1. No category

FNKFYC OKNG[N[ \GNIP
[K Z[BM (EIGKPC OKENKC) FVF LZE UGDN SRMR NKVJF :FKEZBK'D
N[ QGKNTF YNIC \GI\V\P NKVJF N[ \GJSKXF .FCKCSF OT TDP
OKZIBC .OF[NM FNIP KRPKS FBZP GRKB OKENKFP YNI .KTPF
I\VN OKNGNT OKENK .\GBYFG OKNG[N[ N[ FVKZI FRGP\ QM\K\
LB FMGPR \GZKE\C NG[N[ ,QJC \GIKV\C BJC\PF L[GPP NG[N[
ZCEF .NGMKTF \MZTPC KGPS OE QECGBC FGGNP OK\KTN ,NGED IVRC
FNIP .FDKVS=\\ \GNIP \GZKMHPF \GTVG\N UBG FKPRBN OGZDN NGNT
.\ZHGIG FIKM[ FYCEF CYT QDC OKENKC ZGHIN FJGR GH
KRPKSC BJC\PG SDF KTPF \B ZYKTC UYG\ FH NKVJ :FCKPB
IKM[ FH NKVJ .(QJC KCBMG KPE NG[N[ ,FGCD OGI) FVKZI \YNE
.FMGPR FBGZC\F \PZ FC FCKCSC ZYKTC
OZGD BGF .OKZIBFP \GIV ZMGP FHF NKVJF :OGKEKZGVSGJVKZY
OT OK[RB CZYC EIGKPCG \GYGRK\ NXB ZYKTC OKKPKP OKNG[N[N
.QGSKIF \MZTPC N[M
ZEGI FNIPF OZGD[ HBP UNGIF QPHM \ZEDGP :FZKDEF \VGY\
ZVSP QKC TRF QPHC ZCGEP NNM LZEC .FNIPF KRPKS \TVGF ET UGDN
.OKPK ZVSP ET \GT[
?NG[N[F OZDR FPP
KVN OKRG[ OKRGRDRPC ZCGEP F[TPNG ,OKMCGSP NG[N[F KRGRDRP
,OKP \DKVSC FTZVFN OZGD[ ,KTPF \KZKZN ZK[K YHR :FNIPF OZGD
OKRNTZ OF[ OKRKSYGJ \[ZVF ,OKZMGS ZYKTCG QGHP \DKVS
KB\N ZK[K YHR OKPZGD[ GB ,KTPC OKINPG OKP \DKVSN OKTKZVPF
\KRGSKIF FCGD\F K"T [KZVP UGDF[ OKZPGI .KTPF N[ \KZKZF
FCGD\F LNFPC KTPC \KR[P FTKDVN OKPZGD OF OD ,OGFKHN
EGCKB FRKF \NNGMF FBXG\F .KTPF \KZKZC \ZXGRF \K\YNEF
UBG \K\GTP[P \G[CKK\FN BKCFN NGMK ZCEF .QGHP KZPGIG OKNHGR
OGZDN NGMK \KZKZN KR[PF YHRF .UGDC OKINPF QHBPC \GTZVFN
\CKKIPF FTVG\ ,OGFKHF UGNI KZIB OKM[GPP OKNG[N[ N[ FTVG\N
.\EIGKP \KNGVKJ \GSIKK\F
OGFKHF \GZGYP
\G[ZVF OT TDP K"T OEB KRC QKC ZGCTN OKJGR NG[N[N OKPZGDF
.USGR FZCTF KTXPB OKGGFP OKP \GZGYPG QGHP .G\CKCS GB FNGIF
YEKKI :OYNI NT EGPTN KBEM[ OKKEGIKK OKRKKVBP [K OZGD NMN
\B ZKCTFN OKNGNT QGHP KZXGP OD ONGB ,OEB KRC YZ UYG\ FNDK[F
FBGXC [ZVGP FH YEKKI .L[GPP QPHN UG[I QGHP EIGKPC ,FNIPF
OK[RB YCEKFN OKNGNT LMG NG[N[F \VGY\C OKPK ZVSP L[PN
FNRGPNS KYEKKI ,\BH \PGTN .\G[ZVFF OT TDPC OKBCF FCKCSC
ONGB .ZGZC ZGYP FGGFP FNGI OEB .OKRG[ \GZGYPP BGCN OKNGNT
KNCP FBGXC L[GPP QPHN YEKKIF \B OK[KZVP OK[RBFP YNI
YCEGPF OEBF OBC EIGKPC JNGC ZCEF .(OKB[R) FNIP KRPKS GBZK[
.OKCZ CZYC FNIPF \GXZV\FN OGZDN NGMK FH .QGHP \RMFC ECGT
OKGGFPF OKCX N[PN ,EPIP \GKI ,OKXKCCG \GVGTC WGVR FNGPNSF
Z[BM .ZYC QGDM \GKIC BXPR ZJYCGNKVPY YEKKIF .FYCEF ZGYP
OT TDPC OKBCF OKZIBN OGFKHF \B ZKCTP BGF FNGI OEBF
,N[PN .OKYEKKIF N[ FYCEFF \NGMKC OKNECF OKPKKY .GK\G[ZVF
FBGG[FC FYCEFN OGZDN OKNGMK FNDK[F KYEKKI N[ JTGP ZVSP
.FNRGPNSN
\GKPGFKH \GNIP
SKSY EBPT Z"E
OKENK \GKPGFKH \GNIPN FYNIPF
FVKI ,O"CPZ KBGVZF HMZPF
NM JTPM .NKDF \GXGCY NMC KEPN FIKM[ FTVG\ ORKF OKNG[N[
Z[B \GRKEPC .GKKIN \GRG[BZF OKR[C NG[N[ N[ TGZKBP NCGS ENK
OKMVGF ,OKEGZK KBGVZF NGVKJFG FRKKDKFF ,OKKIF \PZ QFC
FBGNI\C FGGNPF F[Y \K\ZCIG \KBGVZ FKTCN OKNG[N[F
OKNCGS BNKPP[ OKENK CZYC ZYKTC ,\GK\GTP[P F\GP\G
.FRGH\=\\P
QGER FHC .NGMKTF KMZEC OKPGFKH GRKF OKNG[N[N TKZMPF OZGDF
.GH FZKYSC
OKIKM[ OKKPGFKH OKPZGD
\B UYG\ Z[B KPGFKHF OZGDC FYCEF CYT OKPZDR OKNG[N[
:\GBCF \GXGCYF KVN FNIPF KPZGD \B YNIN Q\KR .NGMKTF \MZTP
.KB ,FNDK[ ,FNRGPNS GPM OKYEKKI OKNNMR GH FXGCYC :OKYEKKI
OKZGHKBN \NCDGP FZNGMF .OKZIBG ,ZJYCGNKVPY ,KRDG\V KNGY
.OKKPERB
\GRG[ \GKVKDR \GNIP .Rota=F UKDR GRKF Z\GKC IKM[F :OKVKDR
FRGZIBN .(Enterovirus =G Adenovirus) NG[N[C OK\TN \GGNP
\GKRGICBF \GKDGNGRMJF[ NMM ,OKVSGR OKVKDR NT OKIGGKEF OKCZ\P
.(OKZIBG Astrovirus) \GPEY\P
Cryptosporidium, Amoeba, Giardia =C ZYKTC ZCGEP :OKNKVJ
.Lambia
FNIPF N[ OKKRKNY OKRPKS
OK\KTNG QJC KCBM ,\GBYFG \GNKIC ,OKNG[N[C ZCGEP NNM LZEC
.([CGK) \GIKIX KRPKSN BKCP OKNHGR N[ K\GTP[P EGCKB .FGCD OGI
.OZGD NMN OKEIGKP OKRKKVBP [K ONGB
[K OK\KTN .OKRJY OKENKG \GYGRK\ YKCEFN FJGR FH UKDR :Rota
FTVGFC ZCGEP CGZN .FPK[RF KMZEC OGFKH N[ OKPKEYP OKRPKS
UBG \GBYF ,FGCD OGI OK\KTN .CZ IVRC KPKP NG[N[ N[ \KPGB\V
FBKCPF ,YEF KTPF \KZKZC UKDRF N[ FTKDVF ZYKT .OKSGMZKV
OB CNIC KZYKTF ZMGSF) FHGJYN YGZKVCG OKP \DKVSC FTZVFN
,OKYZGVP BN OKZMGSG OKNHGRC UXGP SDF KTPF \BH CYT .(FZV CNIG
OKRJY \GYGRK\ OKDKZI OKCXPC .OKNHGRF EGCKB \B ZKCDPF ZCE
