Diarrhea and Dehydration

Case 1-3.

Based on the frequency of the evacuations and the characteristics of the stools, the infant has acute diarrhea. There is no blood in the stools, so the most probable causative agent is rotavirus or E. coli. In both cases the disease is usually self-limited and does not require antibiotic therapy. Since the child is not dehydrated, advise the mother to give him ORS after every evacuation of loose stools, to provide more fluids than usually, and to continue breastfeeding and giving the child the other foods he usual eats. Determine if other household contacts are similarly affected, which might indicate an outbreak. If adults are experiencing significant watery diarrhea with dehydration, suspect V. cholerae infection. Continued breastfeeding is an important way to reduce potential recurrences. Intensify hygiene measures, and provide adequate water supply and stool disposal.

Case 4

Upon his return, the child presents with more than 2 signs in the IMCI classification for severe dehydration. There are no other signs of severe disease, but there are findings consistent with hemodynamic disorder (shock). Begin immediate treatment for severe dehydration (Plan C in the IMCI guidelines). Once rehydration has been achieved, the child should be switched to a maintenance plan (Plan A) and reassessed in 24 hours. Because there is no history of cholera in the population, antibiotic therapy is not needed.