Aduan mu awuduru, yafunu mu yare a emu yɛ den, ne nsu a ɛtɔ kɛse¶

Yafunu mu yare a emu yɛ den ne yare a efi aduan mu ba bere a mmoawa, mmoawa, mmoawa a wɔsɛe nnɔbae, anaa awuduru nketenkete a wɔadi kan ayɛ no hyɛ wo yafunu ne wo dwensɔtwaa mu nneɛma abufuw na ɛyɛ hyew no. Bere a mpanyimfo a wɔwɔ apɔwmuden dodow no ara ho tɔ wɔn fi yafunu mu atiridii a emu nyɛ den anaa aduan mu awuduru mu wɔ nnɔnhwerew 24 kosi 72 mu denam nsu a wɔnom so no, nsu a wɔhwere kɛse denam ɔfe a ennyae ne akisikuru a nsu wom so no betumi ama mogya mu akisikuru a ɛba fam, asaabo a entumi nyɛ adwuma yiye, electrolyte a ɛnkari pɛ a edi awu, anaasɛ nhyehyɛe mu nsɛnnennen a ɛde nkwa to asiane mu aba wɔ nnɔnhwerew kakraa bi mu.

Nyarewa bi a wonya fi aduan mu nso gyae ntini mu awuduru a ano yɛ den anaa awuduru a ɛsɛe asaabo wɔ baabi a ofie hwɛ a wɔtaa de di dwuma no nnɔɔso. Sɛ wunim sɛnea wobɛkyerɛ nsonsonoe a ɛda ɔyare mmoawa a wɔyɛ daa ne botulism, hemolytic uremic syndrome, anaa nsu a ɛtɔ a emu yɛ den ntam, sɛnea wobɛfra Wiase Nyinaa Akwahosan Ahyehyɛde (WHO) ano aduru a wɔde ma nsu a wɔde ma a ɛyɛ pɛpɛɛpɛ wɔ fie, ne nnuru a ɛko tia akisikuru a ebetumi akyere awuduru a edi awu wɔ wo nipadua mu ankasa a, ɛbɔ wo nkwa ne mmofra a wonni ahobammɔ ne mpanyimfo a wɔn mfe akɔ anim nkwa ho ban.

