LIKE ON FB

Tuesday, December 11, 2012

Loose motions "acute gastroenteritis" dehydration dysentery

For COUGH related queries, please read my article  
for clinic address in Mumbai, India please visit www.doctorchild.com

Acute DIARRHEAS... WATER LOSS.. DEHYDRATION... DYSENTERY,., QUERIES

All diarrheas are not same…
They are caused by infections and many times without infections.
Causes of diarrhea are different at different ages too.
Apart from causes-- pattern of diarrhea is also important. Some are watery and some with less water. Some are sticky and some with blood. Some do have serious reason under it. Some do cause serious complications.
in summary a common medicine or formula can not be applied to a case of diarrhea without knowing above details.
Often there is a confusion that teething causes diarrhea, winter causes diarrhea.. monsoon causes diarrhea...etc there is scientific logic which needs to modify these beliefs.
Teething Diarrhea
Often parents come with various tonics for dentition available in market...practically teething per say does not cause diarrhea. during teething the important milestone of hand to mouth and biting starts developing. at this phase kids even start chewing clothes, fingers and toys. the germs that get carried along with this; often end up causing gut or throat infections. Both may cause diarrhea.. simple hygeinic measures and controlling cloth/toy chewing may settle this. If there is serious pica associated may need an attention.
Cold/ cough related diarrhea
in nose, throat, ear infections the mucus secretions or pus gets swallowed in small infants and passes through gut undigested and may look like mucus in stools.. but may smell same as nose secretions.
monsoon diarrhea
Often this is due to water/ feed or hand contamination. Though usually rotavirus related in first year of life; there are many other viruses and bacteria that may cause such monsoon diarrheas. bacterial diarrheas and dysenteries predominate in summer and in areas and seasons of water scarcity too. Often such diarrheas are more watery compared to dyentry.
watery diarrheas
diarrhea is often watery. how much water content per stool may decide the level of infection. Infections from small inetstine often cause large watery diarrheas (enteritis). As the infection spreads from small to large intestine; the water content gets lesser and pain or cramps .. and mucus/blood may come in stools.(enterocolitis).when this happens.. the diarrhea is no longer just diarrhea, but is called dysentery. All diarrheas may not go through this phase. There are some viruses that causes redominant gastritis.. some do cause gastroenteritis; some cause only enteritis and some cause entrocolitis; while soem cause colitis.
dysentery
whenever water content of stool is not enough to make the bed "wet", lets call these diarrheas as nonwatery or may be dysentry. dysentery is presence of mucus or blood in stool/poop. dysentery may be associated with spurts of water.. which is often due to inflammation of rectum ( proctocolitis).
Dysentery may be due to amebiasis, bacteria or antibiotic induced.
Viruses often do not cause dysentery.

Commonest cause of loose stools in developing countries liek India are giardiasis (a form of protozoa); and in elderly kids may eb amebiasis.
Commonest cause of watery diarrheas.. in infants in rotavirus related, in seasons. otherwise can be toxin producing e coli bacteria or salmonella bacteria.. Cholera is a serious cause of severe watery diarrhea... and needs specific therapy. In cholera 1 or 2 motions can make a child very sick. The stool has fishy smell and looks like rice water.
Common causes of diarrhea without too much of water loss, are non rotavirus viruses and bacteria..Most bacteria produce a toxin or they may also attack the intestinal skin (epithelium) and may cause infection, bleed or holes in mucosa that may take days to heal.
each bacterial diarrhea my not need antibiotic too, but most need it.
When to stop breast milk in diarrheas ?
Breast milk is best and should not be stopped in diarrheas. feeding is essential component in maintaining feeds and tackling dehydrations.In soem cases, when diarrhea lasts for longer than 4-5 days, the gut epithelium loses its factors required to digest lactose, a domonant sugar in milk. When lactose not digested, it carries water with it in stools and may harm and motions persist. In such cases breast milk or any milk that contains lactose should be promptly stopped for a week and the same phase should be replaced by lactose free formula or feeds for the same duration. Doctor diagnose this condition by looking at stool Ph and reducing substances in stools.

