GB 16002-1995 Diagnostic criteria and treatment principles for bacillary dysentery and amoebic dysentery
Some standard content:
GB16002-1995
Bacillary dysentery (hereinafter referred to as bacillary dysentery) is an acute intestinal infectious disease caused by Shigella (also known as Shigella dysenteriae). It is a common and frequently occurring disease. Its incidence ranks first among the Class A and Class B infectious diseases that are legally reported in my country, and it often causes outbreaks or epidemics, which has a great impact on the labor force. This standard is specially formulated in accordance with the "Law of the People's Republic of China on Infectious Diseases" and the "Detailed Rules for the Implementation of the Law of the People's Republic of China on Infectious Diseases". Appendix A and Appendix B of this standard are appendices to the standard. Appendix C and Appendix D of this standard are appendices for reminders. This standard is proposed by the Ministry of Health of the People's Republic of China. The responsible drafting unit of this standard is Beijing Municipal Health and Epidemic Prevention Station, and the participating drafting unit is the First Hospital of Peking University of Medicine. The main drafters of this standard are Jiang Sufang, Lu Wenbin, Che Wenxi, and Wang Qinhuan. This standard is interpreted by the Ministry of Health's technical management unit, the Office of Supervision and Administration of Infectious Disease Prevention and Control. 437
1 Scope
National Standard of the People's Republic of China
Bacillary and amebic dysentery
Diagnostic criteria and principles of managementof bacillary and amebic dysentery This standard specifies the diagnostic criteria and prevention and treatment principles of bacillary and amebic dysentery. GB16002—1995
This standard is applicable to medical and health and epidemic prevention institutions at all levels as the basis for the diagnosis and prevention and treatment of bacillary and amebic dysentery. 2 Referenced standards
The provisions contained in the following standards constitute the provisions of this standard through reference in this standard. When this standard is published, the versions shown are valid. All standards are subject to revision, and parties using this standard should explore the possibility of using the latest version of the following standards. GB4789.4-94 Food hygiene microbiological examination Salmonella examination GB4789.5--94 Food hygiene microbiological examination Shigella examination GB4789.6-94 Food hygiene microbiological examination Diarrhea Escherichia coli examination 3 Diagnostic criteria and treatment principles for bacterial diseases
3.1 Diagnostic principles
A comprehensive diagnosis must be made based on epidemiological history, symptoms and signs, and laboratory tests. Confirmation must rely on etiological examinations. 3.2 Diagnostic criteria
3.2.1 Epidemiological history: The patient has a history of unclean food or contact with patients with bacterial epilepsy. 3.2.2 Symptoms and signs
3.2.2.1 Acute atypical bacterial epilepsy
The symptoms are mild, and there may be only diarrhea and loose stools.
3.2.2.2 Acute common (typical) bacterial
Acute onset, diarrhea (excluding diarrhea caused by other reasons), abdominal pain, tenesmus, may be accompanied by fever, bloody or mucous stool, tenderness in the left lower abdomen.
3.2.2.3 Acute toxic bacterial epilepsy
Acute onset, high fever, severe toxemia symptoms, children may not have obvious abdominal pain and diarrhea symptoms at the onset, often need to be checked by enema or anal swab to find out that it is bacillary dysentery. According to the main clinical manifestations, there are the following types: shock type (peripheral circulatory failure type): there are infectious shock symptoms, such as pale complexion, cold limbs, thin and rapid pulse, decreased blood pressure, skin rashes, hair knots, etc.
Cerebral type (respiratory failure type): there are manifestations of cerebral edema, such as irritability, convulsions, drowsiness or coma, pupil changes, and even brain herniation and respiratory failure.
