Acute diarrhoea with severe dehydration and complications in a 1-year-old child: a case report in a hospital with low resource setting

Abstract

Diarrhea remains a leading cause of child morbidity and mortality because can lead to complications such as hypovolemic shock, electrolyte disturbances and metabolic acidosis. In this case study, the author would like to demonstrate management of diarrhea in a hospital with limited resources. A 1-year-old boy presented with complaints of watery stools 6 times/day, vomiting 3 times/day and fever. Child appeared weak, refused to drink, experience rapid and heavy breathing, and a loss of consciousness. Physical examination revealed heart rate about 156 per min, peripheral pulse was not palpable, respiratory rate 44 per min, oxygen saturation 98% and temperature about 36.7°C. When crying, the face appeared haggard, the eyes sunken, and there were no tears, reduced bowel noise, longer skin turgor and the capillary refill time increases. Laboratory findings showed leucocytosis (23,600/µl), hyponatremia (127 mmol/l) and hypokalemia (2.66 mmol/l). He was treated with resuscitation fluid administration, Ringer lactate 20 cc/kg BW in 20 min continue with 30 ml/kg BW in 30 min and 70 ml/kg BW 2 hrs 30 min later. The patient was then administered with D5% 500 cc±28 cc sodium bicarbonate, 27 cc+KCL 7.4% within 24 hour. The patient was also given oxygen therapy, antibiotic, probiotics and zinc. The patient was discharged home on hospitalization day 5 with a significant improvement condition. Diarrhea can lead to complications that cause of death in diarrhea cases. This case report highlighted to recognize signs and symptoms and manage severe diarrhea in a hospital with limited resources.