Yɛ eyi mprempren¶

1. Hwɛ frankaa kɔkɔɔ a ɛde wo nkwa to asiane mu na sɛ ɛwɔ hɔ a frɛ wɔn a wɔhwɛ ntɛmpɛ so. Frɛ wo mpɔtam hɔ ntɛmpɛ nɔma (911 wɔ United States ne Canada, 112 wɔ European Union nyinaa, 999 wɔ United Kingdom, anaa hwɛ ne nyinaa nɔma ahorow a egye ntɛmpɛ) sɛ onipa no da sɛnkyerɛnne ahorow adi sɛ nsu atɔ no kɛse anaasɛ ne ho adwiriw no (adwene a ɛyɛ basaa, ɔbrɛ kɛse, adwenemhaw anaasɛ ɔtotɔ piti bere a ogyina hɔ, koma a ɛbɔ ntɛmntɛm bɛboro 110 simma biara, n’ani a akɔ fam, anaasɛ wantow nsu nnɔnhwerew 8 kosi 12 wɔ mpanyimfo mu anaa nnɔnhwerew 6 wɔ nkokoaa mu) a, ɔfe mogya anaa nneɛma a ɛyɛ tumm a ɛte sɛ kɔfe a wɔayam a ɛyɛ nsu, ɛtwam a mogya ayɛ no ma anaasɛ mogya kɛse wom nsu mu nsu, anaasɛ ne kɔn mu yɛ den, ntini mu nhumu sesa, anaasɛ ɛyaw a emu yɛ den a ɛba baabiara wɔ yafunu nifa ase.
2. Gye yafunu no home bere tiaa bi bere a woafe akyi, afei fi ase micro-sips of Oral Rehydration Solution (ORS). Mmem nsu a ɛnyɛ den nkuruwa akɛse ntɛm ara bere a woafe akyi, efisɛ sɛ wotrɛw yafunu a ɛho ayɛ hyew mu a, ɛkanyan gag reflex no bio. Twɛn simma 15 kosi 30 wɔ ɔfe akyi, afei fa nsenia, nnuru kuruwa, anaa syringe a wɔde ano nom ma nsu a wɔde ma a wɔnom no mililita 5 (teaspoon 1) simma 2 kosi 5 biara, na nkakrankakra ma ɛkɔ soro kodu nsu nketenkete bere a yafunu no siesie no.
3. Siesie WHO nkyene ne asikre aduru a wɔayɛ wɔ fie sɛ nnurutɔnbea ORS packets nni hɔ a. Nsu a ɛnyɛ den nkutoo nsi sodium ne potassium a ayera ananmu, na nnuaba mu nsu a wɔanhyɛ mu anaasɛ soda a wɔde di dwuma daa no twe nsu pii kɔ awotwaa no mu denam osmotic pressure so, na ɛma akisikuru no mu yɛ den. Wobɛkanyan asikre fitaa teaspoon 6 (mililita 30) ne table nkyene teaspoon 0.5 (mililita 2.5) gu nsu a ɛho tew a ahobammɔ wom a wɔnom lita 1 (U.S. nkuruwa 4.2) mu kosi sɛ ɛbɛbɔ koraa.
4. Mfa nnuru a wɔtɔn a ɛko tia atiridiinini mma sɛ atiridiinini kɛse anaasɛ nsu a mogya wom wɔ hɔ a. Mfa nnuru a ɛma wo ho yɛ hyew te sɛ loperamide anaa bismuth subsalicylate da sɛ wowɔ atiridiinini a ɛboro digrii Celsius 38.5 (digrii Fahrenheit 101.3) anaa mogya anaa akisikuru a wotumi hu wɔ wo nsu mu a. Sɛ wɔbrɛ dwensɔtwaa no ase a, ɛkyere mmoawa a wɔba ne Shiga awuduru wɔ awotwaa no fasu no so, na ɛma asiane a ɛwɔ hɔ sɛ awuduru megacolon ne asaabo no bedi huammɔ no yɛ kɛse.
5. Kora na kyerɛw nnuan a wosusuw sɛ wubenya no so dwoodwoo wɔ baabi a wuntumi nkɔ hɔ. Sɛ wususuw sɛ adidibea aduan pɔtee bi, ade a wɔmfa pasteurized nni dwuma, wuram nsenia, anaasɛ toa a wɔde ahyɛ toa mu a ahonhon de yare a emu yɛ den baa nnipa pii so a, fa aduan a aka no to plastic bag a wɔakyerɛw so pefee mu wɔ frigye no mu (mmfa nhyɛ nwini mu gye sɛ wɔakyerɛ) sɛnea ɛbɛyɛ a ɔmanfo akwahosan ho nhwehwɛmufo anaa awuduru ho nnuruyɛfo betumi asɔ nea ɛyɛ pɛpɛɛpɛ no ahwɛ ɔyare mmoawa anaa awuduru.
6. Fa chlorine bleach yi mmeae a efĩ wom no fi hɔ, ɛnyɛ nsa. Sɛ norovirus anaa atiridiinini a ɛde ɔyare mmoawa ba retrɛw fa wo fie a, nsa ho aduru a wɔde nsa ayɛ ne standard quaternary ammonium disinfecting wipes renkum mmoawa no akorade no. Fa samina ne nsu a ɛyɛ hyew hohoro wo nsa yiye sikɔne 20, hyɛ nsateaa a wɔtow gu bere a worehohoro ɔfe anaa nsu mu no, na fa ofie chlorine bleach aduru a wɔde afra foforo a wɔagyaw no nsu anyɛ yiye koraa no simma 5 kosi 10 kum mmoawa wɔ mmeae a ɛyɛ den no.

