Plan A: amount of fluid is in addition to normal feed intake. The health worker must estimate the amount to give for the mother in terms of available utensils.

Plan B: the starting amount is fairly low and must be given frequently in small amounts to avoid vomiting, but must be increased as soon as the child is taking fluid well.

Composition of fluids

“Home fluids”

Any fluids including water, tea, thin porridge, maize-based SSS, but avoiding cold drinks with high sugar content.

Salt/Sugar Solution (SSS)

6 level teaspoons of any household sugar (white or brown), 1/2 teaspoon of salt (coarse salt may have to be ground fine) dissolved in 750 ml of clean water measured in any 750 ml bottle (soft drink, cooking oil etc); it is boiled only if from a contaminated scarce and is cooled before adding ingredients.

Assessment of Dehydration/Other Problems

* If two or more observations with asterisk are present treat according to listed Plan

Other Problems

• If Blood in stool treat for Bacillary Dysentry (Co - trimoxazole).

• If diarrhoea has lasted 14 days, if has severe malnutrition, refer to hospital for investigation.

• If temperature is 39 degrees or higher, look for other causes of fever and treat

Appropriate Use of Drugs for Children with Diarrhoea

Antibiotics only in dysentery and suspected cholera

Never use Antidiarrheal drugs and antiemetics.

Treatment Plans A, B and C

Plan A: No Sign of Dehydration

Can be treated at home

To prevent dehydration: give more fluids than usual, salt/sugar solution(SSS) or other recommended home fluid.

To prevent malnutrition: continue breast-feeding, offer food 5 to 7 times per day.

Care giver should be advised on:

1. Function of ORS - eg. it does not stop diarrhoea.

2. How much SSS to give 100 ml/kg/day (to nearest half bottle). If vomiting, give fluid slowly by spoon, continue giving more fluid until diarrhoea stops.

3. When to come back to clinic-if worried about condition, vomiting continues, child is eating or drinking poorly, child has fever or blood in the stool, fontanelle is depressed, breathing is difficult or too fast.

Plan B: Some Dehydration

Keep at health center or hospital OPD

Aim to rehydrate over the next 4 hours. Give ORS by cup and spoon. Start with 10 ml/kg/hour, increase as soon as possible to as much as child will take. Continue giving food and breast milk. Constant supervision is essential.

Reassess in 4 hours: If no signs of dehydration, refer to Plan A. If still some signs of dehydration, continue with Plan B. If signs of severe dehydration, refer to Plan C.

If the mother must leave before completing treatment Plan B: Show her how to prepare ORS and how to give the child to complete Plan B and then to follow with Plan A.

Ensure that the mother knows how to prepare SSS at home.

Plan C: Severe Dehydration

Give: Dextrose 5% 30 ml/kg/hour IV, except in cases of severe malnutrition, severe ARI, cardiac problems or neonates who should receive half this volume.

Reassess after one hour: If improving, give 10 ml/kg/hour for the next 5 hours. If not improving and still dehydrated, give 20 ml/kg IV for 1 hour more, then give 10 ml/kg/hour for the next 4 hours. Start oral fluids as soon as patient can drink (usually after 3 to 4 hours). Re-evaluate after 5 hours: If some dehydration persists, then follow Plan B.

Indications for Antibiotic Treatment

Co-trimoxazole (O) Acutely ill child with blood in stool or suspected cholera.

Metronidazole (O) Blood diarrhoea persisting after above, presumed or proved amoebiasis. Persistent diarrhoea with Giardia in the stool.

Drug Doses for Antibiotic Treatment of Diarrhoea

Rice based Oral Rehydration Fluid

Experience with this type of fluid is limited and guidelines may therefore differ. Different methods of measuring may differ depending on the level of management.

Rice meal: About 50 g or 10-12 level desert spoons or hand scoop of rice is put in.

Water: 1000 ml (2 beer bottle), this is boiled for 10 minutes. Then measure 500 ml (one beer bottle);

Table salt: 1/4 - 1/2 level teaspoon is added and the solution used when cool.

It should be discarded after 6 hours if not fully used.

Full Formula ORS Solution

Made in hospital pharmacies as follows:

However, ORS may be available in packets (sachets) in certain situations according to current Ministry policy.

Acute Diarrhoea and Associated conditions in Adults

Stool should be examined microscopically and cultured. See also HIV related diarrhoea and diarrhoea in children as appropriate.

Gastro-enteritis (Food Poisoning, viral)

Rehydrate - oral fluids in mild cases. IV fluid in more severe cases. If antiemetic is necessary give: