Intractable Diarrhoea - Paediatric Palliative Care
Description General and supportive measures Medicine treatment Referral ICD-10 code: R19.7 DESCRIPTION See: Persistent Diarrhoea and Diarrhoea, Chronic Other Than Post Infectious respectively. Although uncommon, intractable diarrhoea not amenable to any treatment may be encountered in paediatric palliative care. Examples of causes include: Short bowel syndrome in neonatal survivors of NEC (
General and supportive measures
ICD-10 code: R19.7
DESCRIPTION
See: Persistent Diarrhoea and Diarrhoea, Chronic Other Than Post Infectious respectively.
Although uncommon, intractable diarrhoea not amenable to any treatment may be encountered in paediatric palliative care. Examples of causes include:
- Short bowel syndrome in neonatal survivors of NEC (< 50 cm, no ileocaecal valve).
- Severe burns.
- Unmanaged HIV.
- Uncontrolled inflammatory bowel disease.
- Degenerative leiomyopathy.
- Graft vs Host disease.
- Bowel failure.
GENERAL AND SUPPORTIVE MEASURES
- Whilst many of these children may be initially treated at tertiary level, they may be down referred to district or regional hospitals, especially if ongoing treatment is futile.
- Address the underlying cause in as much as this is possible.
- Feed for comfort for as long as possible and whilst child is hungry but do not prolong dying if pre-terminal and not candidates for TPN, see: End of life and Terminal care.
- Pay close attention to perineal and peri-anal excoriation that can cause much discomfort.
- Manage abdominal cramps.
MEDICINE TREATMENT
- Loperamide: 0.1 mg/kg 6 hourly increasing up to 2 mg/kg/day.
For acute hypocalcaemia associated with tetany:
- Calcium gluconate:
- Loading intravenous bolus: 10% calcium gluconate 0.5 mL/kg (0.11 mmol/kg) to a maximum of 20 mL over 10 minutes (maximum rate 0.5 mmol/minute) followed by a continuous intravenous infusion over 24 hours of 0.5–1.0 mmol/kg (maximum 8.8 mmol).
Spasmodic abdominal pain:
- Hyoscine butylbromide, PO, IM or IV:
- 1 month to 4 years: 300–500 mcg/kg 6–8 hourly. Maximum: 5000 mcg/dose (5 mg/dose).
- 5–11 years: 5–10 mg 6–8 hourly.
- 12–17 years: 10–20 mg 6–8 hourly.
REFERRAL
- Refer for trial of TPN in cases where underlying disease is under control.
Standard Treatment Guidelines And Essential Medicines List For South Africa, Hospital Level, Paediatrics, 2023 Edition
Chapter: 21. Palliative Care, 21.1 Symptom Control, 21.1.1 Gastro-intestinal Symptoms, 21.1.1.3 Intractable Diarrhoea