Mixed type: Symptoms of shock type and brain type appear at the same time, which is the most dangerous type. Approved by the State Administration of Technical Supervision on December 15, 1995 438
Implemented on July 1, 1996
3.2.2.4 Chronic bacillary dysentery
GB 16002--1995
Acute bacillary dysentery is considered chronic bacillary dysentery if the course of the disease exceeds 2 months. 3.2.3 Laboratory examination [See Appendix A (Standard Appendix) 3.2.3.1 Routine stool examination, white blood cells or pus cells ≥ 15/HPF (400 times), red blood cells can be seen. 3.2.3.2 Etiological examination, stool culture Shigella genus positive is the basis for diagnosis. 3.2.4 Case classificationbzxz.net
3.2.4.1 Suspected cases, diarrhea, bloody stool, mucus, watery stool, or loose stool, accompanied by acute and severe symptoms, and it is difficult to determine other causes of diarrhea.
3.2.4.2 Clinically diagnosed cases, with any of 3.2.1, 3.2.2 and 3.2.3.1, and excluding diarrhea caused by other reasons. 3.2.4.3 Confirmed cases, with any of 3.2.3.2 and 3.2.4.2. 3.3 Principles of prevention and treatment of bacterial epilepsy
3.3.1 Principles of prevention [see Appendix B of the standard) should focus on cutting off the transmission route, while strengthening comprehensive prevention and control measures for the management of the source of infection. Special attention should be paid to preventing outbreaks or epidemics for key populations and collective units.
3.3.2 Principles of treatment [see Appendix C and Appendix D (suggested appendix) 3.3.2.1 General and symptomatic treatment.
3.3.2.2 Pathogen treatment: Antibiotics should be used in time, with a course of 5~~7 days. 3.3.2.3 Treatment of shock-type bacterial epilepsy Anti-infection, anti-shock. 3.3.2.4 Treatment of brain-type bacterial epilepsy Anti-infection, prevention and treatment of cerebral edema and respiratory failure. 4 Diagnostic criteria and treatment principles of amoebic dysentery 4.1 Diagnostic principles
Diagnosis is based on comprehensive analysis of clinical symptoms and signs and laboratory tests. 4.2 Diagnostic criteria
4.2.1 Symptoms and signs
4.2.1.1 Acute amoebic dysentery (common type): Slow onset, abdominal pain, diarrhea, moderate stool volume, blood and mucus, dark red like jam, fishy smell, tenderness in the right lower abdomen
4.2.1.2 Fulminant amoebic dysentery: Acute onset, obvious symptoms of poisoning, high fever, abdominal pain, diarrhea, dozens of bowel movements per day, even incontinence, watery or bloody stools, very smelly, dehydration, electrolyte imbalance, shock may occur. 4.2.1.3 Chronic amoebic dysentery: Often a continuation of the acute type, the course of the disease exceeds several months, and symptoms persist or recur. 4.2.1.4 Asymptomatic cystic type (also known as protozoan carrier state): Asymptomatic, Entamoeba histolytica cysts can be seen in stool examination. 4.2.2 Laboratory examination
Stool examination: Acute and fulminant stool smear examinations can reveal a large number of red blood cells, a small number of white blood cells and trophozoites of Amebiasis histolytica. Trophozoites and cysts can be found in chronic cases, and amebiasis cysts can be found in patients who excrete cysts. 4.2.3 Case classification
4.2.3.1 Suspected cases: Patients with a slightly slower onset, diarrhea, dark red stool, bloody or mucous stool, or loose and mushy stool with a fishy odor, and it is difficult to determine other causes of diarrhea.
