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A few symptomes and syndromes
T h e d iagno sis is m ad e o n th e basis o f a h isto ry o f w atery d iarrh o ea o f recent 1
o nset acco m p anied by w eigh t lo ss, co rresp o nd ing to fluid lo sses since th e
o nset o f d iarrh o ea. C h ro nic and p ersistent d iarrh o ea d o es no t require rap id
reh y d ratio n.
I n th e event o f d eh y d ratio n:
• In there is no hypovolaemic shock, reh y d ratio n is m ad e by th e o ral ro ute ( if
necessary using a naso gastric tube) , w ith sp ecific o ral reh y d ratio n so lutio n
( R eS o M 6al) , co ntaining less so d ium and m o re p o tassium th an stand ard
so lutio ns.
ReSoMal is ad m inistered und er m ed ical sup ervisio n ( clinical evaluatio n and
w eigh t every h o ur) . T h e d o se is 2 0 m l/ k g/ h o ur fo r th e first 2 h o urs, th en
1 0 m l/ k g/ h o ur until th e w eigh t lo ss ( k no w n o r estim ated ) h as been co rrected .
G ive R eS o M al after each watery sto o l acco rd ing to the W H O treatm ent P lan A
(p age3 1 6 ).
I n p ractice, it is useful to d eterm ine th e targ et w eig h t b efo re starting
reh y d ratio n. T h e target w eigh t is th e w eigh t befo re th e o nset o f d iarrh o ea. I f
th e ch ild is im p ro ving and sh o w ing no signs o f fluid o verlo ad , reh y d ratio n is
co ntinued until th e p revio us w eigh t is attained .
I f th e w eigh t lo ss canno t be m easured ( e.g. in new ly ad m itted ch ild ) , it can be
estim ated at 2 to 5 % o f th e ch ild ‟s current weigh t. T h e target w eigh t sh o uld
no t exceed 5 % o f th e current w eigh t ( e.g., if th e ch ild w eigh s 5 k g befo re
starting reh y d ratio n, th e targ et w eig h t sh o uld no t exceed 5 .2 5 0 k g ) .
R egard less o f th e target weight, rehy d ratio n sho uld be sto p p ed if signs o f fluid
o verlo ad ap p ear.
• In case of hypovolaemic shock ( w eak and rap id o r absent rad ial p ulse, co ld
extrem ities, C R T ≥ 3 seco nd s, whether o r no t co nscio usness is altered ) in a child
with d iarrho ea o r d ehy d ratio n:
– P lace an IV line and ad m inister 1 0 m l/ k g o f 0.9% sodium chloride o ver 3 0 m inutes,
und er clo se m ed ical sup ervisio n.
S im ultaneo usly :
– S tart bro ad sp ectrum antibio tic therap y :
ceftriaxone IV 1 0 0 m g/ k g/ d ay + cloxacillin IV 2 0 0 m g/ k g/ d ay
– A d m inister o xy gen (2 litres m inim um ).
– C h eck blo o d gluco se level o r ad m inister 5 m l/ k g o f 1 0 % gluco se by slo w I V
injectio n.
E very 5 m inutes, evaluate clinical resp o nse ( reco very o f co nscio usness, stro ng
p ulse, C T R < 3 seco nd s) and check fo r signs o f o ver-hy d ratio n.
- If the clinical co nd itio n has im p ro ved after 3 0 m inutes, switch to the o ral ro ute
with ReSoMal: 5 m l/ k g every 3 0 m inutes fo r 2 ho urs.
6 Except for cholera, in which case standard oral rehydration solutions are used.
43
T h e d iagno sis is m ad e o n th e basis o f a h isto ry o f w atery d iarrh o ea o f recent 1
o nset acco m p anied by w eigh t lo ss, co rresp o nd ing to fluid lo sses since th e
o nset o f d iarrh o ea. C h ro nic and p ersistent d iarrh o ea d o es no t require rap id
reh y d ratio n.
I n th e event o f d eh y d ratio n:
• In there is no hypovolaemic shock, reh y d ratio n is m ad e by th e o ral ro ute ( if
necessary using a naso gastric tube) , w ith sp ecific o ral reh y d ratio n so lutio n
( R eS o M 6al) , co ntaining less so d ium and m o re p o tassium th an stand ard
so lutio ns.
ReSoMal is ad m inistered und er m ed ical sup ervisio n ( clinical evaluatio n and
w eigh t every h o ur) . T h e d o se is 2 0 m l/ k g/ h o ur fo r th e first 2 h o urs, th en
1 0 m l/ k g/ h o ur until th e w eigh t lo ss ( k no w n o r estim ated ) h as been co rrected .
G ive R eS o M al after each watery sto o l acco rd ing to the W H O treatm ent P lan A
(p age3 1 6 ).
I n p ractice, it is useful to d eterm ine th e targ et w eig h t b efo re starting
reh y d ratio n. T h e target w eigh t is th e w eigh t befo re th e o nset o f d iarrh o ea. I f
th e ch ild is im p ro ving and sh o w ing no signs o f fluid o verlo ad , reh y d ratio n is
co ntinued until th e p revio us w eigh t is attained .
I f th e w eigh t lo ss canno t be m easured ( e.g. in new ly ad m itted ch ild ) , it can be
estim ated at 2 to 5 % o f th e ch ild ‟s current weigh t. T h e target w eigh t sh o uld
no t exceed 5 % o f th e current w eigh t ( e.g., if th e ch ild w eigh s 5 k g befo re
starting reh y d ratio n, th e targ et w eig h t sh o uld no t exceed 5 .2 5 0 k g ) .
R egard less o f th e target weight, rehy d ratio n sho uld be sto p p ed if signs o f fluid
o verlo ad ap p ear.
• In case of hypovolaemic shock ( w eak and rap id o r absent rad ial p ulse, co ld
extrem ities, C R T ≥ 3 seco nd s, whether o r no t co nscio usness is altered ) in a child
with d iarrho ea o r d ehy d ratio n:
– P lace an IV line and ad m inister 1 0 m l/ k g o f 0.9% sodium chloride o ver 3 0 m inutes,
und er clo se m ed ical sup ervisio n.
S im ultaneo usly :
– S tart bro ad sp ectrum antibio tic therap y :
ceftriaxone IV 1 0 0 m g/ k g/ d ay + cloxacillin IV 2 0 0 m g/ k g/ d ay
– A d m inister o xy gen (2 litres m inim um ).
– C h eck blo o d gluco se level o r ad m inister 5 m l/ k g o f 1 0 % gluco se by slo w I V
injectio n.
E very 5 m inutes, evaluate clinical resp o nse ( reco very o f co nscio usness, stro ng
p ulse, C T R < 3 seco nd s) and check fo r signs o f o ver-hy d ratio n.
- If the clinical co nd itio n has im p ro ved after 3 0 m inutes, switch to the o ral ro ute
with ReSoMal: 5 m l/ k g every 3 0 m inutes fo r 2 ho urs.
6 Except for cholera, in which case standard oral rehydration solutions are used.
43