Ntɛmntɛm triage ne dehydration gyinaesi flowchart¶

Fa saa ayaresabea gyinaesi dua yi hwɛ sɛ ebia wobetumi adi obi a ɔfe a emu yɛ den ne akisikuru no ho dwuma wɔ fie denam anom nsu a wɔde ma no so anaasɛ ɛsɛ sɛ wɔde ayaresabea fa ntini mu ayaresa ntɛm ara.

flowchart TD
    Start["Ɔfe a Ɛyɛ Den, Nsu a Ɛma Ɔfe, Anaa Yafunu mu Akisikuru"] --> NeuroCheck{"Ntini mu sɛnkyerɛnne biara?<br/>Aniwa a ɛyɛ mmɔho abien, aniwa a ɛrehwe ase,<br/>kasa a ɛyɛ mmerɛw, ɔhaw a ɛwɔ menewa mu, anaasɛ ɛyɛ mmerɛw?"}

    NeuroCheck -->|"Yiw"| Call911Neuro["Frɛ Emergency Services Ntɛm ara<br/>Wosusuw sɛ Botulism anaa Marine Neurotoxin<br/>Ma ɔyarefo no ntra hɔ fã na hwɛ sɛnea ɔhome"]
    NeuroCheck -->|"Dabi"| RedFlags{"Hwɛ Systemic Red Flags:<br/>Mogya anaa tuntum a ɛwɔ nsu mu, kɔfe a wɔayam,<br/>adwene a ɛyɛ basaa, akisikuru, yafunu a ɛyɛ den, anaasɛ nsu a enni mu >8 hrs?"}

    RedFlags -->|"Yiw, 1 anaa nea ɛboro saa wɔ hɔ"| ERVisit["Kɔ Ayaresabea Dwumadibea a Ɛho Hia Ntɛmntɛm Mprempren<br/>Ɛhwehwɛ sɛ wɔde IV Crystalloids, Electrolyte Panel,<br/>Stool Culture, ne Oprehyɛn anaa Adwene mu Nhwehwɛmu"]
    RedFlags -->|"Dabi"| HighRiskCheck{"So ɔyarefo yɛ akokoaa <asram 6,<br/>ɔpanyin a ne mfe akɔ anim a ɔyɛ mmerɛw >65, onyinsɛn,<br/>asikreyare, anaasɛ ne nipadua mu tumi a ɛko tia nyarewa no ayɛ basaa?"}

    HighRiskCheck -->|"Yiw"| SameDayEval["Di Oduruyɛfo anaa Ɔhwɛ a Egye Ntɛmntɛm Di nkitaho Ɛnnɛ<br/>Fi ase micro-sips of WHO ORS ntɛm ara<br/>Lower threshold for IV hydration"]
    HighRiskCheck -->|"Dabi"| TrialORS["Fi aseɛ Home Oral Rehydration Protocol<br/>5 mL (1 tsp) ORS simma 2 kɔsi 5 biara<br/>Kwati nnuru a ɛko tia motility sɛ atiridiinini wɔ hɔ a"]

    TrialORS --> ToleranceCheck{"So ɔyarefo betumi ama micro-sips akɔ fam<br/> nnɔnhwerew 4 kosi 6 a ɛrensɛe?"}
    ToleranceCheck -->|"Yiw"| RecoveryDiet["Di kan kɔ Nnuan a Wɔsan Ma no Ntɛm sɛdeɛ Wɔma Ho kwan<br/>Fa ORS 200 kɔsi 250 mL si nsuo biara a ɛho ayɛ hare ananmu<br/>Hwɛ sɛ HUS asaabo mu nsɛnkyerɛnneɛ akyɛ nnafua 14"]
    ToleranceCheck -->|"Dabi, ɔfe a ɛkɔ so tra hɔ a wontumi nsa"| ERVisit

Bere nhyehyɛe a efi ase: wɔde dɔn a wɔde hyɛ nipadua mu no kyerɛ ɔyare mmoawa no¶

