44781 - "We can not guarantee cure but what we can...

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Evidence based Medicine on Acute Diarrhea in Children Dr.H.K.Takvani, MD Ped., FIAP IPP, NNF, Gujarat State Chapter 2009-2010 National Executive Board Member. IAP 4 terms President IAP, Gujarat State Branch, 2001 President IMA Jamnagar City Branch 2008-09 Children Hospital and Neonatal Care Centre JAMNAGAR-361008, Gujarat, India [email protected] [email protected] www.takvanidr.multiply.com 23/02/1223 June, 2010 Takvani 1 "We can not guarantee cure, but what we can guarantee is an honest and  transparent effort".
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Why to talk on diarrhea? Prescription Surveys says…. . No ORS. IVF where ORS works well or better No advice on continuing, increasing BF, (unnecessary stoppage of BF), diet or hygiene No zinc. 23/02/12 Takvani 2
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Why to talk on diarrhea? Use of antiemetics Antibiotics often- Nor-metro, Oflo-ornida, Inj.Am Un-necessary probiotics Racecadotril. 23/02/12 Takvani 3
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IAP Consensus Statement Highlights several important developments. Aims that benefits of new knowledge reach affected. Wants that new products are not 23/02/12 Takvani 4
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ORS in diarrhea ORS for all ages and all types of diarrhea. Low osmolarity ORS recommended, WHO Sodium 75 mmol/L and glucose 75 mmol/l, osmolarity 245 mosmol/L Continue Breast feeding and routine normal diet and energy dense feeds. 23/02/12 Takvani 5
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Why Reduced osmolarity ORS? 39% reduction in need for IVF 19% reduction in stool output 29% lower incidence of vomiting Risk of hyponatremia not significant in any type of diarrhea. 23/02/12 Takvani 6
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Zinc in Diarrhea Based on studies in India and other developing countries there is sufficient evidence to recommend zinc in the treatment of acute diarrhea as adjunct to oral rehydration. 23/02/12 Takvani 7
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Zinc in Diarrhea Zinc has an additional modest benefit Reduces stool volume. Reduces duration of diarrhea. Oral rehydration therapy must remain the main stay of treatment. 23/02/12 Takvani 8
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Zinc in Diarrhea Dose: Elemental Zinc 20 mg/day for 6months and older for 14 days 10 mg/day Between 2-6 months. Any of zinc salts e.g ., sulphate, gluconate 23/02/12 Takvani 9
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Recommendations of the IAP National Task Force for Use of Probiotics The group recommended that based on analysis of studies there is presently insufficient evidence to recommend probiotics in the treatment of acute diarrhea in our settings
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Recommendations of the IAP National Task Force for Use of Probiotics Almost all the studies till now were done in developed countries except for one very small study from Pakistan. It may not be
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44781 - "We can not guarantee cure but what we can...

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