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Okay, so and I'm going to be talking about gastrointeritis and Children. Cause it's so common for us to see is that and so again, if you freeport any questions into the chop walks, I'll try and keep my chart books. Um, Andi questions for the Amber Ground as well. So, um, first of all, what is it with gastroenteritis? Its presence of diarrhea or vomiting or both? That may or may not be accompanied by a fever of Donald Pee in honor. Axiom on. And diarrhea is a possible excessively, like with a or frequent stools with like with high war content. Okay, and it was on only often felt to be extra common minor illness. Presentation is actually major cause of childhood. My salad every other day on, because is millions of deaths related granted mostly in the middle income countries, and it doesn't kind of for a large portion of the tens. Is the DPT on the D on the UK on, they asked me in Europe that's between four and 17% off presentations toe primary care or he's on in terms of pediatric presentations. So so not not affecting you is it's a fairly sizeable chunk of what we might see in the So what causes it well, the most likely are the colon pathogens that that could cause gastritis are viruses, and this is a norovirus a which we'll are familiar with the term of on. But again, viruses are very common causes, as already know, viruses or intravenous is, and the viral infections cause down with the small, small vial Intrasite it's on felt a little bit. Fevers on water area and normally was like blunt cases are Brian Diarrhea is green virus, but more blunt. Okay, And the room virus, especially our seasonal. I will very different geographical areas, even from UK, on the peak age. These faces between six months and two years and Children with pair of nutrition or, um, they're having failure to thrive are much more nightly. Teo acquire aspirin dress onda also much more. It's develop dehydration or call other complications as a consequence. And but 20% of cases will be bacterial on, but we but they're much more. I did have blood in the stool. Onda Colon kind of causes are comparable. Doctor Spacey, salmonella in Coliand Shigella. Spacey's Okay, uh, especially the equal at the Scala. They can be complicated by humanitarian symptoms. On to these kids will come any and on the metformin therapy neck on that acute renal failure. So very, um Well, okay. And actually they kind of happened in the absence of blood in the stools. And it's just important that even for the ones that we think that your blood So we're thinking that the viral side, it could still be on one of these more. But bacterial causes on and 11 units under less than 10% of gastric varices will be cause. But it was a while, like crackers, bread, mmr, giardia. And you certainly see someone about up in this part of words. And averages are spread. Mean Levi, the fecal or older, it again put away. It spread so easily in the kids because they're not so good with the heart hiding on. But, um, as we know should read it in rice on. Do you get the the serious and rescue with rewarmed rice? And so there are other fish obviously, that could be contaminated on. We've only blame the fast foods to make soup and that sort of thing and foreign travel a Well, obviously and maybe not quite as common in a moment and press climate. But, um, a contaminated water sources on one of the big ones on your word, right? So important that we were seeing in these patients that do you think about how the map golden that is, that people will spread if they have foreign travel or any foods on. But I have being the cause of organized with short course of it. Okay, So what? I want to come in around t assessment eso, just like alpha blocks on were going three or 80 may require IV access on major Bibles is a fluid if they're shocked on the ball is where the big bosses with the 10 miles, but you're more 100.9% ceiling heard. I think I was. Well, having it in the tree I stopped this morning is always, always, always do your bm on to check that sugar level on almost 10% off patients less than five to come in with the gastroenteritis. So looking at the ones under five is coming with gastroenteritis. Um, almost 10% of them will have hypoglycemia, and that's a high high income countries that's no. And then the little countries on the rest factor for hypoglycemia presentation Could a long duration of warning on diarrhea or increased frequency of going and um unless I said, um, you know, we do need to protect much other words with these ones and just briefly about, you know, sugars as we have a tangent, because I think it's really important. And so so what we would generally advocate for if it's very, very clear, there's a senior history off very involved in for a few days, and they come in with a little sugar on their child is otherwise healthy with no other health problems. And they've been the family of any inherited disease is, and you can go ahead and treat that solution there with and some rapid loose or some you tried on the drinks. And if they won't take out early or the sugars recess into coming up and it's not improving, and then you'll have to get an IV line and give two mils per kilo of temperament. That reason we tried to this is remember times and does that we do worry about and born average metabolism on, especially in the knee and the old ones. It's if you go a child who comes in last in six months, last three months and whether diarrhea was rebelled. US go low sugar, and you think about the prevalence of important iron tablets, um, and newborns and Northern is very, very low. So I think we'll repeat Interesting to be happy enough for us in this, in this circumstance of a very clear diarrhea with us on. But just to go ahead and treat on. But there's not very clear yesterday, or, um, there may be a family has your whole day and from another agent in the UK or or from another country. And then we think of it. You know what we call hyperactive, which are available, and recess that's really important to the table pack is done. Before we correct the sugar level case, we would not take a correction level, Um, until after you've done the hyper part of paper. Back is is a range of blood tests, which the pediatric endocrinologists and will rely on t a diagnosis of number on there, and that was, um, man on. If you haven't done it before, it affects the sugar will come. You don't normally soon and please just think about it. But as I said, we're not just reiterate a child's You know, Um, look at the house with a little prevalence off disease on the coming with a