Diarrhea in infants (infantile diarrhea) are the most common of the infant's digestive tract syndrome. 1982 National Pediatric diarrhea collaborative group discussed and approved the classification, the children with diarrhea divided into infectious and non-infectious. Infectious diarrhea in addition to the existing fixed names such as bacillary dysentery, cut off the left ear of the slain Miba dysentery, cholera, Salmonella typhimurium infection endures, other bacteria such as E. coli, Campylobacter jejuni, viruses such as rotavirus, astrovirus, Coxsackie virus , as well as infections caused by fungi, and some unexplained infections are diagnosed in children enteritis.
1, the general symptoms of mild diarrhea symptoms varies.
(1) Light diarrhea: with an increase in the number ambassador several times a day to 10 families times. Ambassador rare, sometimes a small amount of water, yellow or yellow-green, mixed with a small amount of mucus. Each time the amount of small, common small white or yellow, the Department of calcium, magnesium and a fatty acid compound of the soap bar. Occasional small amount of vomiting or galactorrhea, loss of appetite, body temperature normal or occasional fever. Looking a little pale, the spirit is still good, the whole body has no other symptoms. Weight gain or decreased slightly. Fluid loss at 50ml / kg or less, significant clinical symptoms of dehydration from time to time. Good prognosis, course of about 3 to 7 days. In children with rickets or malnutrition, diarrhea, although light, but often three to seven times a day, the color yellow, often with mucus, fetid. Stool check shows a small amount of white blood cells. Ambassador traits and frequency instability. Protracted course, the deterioration of the nutritional situation, often secondary to urinary tract infection in the middle ear or other parts.
(2) Severe diarrhea: made worse by light. Daily stool ten times to 40 times. Switch heavy at the beginning, then the increased moisture, occasional mucus, yellow or yellow-green, a stench, acidic reaction. Changing diapers is not timely, often hip skin corrosion, skin exfoliation and redness. With exacerbations and reduce food intake, fecal odor mitigation, fecal disappearance watery or egg drop soup, lighter color, the main ingredient is a small amount of intestinal fluid and mucus, alkaline reaction. Increased stool volume every 10 ~ 30ml, more are up to 50ml. Microscopically, fat droplets, swimming bacteria, mucus, severe and occasionally red blood cells, white blood cells per field of view up to elevations of about 10. Children with poor appetite, often accompanied by vomiting. More irregular fever, severe fever. Reduce weight quickly, significant weight loss. If not timely rehydration, dehydration, acidosis gradually increased. Few sharply from severe, high fever up to 39 ~ 40 ℃, frequent vomiting, watery diarrhea, rapid onset of symptoms of water and electrolyte imbalance. Over the past decade, since early treatment can seriously heavy diarrhea has been significantly reduced.
2, water and electrolyte imbalance symptoms of dehydration, acidosis mainly, sometimes low potassium, low calcium symptoms.
(1) dehydration: children quickly weight loss, weight loss, listlessness, pale skin and even gray hair, poor flexibility, anterior fontanelle and orbital subsidence, dry mucous membranes, sunken abdomen, rapid pulse, blood pressure, and decreased urine output. Dehydration is divided into mild, moderate and severe degrees: ① mild dehydration: fluid loss accounted for 5% of body weight or less. Children somewhat less spiritual, looking slightly pale skin a little dry but still good elasticity, orbital somewhat less, looking slightly pale skin a little dry but still good elasticity, the eye socket a little depression, urine slightly less than usual; ② moderate dehydration: fluid loss about accounting for 5 to 10% of body weight. Children malaise, bursts of irritability, pale skin, gray hair, dry, relaxation, poor flexibility, not immediately flattened picked. Zhou Faqing mouth, before the skull and eye socket significant subsidence, lips and dry mucous membranes, heart sound blunt, concave abdomen, cold extremities, decreased urine; ③ severe dehydration: fluid loss accounted for 10 to 15% of body weight. Children apathetic, indifferent, unresponsive to the surrounding environment, pale gray skin, poor flexibility, not easy to heal after picked. Anterior fontanelle and sunken eyes, eyes are not closed, conjunctival dryness, cry no tears, corneal light, lips cyanosis, dry mucous membranes, confusion, heart rate, blood pressure difficult to measure. Belly deep. Cold limbs. Urine little or no urine.
Estimate the degree of dehydration, we should pay attention to the orbital anterior fontanelle degree of depression. Hypotonic dehydration prone to reduced skin elasticity, and elasticity usually malnourished children usually poor, should be noted.
Different types of clinical symptoms of dehydration are also differences. Hypotonic dehydration due to loss of extracellular fluid and more children with dehydration symptoms early and heavy, but thirst lighter, heavier and sluggish; hypertonic dehydration, relocation of intracellular fluid, extracellular fluid loss relative less. Children with obvious thirst, fever, irritability, muscle tension, occasional convulsions. Orbital anterior fontanelle sunken lighter than the hand, foot temperature, pulse and can.
(2) acidosis: mainly apathetic, deep breathing, it was like interest. In severe cases, breathing faster, and even coma. When newborn infants or small or no later deep breathing, mainly for lethargy, pallor, poor feeding, weakness, etc., it is estimated acidosis, pay attention to the age of the children.
(3) hypokalemia: hypokalemia more apparent than in the watery 1 week old malnourished appeared earlier, heavier. Children generally have fewer symptoms of hypokalemia not before infusion, after entering the liquid potassium, correction of acidosis with dehydration, hypokalemia gradual emergence of symptoms: listlessness, low muscle tone, the first heart sound blunt. Abdominal distension, bowel sounds decreased or disappeared, tendon reflexes and then re-appeared. Failure to timely potassium, low potassium can occur in severe muscle paralysis and even respiratory muscle paralysis, intestinal paralysis, bladder paralysis, tendon reflexes, heart rate, arrhythmia, appeared apical systolic murmur, enlarged heart, can be life threatening . Say nothing more than blood potassium low potassium symptoms appear in 3.5mmol / L or less.
(4) hypocalcemia: original malnutrition, rickets in children falling or diarrhea, irritability often appear after round solution, tetany or convulsions and other symptoms of hypocalcemia. And Phil Foster's examination showed positive reflection.
(5) hypomagnesemia: small number of children to correct dehydration, acidosis, low magnesium of tetany after calcium supplement. The performance of hand-foot tremors, convulsions, crying, susceptible to irritation, can not sleep. Flush individual children appear in the forehead or the skin folds.