danger signs in diarrhea: any of  these signs if there may  risk life by dehydration or sepsis..they are as below:
1.reducing urine frequency and quantity
2.sleepy child, lethargic
3.child refusing feeds, voomiting not getting controlled
4.cranky or irrtable child , very thirsty child.. but fails to drink or digest
5.perianal rash..nappy rash, diaper rash or skin sores ulcers or redness.. easy to secondarily infected to complicate matters
6.fever not settling despite 72 hours

If any of these danger signs.. prefer the doctor sees the child very often or the child remains under hospital supervision and therapy. Parents cannot feel or assess the severity of diarrhea related issues which child may be going through. A child of 10 kg often needs 1 litre liquid daily to maintain circulation.A motion of hundred ml will compromise it by 10 % aqnd a 5 motions can compromise it by 50%.
be liberal with fluids with children suffering from gastroenteritis.

Leave the judgement of medicines to doctors.. as all diarrheas are not same in presentation, severity and treatment response. Commonly a diarrhea starts responding to medicines in 72 hours.. but may last 7 to 10 days.
डॉ कोंडेकर संतोष ,एम .डी,.डी.एन .बी.,डी.सी.एच.,एफ.सी.पी.एस.
विशेष बाल रोग निदान व उपचार केंद्र, ओपिडी नं ११
सायं ७ ते ९, सोम ते शुक्र ; शुश्रुषा हॉस्पिटल 
appt: 9869405747 रानडे रोड दादर (प). मुंबई ४०००२८

 post your free queries at www.kondekar.com 
Part II: managing diarrheas.. awaited..
डॉ कोंडेकर संतोष ,एम .डी,.डी.एन .बी.,डी.सी.एच.,एफ.सी.पी.एस.
सहप्राध्यापक बालरोग विभाग , बाल दमा विभाग 
टोपीवाला राष्ट्रीय वैद्यकीय महाविद्यालय 
बा.य ल नायर धर्मार्थ रुग्णालय मुंबई सेन्ट्रल 

child specialist on call..

DR SK is a qualified pediatrician with MD and DNB qualification, from India who has specialised himself in counselling parents and children about the knowledge and various aspects of child health, illness, treament, diseases and their doctors. Dr SK is working as a pediatric intensivist and respiratory and infections specialist at Seth G S Medical College and KEM Hospital Mumbai India 400012. 
He has clinical expertise in guiding doctors, patients and also managing various illnesses and / or clinical situations concerning child health and its aspects like: Growth, Development Social and behavioural pediatrics including ADHD Respiratory illnesses including cold,cough, asthma Cardiac illnesses including congenital defects and rheumatic diseases Renal diseases Gastrointestinal diseases including diarrhea, vomiting, infections. hematological illnesses including anemias and hemorrhages. and various infections caused by various bugs like bacteria viruses and fungus. and many other clinical situations, illnesses, diseases. He has special interest in tuberculosis and other infections affecting various body organs and systems. 

The answers posted at above website are sole opinions of Dr SK with or without references and personal experience. These answers are just hypothetical and logical assesment of the limited information provided by the parent to the doctor in the form. 
The doctor being not able to examine the patiet and / or being not able to have access to reports, is practically not in a position to make diagnosis orprove it wrong... or suggest any treatment. Treatment suggested by this doctor at this site is just a hypothetical suggestion in agiven hypothetical limited situation which the parent may use for his basic understanding or discussion with his doctor, and for understanding and following basic health norms.
 Donot follow any prescription just because it was mentioned at this site. The consultation didnot take place, as the doctor has not examined the patient, legally its impossible to give any online prscription. What the doctor had written here is not a prescription for the given hypothetical case.



Thursday, February 2, 2012

WHAT IS EPILEPSY?

Child health specialist pediatrician Mumbai presents epilepsy FAQs:
Following is not a medical prescription, but just for information. No medicines should be taken or changed without direct clinical consultation and prescription issued by your doctor.
.paid queries at this site click here 
Visit My Message Board for public or open queries.Fill the form at this site for private queries.

WHAT IS EPILEPSY?
A repetitive seizure disorder due to abnormal cortical excitation, manifesting as local or generalized paroxysmal stereotypical movements with or without loss of consciousness, with or without frothing at mouth, with or without passage of urine and stools , with or without visible, tonic/clonic manifestations of a seizure.

