Infectious diarrhea is largely self-limiting and heals spontaneously within a few days without any therapy (Lübbert 2014).
However, infants and young children are particularly at risk from dehydration. This can be determined for children between 0 - 8 years using the clinical dehydration score (CDS):
- 0 points:
- normal appearance
- Eyes normal
- Mucous membranes and tongue moist
- tears present
- 1 point:
- lethargic or restless, but irritable to touch
- thirsty
- eyes slightly sunken
- mucous membranes and tongue sticky
- only a few tears present
- 2 points:
- cold sweaty, groggy, comatose
- eyes extremely sunken
- mucous membranes and tongue dry
- no more tears present
Score:
No dehydration: 0 points
Mild to mild dehydration: 1 - 4 points
Moderate to severe dehydration: 5 - 8 points (Posovszky 2019)
The first measure should be rehydration with fluids and electrolytes (Herold 2022). For this purpose, sugary and salty liquids / foods such as sweetened tea, salty cookies, rice gruel soup, etc. are suitable (Lübbert / Grimm 2014).
In a milder course, rehydration can be done orally e.g. with ORL = oral rehydration solutions, if necessary also by nasogastric tube (Posovszky 2019).
ORL is available as a ready-to-use preparation Elotrans powder or oral pedon or can be prepared as follows according to WHO recommendation:
- NaCl 2.6 g
- Na- citrate 2,9 g
- KCL 1,5 g
- Glucose 13,5 g
- Aqua ad 1.000 ml (Herold 2022)
Pure electrolyte solutions are less suitable for rehydration because salt and glucose are absorbed in the intestinal epithelium via the enterocytes together with a common transporter, but the water can only be absorbed passively (Lübbert 2014).
In adults, rehydration can be oral or i. v. depending on the initial situation (Herold 2022).
In children, 5 ml of ORL should be given orally every 1 - 2 minutes, even if additional vomiting is present.
i. v. rehydration is required in the event of:
- Failure of oral or nasogastric rehydration.
- state of shock
- severe rehydration with
- loss of > 9 % of the bw
- severe acidosis with a pH < 7 and a BE < - 15ml / l
- neurological symptoms such as lethargy or coma
- hyponatremia (Na + < 130 mmol / l)
- hypernatremia (Na + > 150 mmol / l)
- bilious vomiting
- in case of symptoms of ileus, immediate i. v. rehydration is always indicated in children (Posovszky 2019)
Inpatient treatment should also be given in cases of:
- severe underlying chronic disease such as immunodeficiency, diabetes mellitus, oncologic disease, etc.
- Infants < 3,500 g
- Infants younger than 2 months
- malnutrition and / or failure to thrive
- intestinal transport disorder such as intussusception
- persistent bloody diarrhea (Posovszky 2019).
If the V. a. an infectious diarrhea exists, the patient must be isolated immediately. If the suspicion is confirmed, isolation is to be continued for up to 48 h after the patient is symptom-free. Notification to the public health department is required according to §§ 6, 7 of the Infection Protection Act for certain diseases (see "Notes") (Herold 2022).
In the case of infection with Clostridioides difficile, stool transplantation in the form of endoscopic microbiome transfer can be used in pilot studies for severe, therapy-resistant courses (Lübbert / Grimm 2014).
After dehydration is eliminated, food buildup should include grains and starchy foods such as rice, wheat, potatoes, pasta, etc.... Coffee, highly spiced or roasted products should be avoided for the first 2 - 3 days as well as milk and dairy products (Schöpfer 2007).