4.2.3.2 Clinically diagnosed cases: Patients with any of 4.2.1 and 4.2.2. 4.2.3.3 Confirmed cases: Patients with any of 4.2.1 and 4.2.2. 4.3 Principles of prevention and treatment of amebiasis
4.3.1 Principles of prevention [See Appendix D (Suggested Appendix) for details] Comprehensive prevention and treatment measures should be taken to cut off the transmission route. See Appendix C (Suggested Appendix). 4.3.2 Treatment principles
GB16002—1995
4.3.2.1 General treatment: Same as bacteria [see Appendix C (suggested appendix) for details]. 2 Pathogen treatment
4. 3. 2. 2
1 Nitroimidazoles Metronidazole (Flagyl). 4.3.2.2.1
2 For fulminant type, in addition to pathogen treatment, antibiotics should be used at the same time if there is a concurrent bacterial infection. 4.3.2.2.2
A1 Microscopic examination
A1.1 Routine stool examination
A1.1.1 Stool characteristics
GB16002-1995
Appendix A
(Standard Appendix)
Laboratory diagnostic methods
Acute bacillary dysentery has very little stool volume, which is sticky purulent and bloody stool and mucus stool, without fecal matter; sometimes it is loose stool, watery stool. A1.1.2 Microscopic examination
A1.1.2.1 Add 1 to 2 drops of normal saline on a clean glass slide, use a toothpick to select abnormal parts and different parts of the stool, and directly smear. A1.1.2.2 The coating area should be no less than 2/3 of the size of the glass slide, and the thickness should be uniform. A1.1.2.3 Observe with a low-power microscope first, then switch to a high-power microscope for examination. A large number of white blood cells (or pus cells) can be seen in the feces of acute bacillary dysentery, generally with an average of ≥15 per high-power microscope field of view, and red blood cells can be seen. A2 Methods of etiological diagnosis
A2.1 Collection of specimens
A2.1.1 Collection of stool specimens from patients
Feces can be collected by stool box, anal swab or stool collection tube. Stool box: When collecting stool, the pus and blood part, mucus part, watery stool or loose stool of fresh stool should be collected. The stool volume is 1 to 5g. The amount of stool collected from patients with collective diarrhea or foodborne outbreaks should be determined according to the number of patients. A2.1.2 When a patient is suspected of bacteremia, 10~15 mL of blood should be collected from the vein with aseptic operation and placed in a bottle with EDTA anticoagulant for examination.
The stool specimen should be sent to the laboratory as soon as possible and should not exceed 2 hours. Otherwise, the specimen should be placed in Cary-Blair transport medium. If the transport time exceeds 2 hours, it should be sent to the laboratory under ice bath conditions. A2.2 Separation method
A2.2.1 Use an inoculation loop to dip the lesion part of the specimen at multiple points, and directly streak it on SS, EMB (or HE, MacConkey) agar plates. Culture at 37C for 24 hours.
A2.2.2 Blood culture
Put the anticoagulated blood specimen into glucose broth, culture at 37℃, and observe the results daily. Generally, the positive rate is higher within 1 to 3 days. To increase the positive detection rate, 0.5 mL of OP emulsifier (polyethylene glycol octylphenyl ether) can be added to the specimen to dissolve the blood cells, so as to increase the positive detection rate.
A2.2.3 Select suspicious colonies
From the separation culture medium cultured at 37 (16 to 24 hours), observe and select suspicious colonies, which are colorless, translucent, round, moist, smooth, and sinus-shaped, with a size of 1 to 2 mm; select suspicious colonies, inoculate TSI and glucose semisolid or comprehensive culture medium, first draw a line and then puncture, mark well, and culture at 37℃ for more than 16 hours to observe the results. A2.2.4 Preliminary biochemical reaction
The biochemical reaction of Shigella on TSI is: the inclined surface is red, the bottom layer produces acid yellow, and no gas is produced. The acid produced in the glucose semisolid tube is yellow, no gas is produced, and there is no power. On the comprehensive culture medium, it is: the inclined surface is red, the neutral section produces acid yellow, and the bottom layer is green , no power. Shigella flexneri type 6 can sometimes produce a small amount of gas in the above three culture media. A2.3 Biochemical identification
