Once upon a time, pediatric diarrhea was one of the key prevention and treatment of the four pediatric diseases (childhood pneumonia, pediatric diarrhea, rickets, and nutritional anemia) in China. With the progress of the diagnosis of pediatric diarrhea in recent years, the number of medical visits and hospitalizations of children with diarrhea has been significantly reduced, and the mortality rate has been significantly reduced. Chief Physician Liu Xingyuan and Dr. Qin Xueyan from the Department of Pediatrics of Tongji Hospital Affiliated to Tongji University will take you to review the history of pediatric diarrhea and how to prevent and treat it.
What is a diarrhoeal disease
Pediatric diarrhea is mainly manifested by an increase in the frequency of stools (3 or more) or a change in stool quality. **Variable, with infectious, non-infectious, and extraintestinal factors.
4 revolutions in diarrhoea diagnosis
1. Indigestion: In the past, it was believed that vomiting and loose stools were caused by indigestion.
2. Diarrheal disease: Later, it was found that there was not only the problem of indigestion, but also the existence of infectious factors.
3. Enteritis: 90% of diarrhea is caused by infection, especially viral infection.
4. Accurate diagnosis: With the progress of medicine, the cause of infection can be determined, such as: rotavirus acute enteritis, pathogenic Escherichia coli enteritis.
4 revolutions of diarrhea **
1. The advent of intravenous infusion: In the past, pediatric medicine in China was still very backward, and there were few intravenous infusion conditions and technologies. After the advent of intravenous fluids, intravenous fluids can rapidly improve the water, electrolyte and acid-base balance in children with diarrhea, adjust the composition, amount and duration of intravenous fluids according to the degree and nature of dehydration, and reduce the mortality rate of children with diarrhea.
2. The emergence of oral rehydration salts (ORS): oral rehydration is as effective as intravenous rehydration, and is the preferred method for preventing and mild and moderate dehydration. Hypotonic oral rehydration salts (ORS) are currently recommended. There is a decrease in the number of children with severe illness and a decrease in hospitalizations for diarrhoeal diseases.
3. The appearance of montmorillonite: montmorillonite has a fixed and inhibiting effect on viruses, bacteria and toxins produced in the digestive tract, which can make them lose their pathogenic effect. Moreover, it has a strong ability to cover and protect the mucosa of the digestive tract, repair and improve the defense function of the mucosal barrier against attack factors. As a result, hospitalizations for diarrhoeal diseases have been significantly reduced.
4. Comprehensive probiotic preparations: adjusting diet, preventing and correcting dehydration, rational use of drugs, supplemented by probiotics, etc.
How can I tell if I have diarrhea?
When the small intestinal mucosa is affected by the lesion, its ability to reabsorb water and electrolytes is impaired, and intestinal fluid accumulates in the intestinal lumen in large quantities, causing diarrhea. Therefore, intestinal diarrhea is mostly manifested as loose stools, watery stools, large amounts of stool and too many nutrients in the stool, unpleasant stool smell, pain around the navel, and diarrhea in the small intestine is mostly characterized by a large amount, decay or thinness. It is mainly infected by various viruses, toxigenic bacteria and virulents.
However, there is only a small amount of water and electrolytes reabsorbed in the large intestine, so children with colorectal diarrhea may have a large number of stools, but the amount is not large, and the total amount of stool per day is not largeDiarrhea in the large intestine is usually characterized by a small amount of pus and blood visible to the naked eye, and even watery stools, mucus stools, etc.
Diarrhea**
Adjust diet, prevent dehydration, correct dehydration, use antibiotics rationally, strengthen care, and prevent complications. Oral rehydration solutions are effective in preventing mild to moderate dehydration and should be started as early as possibleHypotonic oral rehydration salts are the first-line regimen for acute gastroenteritis. Intravenous fluids are suitable for children with severe dehydration and moderate dehydration who cannot tolerate oral rehydration, children with shock or altered consciousness, children with no improvement or worsening of oral rehydration dehydration, and intestinal obstruction.
Diarrhea also has severe cases, and we still adhere to four principles for children with severe dehydration and shock:
1. A program (according to the degree and type of dehydration, 1 ** program is determined).
2. Two-step (adjust the ** plan at any time according to the condition and electrolyte level).
3. Three determinations (quantitative, qualitative, and timed intravenous infusion).
4. Four sentences (first fast and then slow, first thick and then light, see surprise to supplement calcium, see urine to supplement potassium).
Expert presentation
Liu Xingyuan
Chief Physician of Pediatrics
Doctoral supervisor
Specialist Clinic: Thursday morning
Specialty: Diagnosis and treatment of bronchial asthma, allergic cough, cough variant asthma, and chronic cough. Implement an individualized, step-by-step approach to bronchial asthma and wheezing-related diseases. He specializes in the diagnosis and treatment of digestive tract diseases, pediatric critical illness, and pediatric cardiovascular diseases.
He is a member of the Immunology Group of the Shanghai Medical Branch of the Chinese Medical Association and the Emergency Group of the Shanghai Medical Branch of the Chinese Medical Association. Member of the ** Review Committee of the Ministry of Education, member of the ** Shanghai ** Review Committee. Shanghai Municipal Science and Technology Commission project evaluation expert. Reviewer of several SCI journals.
Author: Qin Xueyan, Tongji Hospital, Tongji University.
Editor: Jiani Lu.
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