Sɛ nnipa pii yare bere a wɔakyɛ adidi akyi a, nnuruyɛfo a wɔhwɛ ntɛmpɛ so ne awuduru ho animdefo di kan hwɛ bere a wɔde bɛwo (nnɔnhwerew anaa nna dodow a ɛda aduan a wosusuw sɛ wobedi ne sɛnkyerɛnne a edi kan no ntam) ka sɛnkyerɛnne titiriw no ho. Ɛkame ayɛ sɛ bere nyinaa na sɛnkyerɛnne ahorow a efi ase ntɛmntɛm wɔ nnɔnhwerew 1 kosi 6 mu no kyerɛ nnuru anaa awuduru a efi mmoawa mu a wɔadi kan ayɛ a na ɛte aduan no mu dedaw ansa na woamene, bere a sɛ ɛkyɛ nnafua 1 kosi 5 a, ɛkyerɛ sɛ mmoawa a wɔte ase, mmoawa, anaa mmoawa a wɔsɛe nnɔbae redɔɔso wɔ wo dwensɔtwaa mu.

Nsu a ɛho ntew ho nhwehwɛmu wɔ ayaresabea wɔ mfe nyinaa mu¶

Nsu a ɛho nhia wɔ yafunu mu yare a emu yɛ den mu no nyɛ sɛ obi te nka sɛ sukɔm de wo ara kwa; ɛyɛ ntini mu nsu dodow ne nkwammoaa mu anyinam ahoɔden (sodium, potassium, chloride, ne bicarbonate) a ɛso tew nkakrankakra. Bere a plasma dodow so tew no, ɛsɛ sɛ koma no bɔ ntɛmntɛm na mogya ntini a ɛwɔ honam ani ne asaabo mu no twetwe na ama mogya mmoroso atra amemene ne koma no mu.

Ayaresayɛfo ne Wiase Nyinaa Akwahosan Ahyehyɛde no kyekyɛ nsu a ɛho nhia mu akuw abiɛsa a wobetumi ayɛ ho biribi: Nsu a ɛho nhia a enni hɔ anaasɛ kakraa bi (ɛnɔɔso ɔha biara mu nkyem 3), Nsu a ɛho ntew a ɛnyɛ den kosi nea ɛkɔ fam (ɔha biara mu duru a ɛso tew ɔha biara mu nkyem 3 kosi 9), ne Nsu a ɛho ntew kɛse (ɔha biara mu duru a ɛso tew ɔha biara mu nkyem 10 anaa nea ɛboro saa, a ɛyɛ hypovolemic shock).

Sɛnea wɔde Oral Rehydration Solution (ORS) fra na wɔde ma .¶

Wɔ afeha a ɛto so 20 mu no, sodium-glucose cotransport mechanism (SGLT1) a wohuu wɔ nnipa dwensɔtwaa ketewaa mu no sesaa nnuruyɛ a egye ntɛmpɛ. Sɛ kɔlera, rotavirus, anaa Salmonella awuduru ma akisikuru no mu nsuo lita pii hwie gu dwensɔtwaa no mu mpo a, SGLT1 akwantuo protein a ɛwɔ dwensɔtwaa no brɔs hyeɛ so no kɔ so yɛ adwuma koraa. Nanso, sɛ glucose (asikre) ne sodium (nkyene) bom wɔ molar ratio 1-to-1 pɛpɛɛpɛ nkutoo a, saa protein ahorow yi betumi atwe sodium ne nsu atwa dwensɔtwaa no fasu no so.

• Sɛ wonom nsuo a ɛnyɛ den pii wɔ berɛ a worefe ne akisikuru a emu yɛ den a, ɛntwam fa awotwaa a ayɛ hyew no mu yie na ɛma sodium a aka wɔ wo mogya mu no yɛ mmerɛw, na ɛde asiane ba hyponatremia (amemene mu ahonhon, adwene a ɛyɛ basaa, ne akisikuru).
• Sɛ wonom apɔw-mu-teɛteɛ nsu a wɔanhyɛ mu, cola a wɔde di dwuma daa, agumadi anonne a ɛyɛ dɛ, anaa tii a ɛyɛ dɛ a, asikre pii (osmolality a ɛkɔ soro) ne sodium kakraa bi na ɛwom. Asikre a ɛboro so a wɔannye no tra dwensɔtwaa no mu na ɛyɛ adwuma te sɛ ɔpon, na ɛtwe nsu pii mpo fi wo mogya mu kɔ wo dwensɔtwaa mu (osmotic diarrhea).