A2.3.1 All cultures of Shigella should meet the biochemical characteristics listed in Table A1. 4.11
Indigo
Methyl red
Simmon's citrate
Hydrogen sulfide
Phenylcarboxylic acid
Lysine
Arginine
Insulamic acid
Renolate
D-glucose acid production
D-glucose gas production
D-mannitol
Dysostigmine
—1995
GB 16002
Shigella system biochemical reaction
Note: +, 90% to 100% positive; (+), 76% to 89% positive; d, 26% to 75% negative (-), 11% to 25% negative; -, 0 to 10% negative; (d), delayed positive, 72 h or more. Salicin
D-aconitol
D-sorbitol
L-arabinose
raffinose
L-rhamnose
maltose
D-xyloglucan
cellobiose
α-methyl-D-glucoside
esculin
meticulose
D-arabinose
D-mannose
A2.3.2 Shigella is divided into four biochemical groups. Those whose serological typing and biochemical reactions are inconsistent are all non-Shigella. B
() (-)
A2.3.3 Biochemical reactions Cultures with suspicious or serological reactions should be subjected to Gram staining microscopy, and VP, phenylalanine, Simon's citrate, lysine and glucose ammonium tests should be performed to distinguish them from related bacteria. A3 Methods for the diagnosis of amoebic dysentery
A3.1 Direct smear method
A3.1.1 Take a clean slide and drip 1-2 drops of saline in the center. A3.1.2 Use a bamboo stick to pick up a small piece of feces and smear it in the saline to form a fecal film with a diameter of 1 cm. The thickness should be such that the words on books and newspapers can be clearly seen through the fecal film.
A3.1.3 After covering with a coverslip, observe under a microscope (pay attention to the heat preservation of the slide when it is cold). A3.2 Iodine solution slide method
The smear preparation method is the same as A3.1, only iodine solution is used instead of saline to prepare the smear. The cysts are brown, the glycogen vesicles of immature cysts are brown, and the nucleus and cyst wall are not colored but transparent.
A3.3 Iron hematoxylin staining method
A3.3.1 Use fresh feces to make a thin film on the slide. A3.3.2 Immediately put it in Shaw's fixative heated to 40°C for about 3~~5 minutes. If the fixative temperature is lower than 40°C, it takes 15~~30 minutes. A3.3.3 Then put it in 70% alcohol for 5~~10 minutes, then move it to 70% iodine alcohol to remove the mercury for more than 10 minutes, so that the smear turns brown. A3.3.4 Put it in 70% alcohol for 1 hour or overnight, and then put it in 50% alcohol for 5 minutes. 4.42
GB16002—1995
A3.3.5 Gently rinse with running water for 10 minutes, then rinse with distilled water. A3.3.6 Place in 20g/L iron alum solution heated to 40°C for mordanting for 2 minutes or in 40g/L iron alum solution for 16 hours, then rinse with tap water for 5 minutes.
A3.3.7 Transfer to 5g/L hematoxylin staining solution for 1 to several hours or overnight, then rinse with tap water for 5 minutes. A3.3.8 Place in 20g/L iron alum solution for 20 minutes, until the color is appropriate and the cell nucleus is clearly visible, then rinse with running water for 5 minutes.
A3.3.9 Place in 50%, 70%, 80%, 90%, 95%, and 100% alcohol in turn for 2 to 10 minutes each. A3.3.10 Place in a solution of half xylene and half pure alcohol and in pure xylene for about 2 minutes each to make it transparent. A3.3.11 Seal the slide with neutral gum, dry, and examine under a microscope. A3.4 Staining results
The nuclear membrane of the trophozoite is dark blue-black, the nucleolus and the nuclear membrane are clear, the chromatin particles in the nuclear membrane are distinct, the cytoplasm is blue, and the food vacuole contents are dark blue. The cyst is blue, and the nucleus and trophozoite are clearly visible. The red blood cells are red, the pseudochromosomes are dark blue-black, and the glycogen vesicles are dissolved into vacuoles during the staining process.
A3.5 Culture test method
A3.5.1 Take stool specimens, make sure they are fresh, and the instruments used are clean. Do not mix urine or water into stool or containers. A3.5.2 When collecting specimens, choose the pus, blood, and mucus parts; for normal stool, take samples from different parts. 5 to 10 g of formed or semi-formed stool should be taken and placed in a stool box. Liquid or semi-liquid feces can be placed in a test tube or specimen bottle with a small spoon. Any container should be covered, and the outside of the container should not be contaminated with feces.