.NG[N[F \TVGF OT ZCM OKJNGC \GIKIX KRPKS OKBZP
YNIG ZJYCGNKVPY ,FNDK[ ,FNRGPNS QGDM OKIKM[F OKYEKKIF
OZGD KTPN YHRF .SDF KTPF \KZKZ \B ZYKTC OKVYG\ KNGY .KB KRHP
QPHC OKCBM) SGPHRJ ,\GCGZPG \GRJY \GBKXKN FKKJR ,QJC KCBMN
.GN[P OKKEGIKK OKRKKVBP [K YEKKI NMN .FGCD OGIG ,(FBKXKF
FGGNPF \ZTGS Z\GK FNIPN OGZDN FJGR FNDK[F YEKKI ,BPDGEN
\GKDGNGZKGR \GTZVF I\V\FN \GNGNT OK\KTN .(FKZJRSKE) FGCD OGIC
.Z\GK \M[GPP FNIPN OGZDN FJGR FNRGPNSF YEKKI .OKSGMZKVG
LM .OEF OZH LG\N KTPF \KZKZ LZE [NGV YEKKIF OKNGIFP YNIC
OKMKK[F OK[RBC EIGKPC ,OKKR[P OKMGCKSG L[GPP OGI OKPZDR
.\GEIGKP QGMKS \GXGCYN
10
\GKGZKBPP ,\K[PZI FKPRB ,QGSKIF \MZTPC \GPKGSP \GTZVF
FZGZC \GET ONXB [K[ OK[RB ,QCGPMG (SGVGN) \CBH ,\GKDGNGJPF
.OEF OZHN YEKKIF \[KNVN
\B QKJYFN KG[T OEYGP KJGKCKJRB NGVKJ :KRG'D'D ZJYCGNKVPY
YEKKIF \B OKFHP Z[B ET ,ONGB .\PKGSP FEKPC FNIPF L[P
\B ZXYP KJGKCKJRB NGVKJ .BKZCP ZCM OEBF CGZN ,FBGXF \KCZ\C
FYCEFF \B QKJYFN KG[T LMG FBGXC [ZVGP YEKKIF FC FVGY\F
.\KR[PF
,OKPKGSP OKCXPC .GPXTP ZE\SP FNGIF NNM LZEC :KNGY.B
OKZK[M\C (O157) FH YEKKI N[ EIGKP QHP GNI[ OKENK GNVGJ OFC
I\VN Z\GK FGCD QGMKSC GKF FNBF OKENKF KM BXPR ,OKKJGKCKJRB
.(\KPKZGB \KJKNGPF \RGPS\) FNIPF N[ ZKER LGCKS
NCGSF FNGIC FNIPF OZGD \B [BZP \GFHN Q\KR BN CGZN
NGVKJ NCYK OKNGIFP NGED YNI ,ENKG FNGI NMC NVJR OB .OKNG[N[P
FZKICC ,QM OB BKF FKTCF .YKHFN UB NGNT[G OBG\ K\NC ,Z\GKP
.NGVKJFP GRFKK[ OKNGI O\GB N[ FRGMR
.ONGF ZK[M\ K"T GRKF FCPBG FKEZBK'D K"T OGFKHC NGVKJF
KPZGD OKVKDRC NGVKJN OKK\ZD[ OKNKTK OKZK[M\ OKPKKY BN
.OGKEKZGVSGJVKZYCG OKNG[N[F
OKNGMK FYKJGKCGZV OKNKMPF OKZK[M\ KM \GKGET GVSGR FRGZIBN
.NG[N[F \VGY\ ZGXKYN OGZ\N
OKHPZ YVSN FKG[T VGYSGZYKPC FBGX \YKEC :QGICBF \GJK[
OE \GKZGEMG OKRCN OE KB\ KGCKZ) KYEKKI NG[N[C ZCGEP OBC
OKB\PF KJGKCKJRBF ZK[M\F \YKECG YEKKIF KGFKH O[N .(\GPGEB
OKKY .FCG[\F \NCY ET OKPK ZVSP OKXGIR .FBGX \KCZ\C LZGX [K
FKEZBK'D KNKVJ .FBGXC FJGZ KVKDRN ZKFP FYKEC KTXPB YG[C
\GKDGNGRMJC GB OKKVGYSGZYKP OKTXPBC OKFGHP OGKEKZGVSGJVKZYG
CYT ZYKTC \BHG EIGKP ZD\B FGGFP FBGXC FCKPB KGFKH .\GEIGKP