1. WHO-formula ORS packets a wɔde di gua (Nea edi kan a wɔpaw) .¶

Bere biara a ɛbɛyɛ yiye no, fa nkyene a wɔde anom nsu a wɔsan de ma a wɔadi kan asusuw a efi nnurutɔnbea (te sɛ WHO/UNICEF Reduced Osmolarity ORS, Pedialyte, Dioralyte, Hydralyte, anaa CeraLyte), a wɔde nsu pa dodow pɔtee a wɔatintim wɔ packet no so afra katee di dwuma. Mfa ORS packet nfra nufusu, soup, anaa nnuaba nsu mu da, na nnoa solution no da bere a wode nkyene no aka ho (sɛ wo nsuo no hia sɛ ɛnoa a, di kan noa nsuo no, ma ɛnnwo koraa, na afei woakanyan packet no mu).

2. WHO ORS aduannoa ho nyansahyɛ a wɔyɛ no ntɛm a wɔyɛ wɔ fie pɛpɛɛpɛ¶

Sɛ wuntumi nkɔ nnurutɔnbea bi a, siesie aduan a egye nkwa a Wiase Nyinaa Akwahosan Ahyehyɛde ne Nsu a Wɔde Ma Nsu Ho Dwumadi no kamfo kyerɛ yi pɛpɛɛpɛ. Fa standard susuw spoons (ɛnyɛ adidi dwetɛ nneɛma a ɛnyɛ daa) di dwuma na ka nsu a etwa to no hwɛ ansa na wode ama abofra: ɛnsɛ sɛ ɛyɛ dɛ sen nkyene sen abɔde mu nnipa nusu.

• Nsuo a ɛho tew na ahobammɔ wom a wɔnom: lita 1 (bɛyɛ U.S. nkuruwa 4.2, anaa nkuruwa anum a emu duru yɛ mililita 200).
• Asikre fitaa a wɔayam wɔ pon so (sucrose): 6 level teaspoons (millilita 30, anaa gram 25.2).
• Nkyene a wɔde di dwuma wɔ pon so (sodium chloride): 0.5 (fã biako) level teaspoon (mililita 2.5, anaa gram 2.9).

Wobɛkanyan no denneennen simma 60 kosi sɛ nkyene ne asikre ahwehwɛ biara bɛpete. Fa sie baabi a ɛhɔ yɛ nwini na tow ɔfã biara a wɔmfa nni dwuma wɔ nnɔnhwerew 24 akyi, na siesie batch foforo da biara.

3. Ofie nsu a wɔde yɛ aduan foforo bere a asikre nni hɔ no¶

• Starch-based cereal ORS (Highly effective for severe watery diarrhea): Starch a ɛyɛ den a ɛwɔ aburow mu no paapae nkakrankakra kɔ glucose mu wɔ dwensɔtwaa mu a ɛmma dwensɔtwaa mu osmolality nkɔ soro, na ɛtew nsu a ɛba nsu mu dodow so ɔha biara mu nkyem 30 sɛ wɔde toto asikre a ɛnyɛ den ho a. Noa aburow fitaa a ayow gram 50 kosi 60 (bɛyɛ kuruwa 0.5) anaa aburow fitaa a wɔayam a wɔanoa wɔ nsu 1.1 lita mu simma 5 kosi 7 kosi sɛ ɛbɛyɛ gruel a ɛyɛ tratraa a nsu wom, ma ɛnnwo nkɔ dan mu hyew mu, fa table salt 0.5 level teaspoon ka ho, na hwɛ sɛ dodow a etwa to no yɛ lita 1.
• Diluted fruit juice plus salted cracker fallback (Ma nsɛm a ɛnyɛ den wɔ mmofra a wɔanyinyin ne mpanyimfo mu): Sɛ abofra anaa ɔpanyin a nsu nnim kakra pow standard ORS a, nhwehwɛmufo ada no adi sɛ wɔde apɔw-mu-teɛteɛ a wɔanhyɛ mu dɛ fã biako a wɔde nsu afã 4 (1:4 dilution) afra mu anaasɛ wɔsesa nom agumadi mu anonne a wɔahoro (agumadi mu anonne fã 1 kɔ nsu fã 1) a wɔde nkyene a ɛnyɛ den ahyɛ mu krak ne broth betumi akura nsu mu bere a ɔyare mmoawa yafunu mu yare a emu nyɛ den no. Mfa saa fallback yi nni dwuma mma nkokoaa anaasɛ nsu a ɛho ayɛ fĩ a ɛkɔ fam kosi nea emu yɛ den.

