612/56649ec65503460f94bd2963/html5/thumbnails/46.jpg)
Epidemiology
18% of childhood deaths >700 million episodes of diarrhea
annually < 5 years old (WHO)
Philippines 2nd leading cause of morbidity 6th leading cause of mortality for all ages 3rd leading cause of infant deaths Predominance of rotavirus and
enterotoxigenic E. coliNelson/ Carlos and Saniel, Etiology and Epidemiology of Diarrhea (1990)
![Page 47: Ryan Em C. DalmanMD MBA - 070070. Objectives Case Presentation Case Discussion.](https://reader030.fdocuments.us/reader030/viewer/2022032612/56649ec65503460f94bd2963/html5/thumbnails/47.jpg)
Manifestation
Most common Diarrhea Vomiting
May also have systemic symptoms Abdominal pain fever
![Page 48: Ryan Em C. DalmanMD MBA - 070070. Objectives Case Presentation Case Discussion.](https://reader030.fdocuments.us/reader030/viewer/2022032612/56649ec65503460f94bd2963/html5/thumbnails/48.jpg)
Clinical types of Diarrhea
Acute watery diarrhea Several hours to days
Acute bloody diarrhea Persistent diarrhea
> 14 days Diarrhea with severe malnutrition
![Page 49: Ryan Em C. DalmanMD MBA - 070070. Objectives Case Presentation Case Discussion.](https://reader030.fdocuments.us/reader030/viewer/2022032612/56649ec65503460f94bd2963/html5/thumbnails/49.jpg)
Pathophysiology
Enters villi and releases viral proteins
(NSP4)
Feca-oral route NSP4 cause release Ca2+
intracellularly
Virus infects adjacent cell
NSP4 produced disrupts tight
junctions
Paracellular flow of water
and electrolytes
Ramig (2004), Pathogenesis of intestinal and systemic rotavirus infection
![Page 50: Ryan Em C. DalmanMD MBA - 070070. Objectives Case Presentation Case Discussion.](https://reader030.fdocuments.us/reader030/viewer/2022032612/56649ec65503460f94bd2963/html5/thumbnails/50.jpg)
Ramig (2004), Pathogenesis of intestinal and systemic rotavirus infection
![Page 51: Ryan Em C. DalmanMD MBA - 070070. Objectives Case Presentation Case Discussion.](https://reader030.fdocuments.us/reader030/viewer/2022032612/56649ec65503460f94bd2963/html5/thumbnails/51.jpg)
Pathophysiology
Intracellular Ca2+
cascade
NSP4 causes release of more
Ca2+
Disruption of
microvillar cytoskeleton
Intracellular Ca2+ cascade
Induces chloride secretion
Ramig (2004), Pathogenesis of intestinal and systemic rotavirus infection
![Page 52: Ryan Em C. DalmanMD MBA - 070070. Objectives Case Presentation Case Discussion.](https://reader030.fdocuments.us/reader030/viewer/2022032612/56649ec65503460f94bd2963/html5/thumbnails/52.jpg)
Ramig (2004), Pathogenesis of intestinal and systemic rotavirus infection
![Page 53: Ryan Em C. DalmanMD MBA - 070070. Objectives Case Presentation Case Discussion.](https://reader030.fdocuments.us/reader030/viewer/2022032612/56649ec65503460f94bd2963/html5/thumbnails/53.jpg)
Diagnostics
Clinical evaluation Fecalysis
Suspected amoebiasis or giardiasis Acute watery diarrhea▪ Very young/elderly▪ Immuno-compromised▪ Severely dehydrated
Clinical presentation is atypical
UMED Acute infectious diarrhea and common intestinal parasitism workbook
![Page 54: Ryan Em C. DalmanMD MBA - 070070. Objectives Case Presentation Case Discussion.](https://reader030.fdocuments.us/reader030/viewer/2022032612/56649ec65503460f94bd2963/html5/thumbnails/54.jpg)
Treatment
Assess for the level of dehydration
![Page 55: Ryan Em C. DalmanMD MBA - 070070. Objectives Case Presentation Case Discussion.](https://reader030.fdocuments.us/reader030/viewer/2022032612/56649ec65503460f94bd2963/html5/thumbnails/55.jpg)
Treatment
![Page 56: Ryan Em C. DalmanMD MBA - 070070. Objectives Case Presentation Case Discussion.](https://reader030.fdocuments.us/reader030/viewer/2022032612/56649ec65503460f94bd2963/html5/thumbnails/56.jpg)
Treatment
No signs of dehydration Home therapy to prevent
dehydration More fluids than usual▪ ORS, salted drinks (salted rice water), chicken
soup with salt▪ Add salt (3g/L) for unsalted drinks and food▪ Usual milk feed every 3 hours▪ As much as the child wants
Frequent small feedings every 3-4 hours
Failure of oral
rehydration
![Page 57: Ryan Em C. DalmanMD MBA - 070070. Objectives Case Presentation Case Discussion.](https://reader030.fdocuments.us/reader030/viewer/2022032612/56649ec65503460f94bd2963/html5/thumbnails/57.jpg)
Treatment
For failure of ORT ORS via nasogastric tube IV Ringer’s Lactate Solution
75 ml/kg in 4 hours Reassess
![Page 58: Ryan Em C. DalmanMD MBA - 070070. Objectives Case Presentation Case Discussion.](https://reader030.fdocuments.us/reader030/viewer/2022032612/56649ec65503460f94bd2963/html5/thumbnails/58.jpg)
Treatment
Some signs of Dehydration Oral rehydration therapy with ORS
solution 75 ml/kg/hour
If a child wants more than the estimated amount of ORS solution, and there are no signs of over-hydration, give more
Teaspoonful every 1-2minutes Reassess
![Page 59: Ryan Em C. DalmanMD MBA - 070070. Objectives Case Presentation Case Discussion.](https://reader030.fdocuments.us/reader030/viewer/2022032612/56649ec65503460f94bd2963/html5/thumbnails/59.jpg)
Treatment
Severe signs of Dehydration Admit in the Hospital If patient can still drink poorly, give ORS
until IV drip is running 5 ml/kg for 3-4 hours
IV Ringer’s lactate Solution (100 ml/kg) 1st 30ml/kg in 1 hour Then 70 ml/kg in 5 hours
Reassess every 15-30 minutes until strong radial pulse is present, then 1-2 hours
![Page 60: Ryan Em C. DalmanMD MBA - 070070. Objectives Case Presentation Case Discussion.](https://reader030.fdocuments.us/reader030/viewer/2022032612/56649ec65503460f94bd2963/html5/thumbnails/60.jpg)
Prevention
Promotion of exclusive breast-feeding
Improved complementary feeding practices
Rotavirus immunization Proper food preparation/ hygiene
![Page 61: Ryan Em C. DalmanMD MBA - 070070. Objectives Case Presentation Case Discussion.](https://reader030.fdocuments.us/reader030/viewer/2022032612/56649ec65503460f94bd2963/html5/thumbnails/61.jpg)
Prognosis
Good prognosis as long as adequate hydration has been given