Related Experiment Videos
Persistent diarrhea: management in a diarrhea treatment unit
A K Patwari1, V K Anand, S Aneja
1Diarrhea Training and Treatment Unit, Kalawati Saran Children's Hospital, New Delhi.
Insights
Persistent diarrhea (PD) affects 6% of children attending diarrhea treatment units. Dietary modifications, particularly lactose-reduced or lactose-free diets, are effective for most PD cases, while treating associated infections is crucial for reducing mortality.
Area of Science:
- Pediatrics
- Gastroenterology
- Infectious Diseases
Background:
- Persistent diarrhea (PD) is a significant cause of childhood morbidity and mortality.
- Early identification and management of PD are crucial for improving outcomes.
Purpose of the Study:
- To analyze the clinical spectrum, management, and outcomes of children with persistent diarrhea (PD).
- To evaluate the effectiveness of dietary modifications and treatment of associated infections in PD cases.
Main Methods:
- Retrospective analysis of 592 children diagnosed with PD over one year at a Diarrhea Training and Treatment Unit (DTU).
- Assessment of outpatient management, hospitalization rates, clinical presentations, and dietary interventions.
- Evaluation of mortality rates and associated causes.
Main Results:
- Persistent diarrhea (PD) accounted for 6.0% of cases (592/9795).
- 88.5% of PD cases responded to outpatient treatment; 8.3% required hospitalization.
- Common comorbidities included severe malnutrition, pneumonia, and urinary tract infections. Lactose-reduced/free diets showed high success rates.
- Mortality was 22.4% in hospitalized children, highest in infants <6 months, with severe malnutrition, septicemia, and pneumonia as primary causes of death.
Conclusions:
- Screening and treating associated infections (septicemia, pneumonia, UTI) are key to reducing PD morbidity and mortality.
- Modified hospital diets, especially lactose-reduced or lactose-free, benefit the majority of PD patients.
- A small proportion of PD cases may necessitate carbohydrate-free diets.
Abstract:
Five hundred ninety two children (6.0%) were diagnosed as persistent diarrhea (PD) out of a total attendance of 9795 cases in the Diarrhea Training and Treatment Unit (DTU) over a period of 1 year. Most of the cases were initially managed as outpatients on dietary advice and treatment of associated infections. Eighty eight per cent of the cases followed as outpatients from the DTU responded to treatment and only 11.5% of them had to be hospitalized. A total of 49/592 cases (8.3%) required to be hospitalized on account of treatment failure from outpatients and other indications. Clinical spectrum of hospitalized children included severe malnutrition (40.8%), pneumonia (40.8%), urinary tract infection (32.7%), lactose intolerance (32.7%), anemia (28.6%), septicemia (16.3%), dysentery (8.2%) and neck flop due to hypokalemia (4.1%). Dietary management included modifications in the diet already offered to hospitalized patients. Thirty eight children were fed on one of these diets. Of these 13/35 children (37.1%) were successfully managed with lactose reduced diet., 18/22 cases (81.8%) with lactose free diet and only in 2 cases carbohydrate free diet was given. In 3 cases, normal feeding was continued. Eleven cases were too sick to be offered any oral feeding. Eleven of forty nine cases (22.4%) expired. Mortality was highest in infants <6 months (31.6%). The causes of death included severe malnutrition (14.3%), septicemia (14.3%) and pneumonia (12.2%). Screening and treating cases of PD for associated infections like septicemia, pneumonia and urinary tract infection seems to be a key factor which determines morbidity and mortality in these cases. Feeding on a hospital food modified as lactose reduced/free diet can benefit majority of cases with PD and a very small proportion of cases may require carbohydrate free diet.