4. Anamɔn biara volume targets ne anti-vomiting technique¶

Sɛ obi refe denneennen a, awofo ne wɔn a wɔhwɛ wɔn no taa fa no sɛ nsu a wɔde ma wɔ anom no adi nkogu efisɛ ɔyarefo no tow nsu kuruwa a ɛyɛ ma gu soro. Wɔ mmofra a wɔpaw wɔn ntɛm mu no, nsu a wɔde ma wɔ ano no di nkonim bɛboro ɔha biara mu nkyem 90 bere a wɔde syringe anaa spoon pacing ma no:

1. Mmara a ɛfa mililita 5 ho: Sɛ wode nnuru a ɛyɛ mililita 5 (teaspoon 1) di dwuma a, fa ORS a ɛyɛ nwini mililita 5 petepete anaa fa nsenia gu ano no nkyɛn simma 3 biara. Wɔ saa ahoɔhare yi mu no, onipa no twe mililita 100 (ɔuns 3.4) dɔnhwerew biara fa yafunu no ne akyi berɛmo no atifi tẽẽ a ɔboaboa nsu dodow a ɛdɔɔso ano wɔ yafunu no mu da sɛ ɛbɛkanyan ɔfe ho adwene.
2. Sɛ wɔfe bere a wɔresan nsuo: Twɛn simma 15 kɔsi 20 na ama aduane ne yafunu mu akisikuru no ano abrɛ ase, afei san fi ase wɔ mililita 5 simma 5 biara.
3. Nnɔnhwerew 4 rehydration botae ma nsu a ɛho ntew a ɛnyɛ den kosi nea ɛkɔ fam: Fa yɛ wo botae sɛ wode ORS bɛyɛ 50 kosi 75 mililita bɛma nipadua mu duru kilogram biara (bɛyɛ ɔuns 1 wɔ nkaribo biara mu) a ɛtrɛw nkakrankakra wɔ nnɔnhwerew 4 a edi kan no mu:
4. Nkokoaa a wɔn mu duru yɛ kilogram 6 (nkaribo 13): ne nyinaa yɛ mililita 300 kosi 450 (ounces 10 kosi 15) wɔ nnɔnhwerew 4 mu.
5. Abofra a ɔretu mmirika a ne mu duru yɛ kilogram 12 (nkaribo 26): ne nyinaa yɛ mililita 600 kosi 900 (ounces 20 kosi 30) a ne nyinaa yɛ nnɔnhwerew 4.
6. Abofra a ne mu duru yɛ kilogram 25 (55 pounds): ne nyinaa yɛ lita 1.25 kosi 1.8 (ounces 42 kosi 60) wɔ nnɔnhwerew 4 mu.
7. Mmabun anaa ɔpanyin (60+ kilograms / 132+ pounds): Lita 2.0 kosi 3.5 (68 kosi 118 ounces) nyinaa yɛ nnɔnhwerew 4 kosi 6.
8. Nsiesie a ɛkɔ so de si ananmu: Sɛ sukɔm ne nsuo a ɛho nhia ho sɛnkyerɛnne a ɛdi kan no tu mpɔn wie a, ma ORS mililita 60 kɔsi 120 (ounces 2 kɔsi 4) foforɔ wɔ nsuo a ɛho ayɛ hare anaa ɔfe biara a ɛba mmofra nkumaa mu, ne mililita 200 kɔsi 250 (kuruwa 1) wɔ nsuo a ɛho ayɛ hare biara akyi wɔ mmofra a wɔanyinyin ne mpaninfoɔ mu.

