04/08/2017
On 29th July a CME on "ORS: The Only Rational Solution to Life" was organized by Department of Pediatrics, HIMS. This event began with the talk of Dr. Utkarsh Bansal who said that diarrhoea is the second leading cause of under-five mortality. Though diarrhoea is usually defined as increased frequency of stools, but the recent change in consistency is more important. Viruses mainly cause it in more than 50% cases, among which Rotavirus mostly is the culprit in younger children. Among bacteria, E. coli cause watery diarrhoea in 20% cases, while shigella and salmonella are the common causes of dysentery. Parasitic causes are rare in children and should be thought of in chronic cases. He told about how to look for signs and symptoms and how to recognise dehydration in a case. Look for level of consciousness, dryness of eyes and mouth, skin pinch and urine output. Red flags in history and examination should alert the physician, like excessive vomiting, high purge rate, not accepting feeds, dysentery, shock, anuria, abdominal distension, acidosis, convulsions and severe malnutrition. Child with diarrhoea looses equal fluids, as adults so are more at risk of getting dehydrated. Children may have no, some or severe dehydration, where the percentage weight loss is less than 5%, 5-10% and more than 10% respectively. Management according to severity of dehydration was discussed by Dr. Ekansh Rathoria. He told ORS should be used to manage no or some dehydration. Child should be offered ORS as much as he desires in small sips. If there is excessive vomiting, lethargy or severe dehydration, patient requires intravenous fluids. Ringer's lactate or normal saline is the fluid of choice and should be given as 100ml/kg over 6 hours in infants and 3 hours in older children. Ongoing losses and maintenance fluid required should be appropriately replaced. DrRavi Ahuja told about ORS in detail, he told it was the most impactful discovery in the treatment of watery diarrhoea. Giving ORS in time can save a lot of lives. With advent of low osmolarity ORS, with osmolarity of 245 mmol/L against the 311 mmol/L of standard WHO ORS has been better in management of diarrhoea. Newer research on amino acid based ORS is in progress and may give even better results. Dr. Ahuja with the help of Dr. Nyay Guptademonstrated the correct way of preparing ORS solution. If commercial ORS is not available, homemade ORS can be made by adding six teaspoons of sugar and half teaspoon of salt to one litre of clean water. Homemade lassi, chhanch, buttermilk, coconut water, rice water, fresh juices with salt can be given. But avoid packed juices, cold drinks, glucose solution and beverages. In the end there was ORS mixing demonstration by students who all participated enthusiastically. All students promised to spread awareness about ORS use in diarrhoea in the society. A wonderful role play was done at the end of the event under supervision of nursing principal Dr. Palaniappan, by nursing students which demonstrated the myths of people regarding management of diarrhoea and gave education in simple language.
More than 200 students were present. This event was attended by the faculty of HIMS including Chairperson Dr. Richa Mishra, Dr. Amod Kumar Sachan, Principal Dr. Jai Vir Singh, CMS Dr. Govind KrishnaTripathi, Dr. Narendra Rai, Dr. Fatima Ismail, Dr. Arvind, Dr. Atul Yadav, Dr. Gaurav Goel, Dr. Abhishek, Dr. Khushbu Singh Dr. Archana Srivastava, Dietician Pragya Singh, Nainika and interns including Ashish Singh Somvanshi, Umesh Sah, Harry Khanal, Shilpi, Shivam and Harsh*ta.