A3.5.3 After the feces are collected, they should be sent for inspection immediately, and the inspection must be carried out within 2 hours. A3.5.4 Culture method (polyhabitat culture method) A3.5.5 For formed or semi-formed feces, use a sterile inoculation loop to take a pea-sized amount, inoculate it in the liquid part of the culture medium, and gently grind it on the wall of the tube to mix the feces in the liquid.
A3.5.6 For liquid or semi-liquid feces, use a sterile pipette to suck up 0.5mL of fecal liquid and inoculate it into the liquid part of the culture medium. A3.5.7 Place in a 37C incubator and culture for 48 hours. Use a pipette to take a drop of sediment and apply it for inspection. See A3.1 for the method. A3.5.8 If the test result is negative, 0.5 ml of sediment should be drawn from the bottom of the culture tube and transferred to another culture medium. After 48 hours of culture, if it is still negative, report it.
Appendix B
(Standard Appendix)
Prevention methods (bacterial and amebic dysentery) B1 Management of infectious sources
Infectious sources: acute and chronic patients and carriers. Acute patients should be isolated and treated. Patients in key industries such as cooking staff, food production and sales staff, water source management staff, and childcare and teaching staff in childcare institutions should be immediately transferred from their original jobs, visited and managed in a timely manner, and given full treatment until the symptoms disappear and the second stool culture is negative before the isolation can be lifted. In the absence of stool culture conditions, the isolation should be lifted one week after the symptoms disappear (the same principle applies to the treatment of childcare institutions after illness).
People with chronic diseases and carriers should be visited regularly, and the most sensitive drugs should be selected through drug sensitivity tests for thorough treatment. The visit management can be lifted only when the stool culture is negative for three consecutive times (each time with an interval of one week). People with chronic epilepsy and carriers are not allowed to work in the above-mentioned key industries.
Close contacts in the outbreak should be placed under medical observation, and antibiotics can be administered for prevention in a small range: norfloxacin 0.4g Bid for three consecutive days. Compound sulfamethoxazole (each tablet contains SMZo.4gTMPo.08g) 2 tablets Bid for adults, for three consecutive days. 4.43
B2 Cut off the transmission route
GB16002—1995
Transmission route: fecal-oral route, can be transmitted through food, water, daily contact with patients, and unclean hands contaminating food, tableware, toys, and utensils.
Comprehensive prevention and control measures including water sources, food, environmental hygiene, and elimination of flies, cockroaches and their habitats should be strengthened, that is, three controls and one elimination (control of water, control of feces, control of food, and elimination of flies), strengthen the management of drinking water sources and drinking water hygiene, especially for surface water in summer and rainy season, water hygiene indicators should be monitored well, and there should be no toilets, pig pens, barns, garbage dumps and other pollution sources within 50m around the water source, and at the same time, disinfection of drinking water should be done well. Effectively implement food hygiene measures: separate raw and cooked food, disinfect the feces of patients (bleaching powder, the ratio of feces to medicine is 5:1, and it should be fully mixed), separate goods and payments, do not buy, sell, or eat rotten and spoiled food, wash hands before and after meals, and prevent diseases from entering the body through the mouth. An outbreak should be reported immediately, and the relevant health and epidemic prevention departments should quickly go to the scene to investigate and verify, find out the cause of the outbreak as soon as possible, and take decisive measures to cut off the transmission route to prevent the spread of the epidemic. B3 Others
Key industries such as food preparation and sales personnel, cooking personnel, water source management personnel, and childcare personnel should undergo regular (at least once a year) health examinations and fecal culture to detect cases as early as possible. Newly transferred personnel must undergo health examinations and training before taking up their posts.
People in key industries should receive annual training on health knowledge or strengthen food hygiene knowledge, insist on holding certificates to take up their posts, and strictly implement the Food Hygiene Law.