\GECTPF CGZN .FNIP \GPZGD QRKB[ FBGXC \GCPB KDGS N[ OPGKY
.FYKHP FRKB[ FCPB QKCG \KR[NGV FCPB QKC NKECFN OKTXPB QKB
OKCXPC .FYKECF \GBXG\ \KKJFG FRICBC NGCNCN \PZGD GH FECGT
LZGX [K ,(FNRGPNSP ZYKTC) OEC KR[NGV OGFKHN E[I OKKY OFC
\G[CKK\F KRPKS \GFHN \GNGMK Q\[G OE \GYKEC .OE \GKCZ\ \NKJRC
.OKINPFG OKNHGRF QHBPC \GTZVFG
NGVKJ QPHC FRKKDKF KNNM NT FZKP[C LZGX [K :FNIPF \TKRP
,ONGF KGJKI ZPGI GB QGCSG OKPC \KEGSK OKKEK \XIZ ZYKTC ,FNGIC
NG[KCC LZGX [K QM QPM .GK\G[ZVFG ,GKNM ,FNGIF OT TDP KZIBG KRVN
NT FZKP[C ,FNIPF \B ZKCTFN OKNGNTF QGHP KZXGP N[ KEGSK
,OGIC \GT[ L[PN QGHPF \VK[IP \GTRPKFC ,QGHPF N[ \GBR QGSIB
OKPF \I\ZFC ,OK[EI OKZGHKBN \GTKSRC OKEIGKP \GIKJC KNNMC
OKKI KNTC \G[ZVF OT TDPP \GTRPKFCG OKPFGHP \GKFN OKNGNTF
.EPIP \GKIG
GNB LB .OKRG[ IG\KV KCN[C OKBXPR NG[N[F KPZGDN OKRGSKI
.K\ZD[ [GPK[C ORKB QKKET
\GZGYP
1.
Ramaswamy K, Jacobson K. Infectious diarrhea in children.
2.
Robins-Browne RM, Hartland EL.
Gastroenterol Clin North Am 2001 Sep;30(3):611-24.
Eschrichia coli as a cause
of diarrhea. J Gastroenterol Hepatol 2002 Apr;17(4):467-75.
3.
Farthing MJ. Oral rehydration: an evolving solution. J
Pediatr Gastroenterol Nutr 2002 May-Jun;34:Suppl 1:S64-7 .
(.\MZTPC OKZGP[ \GZGYPF ZB[)
11
WGVR QG[BZF .OKXGVR OKNKVJ ORKF OGKEKZGVSGJVKZYG FKEZBK'D
OK[ZVGP FNBF OKNKVJF .OKENK KRDC ZYKTCG OKENK CZYC EIGKPC
OKENK Z\GKG Z\GK .FCKCSF KBR\N \GEKPT \GJSKX \ZGXC FBGXC
KP \GZGYP OGFKH OK\KTN .FVN ZCTPG OKKEK TDP K"T OKYCER
WZBC NKVJN FVK[I GB OKTGZKBC OFGHP QGHPC [GPK[ ,FKK\[F
.K\CZ \GXZV\FN UBG FYCEFN OGZDN OKNGMK \ZIB
NGVKJF
,GRKKFE ,(self-limited) QPHC \GNCDGPM \GC[IR \GNIPF CGZ
.\GCZT\F BNN OD ,OKPK ZVSP LG\ BKZCP FNGIF
OKNGIG OKENKC EIGKPC ,\G[CKK\F \TKRP GRKF KZYKTF NGVKJF
LZE OKNHGR Q\P K"T FNKFYC OKNVGJP OKZYPF CGZ .TYZ \GNIP OT
\B \GRKJYPF \GVGZ\ \NKJRP TRPKFN KGXZ .FPKB\P FRGH\G FVF
OKR[ \GZ[T L[PC .KTPF \GK\TGR\ \\IVF K"T NG[N[F \GZKE\
\GPM OKNGIN YVS\[ OKNHGR N[ FISGR \BKXP NT OKRTEP GEY[
OGKF OKXVGP FNB OKZK[M\ .F[KDR FKF\[G OKINPG OKP N[ \RHGBP
