|
Crucial health information for people in disaster area
Dr Walter Schrader by email, weslink@wxs.nl , 4 Dec 2004
I INTRODUCTION
Dehydration is a loss of body fluid, which is not compensated for by sufficient fluid intake. This symptom in general is caused by vomiting and diarrhoea.
Dehydration is not a disease but it comes along with other diseases. About one out of every ten children born in developing countries dies of diarrhoea before reaching the age of five.
Formerly dehydration was mostly treated with intravenous infusion. For this treatment you need infusion sets and there is always the danger of contamination.
In the early sixties in a refugee-camp it was found that drinking a solution of salt and sugar was saving a lot of people from death through dehydration. In mild and moderate cases the oral treatment has proven to be more effective than the intravenous infusion. Nowadays he alth workers generally know about the possibilities to treat and prevent dehydration with the Oral Rehydration Salts for which you can find the preparation guidance in the appendix.
Since so many diseases go along with dehydration it is very important for Village Health Workers and B-level Health Care Workers to know more about causes, diagnoses and treatment of dehydration. With this knowledge we can also inform the mothers of small children how to prevent this serious condition.
The combination of diarrhoea and vomiting increases the danger of dehydration. It can occur in case of infections in and outside the gut and also in case of malnutrition.
II PREVENTION Of DIARRHOEAL DISEASES
1.Breastfeeding.
Milk from a healthy breast is sterile and never causes infectious diarrhoea. It contains anti-bodies which help to kill harmful bacteria. Milk from dirty feeding-bottles often contains many micro-organisms and this can cause diarrhoea.
2.Proper disposal of stools.
Keep faeces away from drinking water. Use a latrine. If there is no latrine the village health committee or the DHMT can provide guidelines to build them.
3.Use safe water only.
If you don't trust the water boil it, or follow the guidelines for chemical disinfection.
4.Wash hands after latrine visits and before eating or touching food.
5.Keep flies away from food.
A fly can easily carry harmful organisms from stools to a child's food. Always cover food.
6.Prevent children from putting dirt into their mouths.
Do not let a child eat food which has fallen on the ground.
III DIAGNOSIS AND TREATMENT DEHYDRATION
|
|
A |
B |
C |
|
ASK ABOUT: Diarrhoea Vomiting Thirst Urine
|
Less than 4 liq stools None or small Normal Normal |
4-10 liquid stools Some Above normal Little and dark |
≥ 10 liquid stools Very frequent Unable to drink No urine for 6 hrs |
|
LOOK AT: Condition Tears Eyes Mouth Breating
|
Well alert Present Normal Wet Normal |
Sleepy or irritable Absent Sunken Dry Faster than normal |
Sleepy, unconscious, fits Absent Very dry and sunken Very dry Very fast and deep |
|
FEEL: Skin Pulse Fontanel |
Pinch goes back quick Normal Normal |
Pinch goes back slow Faster Sunken |
Pinch goes back very slow Very fast and week Very sunken
|
|
WEIGT LOSS:
|
25 grams per kilo |
25-100 grams per kilo |
≥100 gram per kilo |
|
DECIDE: |
No dehydration |
2 or more signs: Some dehydration |
2 or more signs: Severe dehydration |
|
Start |
PLAN A |
PLAN B |
PLAN C |
|
TREATMENT: Fluids
Breastfeeding ORS-solution
Food Clinic/hospital
|
More than usual to Prevent dehydration. continued + (50-100 ml after each stool) Every 3-4 hrs No referral |
According to thirst
continued Every 1-2 min spoon full Every 3-4 hrs (small) No referral
|
If possible, nasogastric tube
Impossible Impossible
Impossible Referral: Yes |
A child which dies from diarrhoea mostly dies from dehydration and not from the diarrhoeal disease as such. So we have to rehydrate the child. A patient with diarrhoea and vomiting can loose up to one litre of fluid in one hour. So to cover normal daily requirements, one needs replacement for any further loss through diarrhoea and vomiting, plus the normal daily intake.
|
The most important rules to treat dehydration are: -ALWAYS look for signs and symptoms of dehydration. -If there are still such signs and symptoms, CONTINUE with rehydrating the child. -If there is no improvement and the dehydration becomes severe, REFER the child.
|
DETAILS TREATMENT PLAN A TO PREVENT DEHYDRATION
1.Give the NORMAL daily requirement of fluid PLUS replacement for any further loss through vomiting or diarrhoea.
Replace after every stool:
|
PRIVATE child less than 2 years old |
child older than 2 years |
adults |
|
50-100 ml ORS 1/4 to 1/2 large cup
give with a spoon |
100-200 ml ORS 1/2 to 1 large cup
drink
|
as much as they want drink |
NOTE: After vomiting, always continue giving ORS. Wait 10 minutes and give the solution more slowly (one spoonful every 2-3 minutes).
DETAILS TREATMENT PLAN B TO TREAT DEHYDRATION
Weigh the child, to know the amount of ORS fluid. When weighing is not possible, estimate the age of the child.
|
PRIVATE Patients weight in kg |
3-5 |
6-9 |
10-12 |
13-19 |
20-40 |
>41 |
|
|
Age (use only when weight is unknown) |
2-8 month |
8-18 month |
2-4 year |
4-8 year |
8-15 year |
adult |
|
|
PRIVATE Give this much ORS solution for 4-6 hours |
|
|
|
|
|
|
|
|
In ml |
400 |
600 |
800 |
1000 |
2000 |
4000 |
|
|
in cups |
2 |
3 |
4 |
5 |
10 |
20 |
|
|
Give every
in spoons |
5 min 1 tea spoon |
10 min 1 table spoon |
7 min 1 table spoon |
5 min 1 table spoon |
|
|
|
|
PRIVATE 1 cup = 200 ml 1 teaspoon = 5 ml 1 table spoon = 15 ml |
After 4 to 6 hours, reassess the child using the Assessment Chart. If the child still has 2 or more signs of some dehydration (=B), continue treatment. |
||||||
Note:
After reassessment, if the child is still dehydrated, tell the mother to continue breastfeeding.
Or if she does not breastfeed, give 100-200 ml of clean water before continuing ORS
| Main | News | Dhivehi | Editorials | Opinions | Open Forum | About Maldives | Downloads | About us | Links |
© Dhivehi Observer 2004