clear history of diarrhea and vomiting, preference, days of blood, sugars and other side. Then you go ahead and just treat that sugar and you don't need to do your paperwork. The things I wanted to mention here was the start of treatment threshold. So there's various different ideas of what, What point of what number? We should go ahead and treat hyperglycemia and Children. So and I mean, I've always been taught 2.8 years is your is your limits, so you would not treat a sugar of 2.9 or three on. But I think last time we meet you actually was just prepare of less on, you know, a better look at Let's see, you're actually other places on Detective. Good sex is that Cough has been a recent study, actually recently, which is sure that there's no increase in long terms of really, if you have your threshold's have to and newborns and so I think he's probably on the low side and I think, and I think it was like a 20 year. So treat anything lasting people in the and Children I spoke to a point. You could just try the oral writ hands with some food, or or both or whatever. Check for you and but just one time a night. Not because it is different. Child's Yes, one tries itself is a clinical diagnosis, and you're gonna make it based on the history in your examination would. You don't need any specific blood tests or investigations toe Diagnose it. And I said before you buy, Inquire, vote on any infections. Contacts or animals in the family have had symptoms and recent problem food, and we want to ask about the frequency of symptoms or have any extra diarrhea. They have a day or in the past before ours on departing on what their fluid intake, especially in terms of these ones. We want to make an assessment off their fluids there so you can ask about and passing urine. The have a wet nappies. Did you pee off tomorrow or as often is normal and also just worth serve covering and anything else and that caused area and a child. And so, like recent recent antibiotics for something else or a history of chronic constipation, with some over from the area and the planet feature and just kind of think the things that would make you be a bit more cautious would be the presence of things like a hay fever. Gastroenteritis, classically, does not give you a very high fever. You can have a little agreed pyrexia, maybe 37 9, 31 32 anything about towards 39 or higher should just, um, ramble on your had to say This is maybe not just a straight forward faster. And try this and start thinking about your appendicitis or your pattern of fried us where other and truck don't know and infection in the presence of I fever and when I say a long duration of symptoms. So you know if if the symptoms of lasted seven days and it's probably trained 20 somewhere, investigation like on my stool sample and the child since of the year, but no pain on, be concerned about a really helpful thing and really important thing that we do is ask the parents really and explicitly what color the bombers and parents will often described it as being belly extra. Let's say he's forming vial, and but it's really, really important that we distinguish on what they are being drove. And clarify wouldn't mean by that because most parents will call yellow vomit bile and bile is not yellow. Vial is bright green. Okay, so and we're interested in breaking vomiting. And if there's any breakthrough in the morning and China's, that is almost always pathological. So if he's if he gastrium of grade involvement or E c. Green vomit in the department and not try to need your affair toe pediatric surgeon, So just be aware of those things and nothing. Just beware. ALS would be isolated vomiting. So if that's the story, is only vomiting and diarrhea. It may be that you're just at the store, every sort of stage, and I'm going to out diarrhea the next f E R's and but it's just for my then I think, some of the other things. So, um, things like diabetes on the birds and born in Asia, populism and obstruction ascertain truck. I'm yeah, that's more violent or obstruction or, you know, track infections. Okay, like raise of this ice with a diary with a moment I'm on. Just think about Is this chronic and constipation with diarrhea or and current area that it's chronic diarrhea and child? Then we have a little threshold to be thinking about some of the other things, like on day, 500 mile disease are your deficiency and that might There's old in some olives works in always, always, always think about it as this tried thriving. Are they getting way it to be happy with their development? And it's quite busy, Slight, sore. Do apologize for that, but I think just about full and table just Teo. Let's think about how it's on the features that we may find clinically with Carly it to on brother Kind of dehydrated or and clinical short. Okay, so and I'll just like a quick quickly through that book. Your red flags there you can see and the little cold Um, so, you know, look so well. And this responsiveness and the largest irritable, sunken eyes and with something from males on both as well from from smaller ones tachycardia add tachypnea. I'm I'm just getting Turker pace when Children are mildly to moderately dehydrated As a general rule that can be treated breath on the oral rehydration solution. Okay. And that that really is probably are going to okay and rehydration solution. Zar recognizes the first time therapy and fridge on mild moderate hydration worldwide by the who's okay, um, on, um, the only problem we do you find with, um is the flavor. Okay, so often they are have awfully running the Children would like. And so what we also know from the evidence is that apple just, um is just as, um good and in fact, with fear treatment failures compared to, like, light. Uh huh. On So it's something we can go to. China isn't taking the Dower light either at home before the company else or in the department. And we can recommend some apple just with the child likes apple juice. And that's probably actually a batter solution to give my child to rehydrate and if need be, what we want it to you in the department is getting more fluid challenge. So we assess a child, we see that miles moderately dehydrated, we decided to give them off challenge and child's just refusing to drink. Then we would have a very frank conversation with parents and say, we're out 0.9. We're we need to be syringing food and to the child. And so what we would tend to do is get one of them little syringes on but juice again. I didn't be able just But I don't I don't have any of that in the friends. And but you could use something, right? Ask mom and Dad or Taliban