Nsɛnnennen a edi awu a ɛsɛ sɛ yɛhwɛ¶

Sɛ wɔhwɛ nsu a wɔhwere so mpo a, aduruyɛ mu nsɛnnennen anan a ɛde nkwa to asiane mu betumi aba wɔ adapɛn abien a edi yare a aduan de ba akyi no mu.

1. Botulism a efi aduan mu ne nkokoaa mu (Descending neurotoxic paralysis) .¶

Clostridium botulinum ma abɔdeɛ mu awuduru a ɛdi awu paa a wonim no mu baako. Nea ɛnte sɛ Salmonella anaa norovirus no, botulism ɛnyɛ atiridii na ɛma ɔyarefo no nhu nhumu koraa na n’adwene yɛ nnam bere a ɛde nkakrankakra twa ntini mu nsɛnkyerɛnne a ɛkɔ ntini a ofi ne pɛ mu no.

• Mpanyimfo ne mmofra aduan mu botulism: Hwɛ "4 Ds": Diplopia (anisoadehu mmɔho abien anaa nea ɛyɛ kusuu), Dysarthria (kasa a ɛyɛ mmerɛw, ɛyɛ den), Dysphonia (nne a ɛyɛ dede anaa ɛyɛ mmerɛw), ne Dysphagia (ɛyɛ den sɛ wobɛmene nsu anaa nnompe), a ɛka ho ne sɛ wobɛmene nsu anaa nnompe aniwa anim (ptosis) ne aniwa a ɛnyɛ den wɔ hann a ano yɛ den mu. Afei mmerɛwyɛ kɔ fam pɛpɛɛpɛ fi kɔn ne nsa so kɔ koko no mu ntini ne nan no so.
• Nkokoaa botulism (Mfeɛ dapɛn 1 kɔsi asram 12): Ɛnam mene so na ɛba C. botulinum spores (a agye din kɛse wɔ ɛwo a wɔannoa anaasɛ wɔde pasteurized ayɛ mu, ne mfutuma ne dɔte nso) a efifi wɔ akokoaa dwensɔtwaa a ennyinii mu. Ɛkame ayɛ sɛ bere nyinaa sɛnkyerɛnne a edi kan ne akisikuru foforo (nnafua 3 anaa nea ɛboro saa a wonni nsu mu), na ɛno akyi no, osu a ɛyɛ mmerɛw, ɛyɛ tratraa, ɛyɛ komm, nufu a wɔnom no yiye wɔ nufu anaa toa mu, ti a wɔhwere ("floppy baby" hypotonia), ne nsu a wɔboaboa ano.
• Adeyɛ ntɛm ara: Kɔ ayaresabea dwumadibea a ɛbɛn hɔ a wɔhwɛ ntɛmpɛ so ntɛm ara. Botulinum Antitoxin (BAT a wɔde fa ntini mu (BAT ma mpanyimfo/mmofra, anaa BabyBIG human botulism immune globulin ma nkokoaa) a wɔde ma ntɛm no gyae ntini a ɛyɛ mmerɛw bio, ɛwom sɛ ntini awiei a abubu dedaw no gye adapɛn pii ansa na nkitahodi foforo afifi bere a mframa a wɔde home boa ma wɔhome no.

2. Hemolytic Uremic Syndrome (HUS) ne asaabo a entumi nyɛ adwuma yiye¶

Nnipa bɛyɛ ɔha biara mu nkyem 5 kosi 10 (ne mmofra a wonnii mfe 5 a ɛkɔ ɔha biara mu nkyem 15) a wɔanya Shiga awuduru a ɛma E. coli (STEC O157:H7) anaa Shigella dysenteriae nya Hemolytic Uremic Syndrome (HUS). Anwonwasɛm ne sɛ, HUS taa ba nnafua 5 kosi 10 akyi bere a akisikuru no afi ase, mpɛn pii no bere a ɛte sɛ nea akisikuru no renya nkɔso no ara.

Shiga awuduru fa akyi berɛmo no fasu a asɛe no mu kɔ mogya no mu na ɛkyekyere mogya ntini nketenkete a ɛwɔ asaabo no mu no tẽẽ. Ɛhɔ no, awuduru no twitwa mogya mu nkwammoaa kɔkɔɔ a ɛkyinkyini no mu (microangiopathic hemolytic anemia), di mogya mu nkwammoaa nketenkete (thrombocytopenia), na ɛto asaabo mu nneɛma a wɔde yiyi mu no mu (acute renal failure).

