Deadly Diarrhoea
A nursing staff of ours almost lost her 7-year old niece to Diarrhoeal Disease yesterday.
The child apparently had had many bouts of watery stools and was clearly, severely dehydrated and quite drowsy at the time of admission - loss of skin turgor, eyes sunken deep into the sockets, sunset gaze; the works.
And then she began to convulse. This posed a dilemma in terms of the dosage of sedative to administer in order to cancel the seizures - one cannot afford to administer too much a dosage so as not to further depress the Central Nervous System. Paraldehyde might have been best preferred due to its low depressive action on the CNS, but we had run out. I ordered i.m. Diazepam 15mg statim.
Clearly she had been electrolyte-imbalanced - in severe dehydration, serum electrolytes like sodium, potassium and so forth, are deranged in terms of their concentration in the blood serum. This clearly contributed to the convulsive seizures she suffered - she had several of them.
She gradually stabilized overnight, the administered fluid and electrolyte replacement infusions, greatly aiding her recovery.
Thanks also to the Paediatrician's input. She ordered Normal Saline, 20 mls/kg body weight, to be given. I had omitted Saline in my management plan, believing potassium to have been the main electrolyte variable since vomiting was minimal.
The child apparently had had many bouts of watery stools and was clearly, severely dehydrated and quite drowsy at the time of admission - loss of skin turgor, eyes sunken deep into the sockets, sunset gaze; the works.
And then she began to convulse. This posed a dilemma in terms of the dosage of sedative to administer in order to cancel the seizures - one cannot afford to administer too much a dosage so as not to further depress the Central Nervous System. Paraldehyde might have been best preferred due to its low depressive action on the CNS, but we had run out. I ordered i.m. Diazepam 15mg statim.
Clearly she had been electrolyte-imbalanced - in severe dehydration, serum electrolytes like sodium, potassium and so forth, are deranged in terms of their concentration in the blood serum. This clearly contributed to the convulsive seizures she suffered - she had several of them.
She gradually stabilized overnight, the administered fluid and electrolyte replacement infusions, greatly aiding her recovery.
Thanks also to the Paediatrician's input. She ordered Normal Saline, 20 mls/kg body weight, to be given. I had omitted Saline in my management plan, believing potassium to have been the main electrolyte variable since vomiting was minimal.
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