with that to be every five minutes, just ranging in 10 mills on there off the fluid. Okay, We should be evening for between 10 and 20 miles per kilo or four R c kind of worked out in the right up on, but you be before ours, okay? And mostly should antral rehydration is just a fact of as i e v hydration on in these mild moder cases. Okay, um is also much less invasive to be dependable and the other option that we will have a snack and Egypt and which can sometimes be using that in the small babies if they're not getting well, but and that's this is an entirely see if see if things but even a big part of it is getting parents onside, getting him to understand what we're doing. Okay. On a sports just documenting I was China's taken the H 5 10 minutes, eh? So So you tell us that only in about 1 20 to 25 kids Well, antral rehydration feel. Okay, so the last majority of kids and we'll be able to be rehydrated with world or the and fruit on say that the buyers to that entry or it would be really and family aren't onboard with your family. Have colon, Spackman child gather up on. But they just say no. We, er drinker. Okay, now this is more recently just taking the parents off to the side and have a chat with them and explaining And why don't financial wouldn't that and contraindications to the antral route would be at the time was clearly short on the fluids. And there's no signs of absolute bile obstruction or concerns over 90 s then. So that would mean if there's no Bible sign from the examine, okay Said before the IV therapy is much more invasive. And of those placing, I'm maintaining an IV access I am and severely dehydrated Children go by top table, the red flags severity 100 Children, lady that are like in the covered. Get your your IV like night because they are you. Hydration is first like, so I can we support and the Androgel as well. And we know the Children who get Give them down strong or last night about what's that's. Actually, you're in the evidence of the make sense on there. Also, much less likely to require IV hydration is the most less like to have a figure of them Children. And nice guy isn't quite up to date because it's and based on the license of the time, which was didn't cover and a Children from Estes on medication so on. But I think it's fairly accepted. Marry that these kids should again someone down strong and almost like it for kids that may have other previous history on in particular problem QT syndrome, and you would want to be given out the drum. You have also need to do something, um, a little bit easier because you used to be doing with the body surface area. But that no said between 100 other 50 micrograms per kilo. Every it ours. Okay, so they can help. And as we know the order special felons or create way Teo, a minister that medication for these ones, especially because they might even when I'm okay, so we go on doing is giving them down strong early when they come into the ET given them half in our on, then start not on world rehydration with syringe if necessary on time. Motivation department one that we are, is to see if it controls about and Jury's still late on the probiotics. But they have Bean mentioned all of that for sure, but one of the B and whether to be used not and but probably and okay, I think it's fair to say that the evidence is Mayor boat, and that doesn't necessarily mean that there's no horrible for them and seen so they seem to report benefits and certain doses in certain sentence, and that's not might be coming in the future. And it's more hard evidence that was using probiotics and DMV. And just to say that until it's number, Dariel agents shouldn't be used. They're not routinely recommended in the margin of gastroenteritis and at some, so leave. It wasn't covered as well said before, and still samples we'll think about it. Still sample if that area and or if a child has a history of new deficient, say on or foreign travel on or if diaries been there for seven days or more cakes, you're just trying to picture of these. A day of a technical causes, um, off the area that might last a bit longer on may also need some treatment, and by a chemical tests are not usually necessary and most cases because most kids are mild to moderate man. Test one, I think, just distract the Chinese so they do tend to make people past and in terms of discharge a race. Then on day, we're gonna have their flu challenge you in the department, you can have some I still always if they want to get something into them and you want to thank you bite on. But in terms of discharge, tell parents you just keep going with the fluids. Generally advise that need to be six are clear of all morning before he would try fits again. So just keep going with fluids, Foods, foods until it had sex. Are there any warning? And then you could try something to eat if they if they are hungry. And, uh, obviously, if they feel that well for the challenge of the media, you know, over the line and I'm getting a lot of pains, Okay, get hygiene. A home is important, A said, before most of these are viruses on most of them are fecal orals brand on the weak bone suit and make sure parents air tools to make sure that we're doing that's con washing on get, get hiding expensive. There are other kids of whom you want, my breaking my ears and the other thing just to quit the mentions vaccination cause we do vaccinate for her and viruses in the UK and so give it will have the world vaccine at eight weeks and 12 weeks and get the good twice on. That's not a huge success with just the number. The cases of viral gastroenteritis when they first did it in Scotland have a really good vaccine. I'll take above 90% and they're under to use this number twos, and there's too much hurting. You know they want that. It's it's impressive. So even just fighting the under to use on do you get good uptake of about 90% the number of tool cases of pattern trays and kids. I actually fell by 84.7% which is a fairly impressive So just a point off on you. If you do, you have kids will be off by giving them about giving them or a virus vaccine. Because, actually, it's it's very, very effective and see if, Okay, so And if there are any questions you can put in the chart, books are yourself and right right on. Do take. Um, points from this we talked would be always, always, always get that blood sugar trapped early. Maybe a triage be where the cancer is. Common area being where they said the vomiting on the ice with the diarrhea. And don't give antibiotics or anti and diarrheal and push fluids or late with the infrared where possible. Okay, so that's me