Z[B = Oral Rehydration Solution = GHF "FBXPFF" .ONGTF NMC
\YVSP ,OKGSP HGMKZC OKPG ZMGS ,OKINP N[ FDKHP NMF LSC FRKF
\GBKXPF ,TCJF[ \GCKSRC OKKI \NXFN KTXPB ONGTC OKCZ OKENKN
KCXP CGZN OKCGJ FNB OKZK[M\ .OEDRM OKNTGV \KNMNMFG \K\ZCIF
OFKRKPN OKXKPG HZC KP GPM ,OKRG[ OKNHGR KM ZGMHN [K .NG[N[F
\KRGRKC \G[CKK\F KCXPC .NG[N[P OKNCGSF OKENKC OKPNGF ORKB
OKINPF QHBPC \GTZVF ,\GCZ \GBYFP NCGS FNGIF Z[BM ,F[Y ET
\KCC EGPX NGVKJC LZGX [K ,OKZIB OK[Y KR[NGV OGFKH KRPKS GB
CKMZP .FNGIF KMZGXN OKPB\GPF OKINPG OKNHGR KGZKT K"T ,OKNGI
WKNPFN OKBVGZ GDFR ZCTC .QGHPF \PB\F GRKF CG[I \GIV BN ZIB
\NCGYP FRKB GH FTE .NG[N[ OT OKENKC EIGKPC FRHFF \YSVF NT
.FNGIF CXPN OB\GP NMGB \\N BKF FRG[BZF \GVKETF CGZN .OGKF
.QMN OEGY NCKY FNGIF[ QGHP G\GB OT LK[PFN KGXZ NNM LZEC
KGRK[ NGY[N [K OKM[GPPG OK[Y OKNG[N[ [K OFC OKCXPC
.OB\FC QGHPF \NGPZGVC
KJGKCKJRB K\VGZ\ NGVKJ Q\P N[ FNB[F :OKK\VGZ\ OKNGVKJ
NGVKJ Q\PP TRPKFN GB \\N OBF OKNGYK[F .\CMZGPG FMGCS FRKF
:OKNNM FPM ZGMHR FCF .CXPN CXPP OKRG[ K\VGZ\
KZYKTF TGRPF \B FGGFP OKKJGKCKJRB OKZK[M\C Z\K [GPK[
NMC \PKKY GH FKTC .FYKJGKCKJRBN OKEKPT OKYEKKI \GI\V\FN
,LMP FZ\K .KRGPXT QVGBC FNB \GNIPP OKBKZCP CGZN .OGKM ONGTF
OKZGPI NG[N[ KCXP .OKNG[N[F \B ZKCDP KJGKCKJRB NGVKJ OK\KTN
.FYJGKCKJRBC L[GPP [GPK[P ZXGGKFN OKNGNT
\B ZXYP ONGF KJGKCKJRB NGVKJ KM BXPR :FNDK[ KYEKKI
ZCE ,FBGXC YEKKIF N[ FZKFP \GPNTKFN OZGDG FNIPF \VGY\
NGVKJF OB ZGZC BN ,LEKBP .\KR[P FYCEFN QGMKSF \B QKJYPF
FKKNT FNI \GRGZIBF OKR[C .OK[YFG OKEEGCF OKMGCKSF \B TRGP
DGFR[ OKKJGKCKJRBF OKZK[M\N FHF YEKKIF N[ \GEKPTC \ZMKR
OEYGP FRGMR FVGZ\ \\N KGMKSF QM NTG FH CXPC O\GTXPBC NVJN
.QJY ,FNIPF LNFPC
FVGY\F \B LKZBFN NGNT KJGKCKJRB NGVKJ :FNRGPNSF KYEKKI
\[KNV N[ OKRPPS \GIMGRC ,LEKBP .FBGXC YEKKIF [ZVGP FC
QGMKSF \B QKJYPG KRGKI GRKF KJGKCKJRB NGVKJ ,OEF OZHN YEKKIF
OGFKHN E[I OKKY OFC[ \GCKSRC FH CXP NT EGPTN CG[I .OKMGCKSN
OT OKNGIG OEF OZHC OGFKHN OKRPKS OT OKNGIC ,OKRJY \GYGRK\C
OT OKNGI QGDM ,FNRGPNSP F[Y OGFKH I\VN OKNGNTF TYZ \GNIP
\GKPGFKH \GNIP