Medical units should make early diagnosis and early report for each case. Promoting isolation and disinfection knowledge to patients, implementing various disinfection measures, and disinfecting toilets used by patients every day to prevent cross infection. Various forms of health and disease prevention knowledge should be promoted and health education should be provided to the general public, cultivating the hygienic habit of hand washing, and improving the public's self-protection awareness.
Appendix C
(Suggested Appendix)
Treatment of bacillary dysentery
C1 General and symptomatic treatment
C1.1 Eat easily digestible food, pay attention to water and electrolyte balance, and give oral rehydration salts (ORS). ORS and intravenous infusion should be used at the same time when necessary. C1.2 High fever: Physical cooling is the main method. Adults can also take 0.5-1.0g of compound aspirin or 1 tablet of bami (each tablet contains 0.5g of aspirin). Children can take 10mg/(kg·time) of aspirin or nasal drops of analgin. Or 1000ml of 1% warm saline. Flow enema. C1.3 Abdominal pain: Belladonna extract tablets 8mgBid or atropine 0.3~0.6mgBid or 4id for adults. C1.4 Diarrhea: Compound camphor oral administration 2~5mLBid for adults, Imodium can also be used. C2 Pathogen treatment
C2.1 Quinolones
C2.1.1 Pipemidic acid: 0.5gBid or 4id for adults, 5~7 days of treatment. C2.1.2 Norfloxacin: 0.4gBid or 4id for adults, other quinolones such as ofloxacin and ciprofloxacin can also be used, but children should be used with caution and pregnant women should not use it.
C2.2 Aminoglycosides: Gentomycin is often used for intramuscular injection for adults, 8×10U each time, 2~3 times a day, and 2~4mg/(kg·day) for children, divided into 2 times and intravenously dripped when necessary.
C2.3 Compound sulfamethoxazole (each tablet contains SMZo.4g, TMP0.08g): 2 tablets Bid for adults, 50mg/(kg·day) for children. 444
GB16002—1995
C2.4 Ciprofloxacin (Ciprofloracin) is commonly used for the treatment of toxic bacterial pathogens: 200～400mg Bid intravenous drip for adults. C3 Treatment of shock-type bacterial epilepsy
The pathogen treatment is the same as before.
C3.1 Rapidly expand blood volume to correct acidosis: For those without obvious water and electrolyte imbalance, the daily fluid intake for adults is 2500-3000 mL; for children with mild to moderate dehydration, the total fluid intake is 120-180 mL/(kg·day). After the condition improves, water can be given, preferably 3:2:1 solution (glucose: 0.9% saline: 1/6 mol/1. sodium lactate or 5% sodium bicarbonate) or 0.9% saline and 10% glucose in half. In case of severe dehydration, the total fluid volume is 180~200mL/(kg·day). Start with 2:1 solution (0.9% saline and 1/6mol/l. sodium lactate or 5% sodium bicarbonate) or 0.9% saline 20ml, drip rapidly in 1/2h, and use 3:2:1 or 1:1 (0.9% saline and 5%~~10% glucose mixture) for the remaining fluid, half of which is dripped in about 10h, and the rest is dripped in about 14h. Potassium is given after urine is seen. C3.2 Improve microcirculatory disorders: Anticholinergic drugs shan alkaloids (654-2) are 40mg each time for adults and 1~2mg/kg for children, and are injected intravenously once every 10~15min. In critical cases, adults can use 50~60mg each time, and children can use 3~4mg/kg, until the complexion improves, the limbs become warm, the urine volume increases, and the blood pressure rises, then the dosage can be reduced and gradually stopped. C3.3 Maintaining blood pressure and protecting the function of important organs: To maintain blood pressure: 0.5~5mg/time of alamin can be used for intravenous drip, or 10~20mg can be added to 100mL of 5% glucose solution (drip rate and drug concentration depend on the patient's blood pressure) for intravenous drip; 20mg of dopamine can be added to 200ml of 5% glucose for intravenous drip. 20~40 drops/min. To protect the function of important organs: For cardiotonic agents, use 0.2~0.6mg of alamin plus 20mL of 25% glucose for slow intravenous drip for adults, and if necessary, inject 0.2~0.4mg every 4~6 hours, and do not exceed 1mg within 24 hours; for children, 0.02~0.04mg/kg. C3.4 Adrenal cortex hormone: hydrocortisone 300-500 mg/day intravenous drip, children with a total daily amount of 5-10 mg/kg, divided into 1-2 intravenous drips; dexamethasone 0.2-0.4 mg/kg for adults can also be used with a small pot of intravenous drip, which can be repeated once every 6 hours; children 1-2.5 mg each time, 1-2 times a day intramuscular injection or intravenous drip.