WHAT IS NOT EPILEPSY?
Single seizure with normal EEG is not an epilepsy. Movement disorders like tremors, chorea may be confused as epilepsy. Epilepsy may mimick syncope, migraine or vertigo

. WHAT ARE THE DIFFERENT PATTERNS OF EPILEPSY?
Epilepsy can be presenting as focal or generalized seizures without any aetiology as idiopathic epilepsy. When some reason is there, it may be called as pathological or syndromic epilepsy. Clinical patterns may vary from just twitching to tonic clonic movements and from syncope like events to unconsciousness.

HOW DO WE DIAGNOSE THEM
Diagnosis is often clinical. Investigations help in understanding prognosis and aetiology. EEG and MRI brain is often asked for in most epileptics.


DO’S AND DONTS WHEN A PATIENT GETS A SEIZURE
When a patient gets a seizure, let the seizure pass, turn the patient on one side to prevent aspiration of secretions. If available you may give oxygen and nasal midazolam or injectable or per rectal diazepam. Even if seizure is settled, giving medicine will delay next seizure. Discourage the myths about pouring water and applying strong smells or onion to nose , as it will harm the patient.

WHAT ARE THE EMERGENCY DRUGS FOR SEIZURE CONTROL?
Emergency seizure control can be achieved by any of the following drugs depending on availability: Intranasal midazolam spray, per rectal diazepam, intramuscular diazepam,intravenous diazepam or lorazepam or phenytoin or phenobarbitone. These drugs may have life threatening side effects if proper precautions not taken by the doctor.

WHATS ANTICONVULSTANTS TO BE USED FOR WHAT TYPE OF SEIZURES?
This is better left to the experts as type and pattern of seizure and availability of drugs and knowledge of dosages and side effects does matter.The drugs used in past for generalized and focal epilepsies in past that is phenobarbitone and phenytoin respectively, may not be recommendable in view of their side effects, as better drugs are available. Focal and temporal lobe seizures, complex partial seizures, respond better with carbamazepine and oxycarbazepine. Most generalized seizures are well controlled with valproic acid which is a relatively safe drug as the dosages with it can be easily titrated to double without side effects.Newer anticonvulsants shouldnot be used without specialists consultations.

WHAT ARE THE DOSAGES OF SEIZURE CONTROLLING MEDICINES?
Most common drugs like phenytoin, phenobarbitone have narrow therapeutic window and are used in dosages of 5mg/kg body weight per day. Valproic acid having a wider therapeutic window is used in doses of 15 to 40 mg/kg/day. Carbamazepine is used in doses of 10-20mg/kg/day. Should always be started by and confirmed with treating doctor.

HOW LONG THE SEIZURE THERAPY SHOULD BE CONTINUED?
Single seizures with normal EEG and also febrile seizures, often do not need long term seizure therapy. Once started for valid reasons, seizure therapy is usually continued to observe at least 2 years seizure free. Then afterwards there may be a chance of tapering and stopping the therapy, though not in all patients.

WHAT ARE THE SIDE EFFECTS OF SEIZURE THERAPY?
They differ with different drugs, from intellectual dysfunction to anemia, rickets, gynecomastia , obesity etc. Overdoses may cause sleepiness, ataxia, diplopia, headaches and convulsions with different drugs.

WHEN WILL IT GET CURED?
Once the patient is seizure free fro more than 2 years, and there is no other reason to continue the same medicines and on with drawl of medicines if seizures donot recur in 6 months, the disease may be taken as cured for that time.

CAN THE PATIENT SWIM OR DRIVE?
Should preferably be avoided till medicines are on, though many countries promote these activities once 2 years seizure free.

IS THERE ANY SURGERY?
Selective refractory cases with focal manifestations on clinical evaluation or EEG or MRI may be subjected to surgery.


CAN THEY GO TO SCHOOL?
Schooling and office work can be permitted as long as it is stress free and doesn’t involve being on empty stomach for longer hours.

ARE ALL OF THESE ARE MENTALLY RETARDED?
Some seizure patients have mental retardation as comorbidity or may be associated with developmental delay, more so in pediatric patients say of birth asphyxia. In fact, some of the epileptics are superintellectuals.




following is an advertisement!