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Fluid therapy: for diarrhea

ISSN 2398-2950

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Pathophysiology

  • Hypovolemia and dehydration are the most common metabolic disturbances of diarrhea.
  • The most common electrolyte disturbance is hypokalemia.
  • The most common acid-base imbalance is metabolic acidosis because of loss of bicarbonate.
  • Other complications include hypoproteinemia with exudative diarrhea   →   edema and effusions, and endotoxemia or septicemia   Shock: septic    →   fever, hypoglycemia and shock   Shock  .

Treatment

  • Emergency treatment of severe hypovolemia or shock:
    • Rapid intravenous infusion of synthetic colloids e.g. gelofusin or Hartmann's solution is needed to restore vascular volume and tissue perfusion.
  • Patients in a less critical condition can be given Hartmann's solution at a slower rate, eg 40 ml/kg/hr to restore circulating volume. Then slow infusion rate and adjust fluid as required.
  • Mild dehydration may be treated with oral fluid therapy with glucose/electrolyte solutions as long as the patient is not vomiting.
  • Serum electrolyte levels (sodium   Blood biochemistry: sodium  , potassium   Blood biochemistry: potassium  , chloride   Blood biochemistry: chloride  ) should be checked. Supplementation of potassium   Potassium chloride / gluconate  may be required.
  • Colloids or plasma are required in patients with hypoproteinemia.
  • Mild to moderate acidosis will be controlled with infusion of Hartmann's solution.
  • Supplement bicarbonate if pH <7.1.

Further Reading

Publications

Refereed papers