C4 Treatment of brain-type toxic bacterial epilepsy
Pathogenic treatment is the same as that of the body type.
C4.1 Prevention and treatment of cerebral edema: timely dehydration treatment. 20% mannitol 1g/kg rapid intravenous injection. Once every 4-6 hours, 50% glucose 80-100 ml can be given intravenously between two intervals. C4.2, adrenal cortex hormone: short-term use for 2-3 days, the same as the shock type. C4.3 Respiratory failure: Lobeline (Lobeline) 3-10 mg/time intramuscular injection, 3 mg/time intravenous injection for adults; 1-3 mg/time intramuscular injection, 0.3 mg/time intravenous injection for children. Use artificial respirator when necessary. C4.4 Convulsion: Chlorpromazine or promethazine, 50-100 mg/time intramuscular injection for adults, 1-2 mg/kg·time for children), 2-3 times a day; or barbiturate 0.2-0.3 mg/time intramuscular injection, 10 mg/(kg·time) for children; diazepam 10-20 mg/time intramuscular injection or intravenous drip; 0.3-0.5 mg/(kg·time) intramuscular injection or intravenous drip for children. Chloral hydrate 10-20 ml./time retention enema for adults, 0.4 mg/(kg·time) for children, not more than 10 ml./time retention enema.
C4.5 Others such as warming, oxygen inhalation, etc.
C5 Pediatric fluid therapy
C5.1 Supplement cumulative losses
Mild dehydration should be supplemented with 30~50mL/kg of fluid; moderate dehydration should be supplemented with 50~80mL/kg of fluid; severe dehydration should be supplemented with 80~100ml/kg of fluid. Types of fluid replacement solutions:
Isotonic dehydration should use 1/2 sheet of sodium-containing solution;
Hypotonic dehydration should use 2/3 sheet of sodium-containing solution;
Hypertonic dehydration should use 1/3 sheet of sodium-containing solution.
GB 16002--1995
C5.2 Supplement continued losses, replenish as much as lost, and the solution should be 1/3 sheet. C5.3 Supplement physiological needs: For those who cannot eat, 50~～80ml./(kg·day) of fluid replacement should be 1/5 sheet of solution. C5.4 Correct acidosis.
C5.5 See urine potassium supplement.
Appendix D
(Suggested Appendix)
Treatment of amoebic dysentery
D1 Nitroimidazoles
Metronidazole (Flagyl) Adults 0.4～0.8g Bid, take for 5-10 days. Children 50mg/(kg·day) divided into 3 times. Nitroimidazoles are effective against tissue-type and enteric-type Entamoeba histolytica trophozoites. Metronidazole is the first choice for anti-amoeba treatment. It has little toxicity and side effects, but it can cause teratogenicity in animals, so it is contraindicated within 3 months of pregnancy. D2 antibiotics
For concurrent bacterial infections, especially for patients with fulminant diseases, in addition to anti-amoeba treatment, antibiotics should be used at the same time (the use of antibiotics is the same as that for bacterial epilepsy).
3 Dicyanocyanate
Can be used to treat amoeba carriers. 500mg/day three times for a total of 10 days. 446
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