• HUS ho kɔkɔbɔ nsɛnkyerɛnne: Ɛyɛ mmerɛw a wotumi hu (honam ani hwɛbea a ɛyɛ mmerɛw, ɛyɛ ahonhonsɛmdi ne aniwa a ɛwɔ mu anaa anom a ɛyɛ mmerɛw), ɔbrɛ anaa abufuw kɛse, akuru a wontumi nkyerɛkyerɛ mu anaasɛ nsensanee nketenkete a ɛyɛ kɔkɔɔ a ɛyɛ pinpoint wɔ honam ani (petechiae), mogya a efi hwene anaa anom, ahuru a ɛhoa atwa aniwa, nansoaa, ne nsa ho ahyia (edema), ne a nsu a ɛtɔ mpofirim anaasɛ egyae koraa (anaasɛ nsu a ɛyɛ pink/cola kɔla) nnafua 5 kosi 14 wɔ mogya anaasɛ akisikuru a ɛyɛ mmerɛw akyi.
• Adeyɛ a egye ntɛmpɛ: Fa abofra anaa ɔpanyin no kɔ ayaresabea a wɔhwɛ ntɛm ara; HUS hwehwɛ sɛ wɔhwɛ mogya ne mmofra asaabo ho yare a egye ntɛmpɛ, mogya a wɔde ma, na wɔyɛ asaabo mu bere tiaa mu.

3. Guillain-Barre Syndrome (GBS) a ɛba wɔ Campylobacter akyi¶

Campylobacter jejuni (a wɔtaa nya fi nkokɔ a wɔannoa no yiye anaa nufusu a wɔmfa pasteurized mu) ne ade biako pɛ a ɛkanyan ɔyare mmoawa wɔ wiase nyinaa ma Guillain-Barre Syndrome, acute autoimmune nerve disorder a ɛtaa fi ase adapɛn 1 kosi 3 akyi bere a obi ho atɔ no wɔ atiridiinini ho.

• Sɛnea ɛsono ne botulism: Bere a botulism fi ase wɔ ti na ɛkɔ kɔ fam no, Guillain-Barre Syndrome ma mmerɛwyɛ a ɛkɔ soro a efi ase wɔ nan so na ɛkɔ kɔ soro. Hwɛ sɛ "pin ne nnade" a ɛyɛ mmerɛw wɔ nansoaa ne nsateaa mu, nansoaa mu ntini a ɛyera, ahwe ase mpofirim anaasɛ ontumi nkɔ antweri so, ne mmerɛwyɛ a ɛforo kɔ nan no so kɔ dua no akyi ne ntini a ɛhome no. Nan mu mmerɛwyɛ biara a ɛkɔ so nkakrankakra wɔ yafunu mu atiridii akyi no hwehwɛ sɛ wɔyɛ nhwehwɛmu ntɛm ara wɔ baabi a wɔhwɛ wɔn a wɔwɔ ayaresa a egye ntɛmpɛ mu.

4. Mogya mu sepsis a ɛba nipadua mu ne megacolon a awuduru wom¶

Wɔ nkokoaa a wonnii asram 3 mu no, mpanyimfo a wɔadi boro mfe 65, ayarefo a wɔyem, nnipa a wɔwɔ HIV, ayarefo a wɔde nnuru sa yare, ne ankorankoro mpo a wɔnom proton-pump inhibitors dodow a ɛkɔ soro da biara da (a ɛma yafunu mu acid akwanside a ɛbɔ ho ban no yɛ adwuma), mmoawa te sɛ Salmonella, Listeria, Campylobacter, ne Vibrio vulnificus (a efi break oysters mu) betumi tẽẽ fa dwensɔtwaa no fasu no mu kɔ mogya no mu, na ɛkanyan sepsis ne septic shock a ɛma mogya tu.

Sɛ ɔyarefo bi akisikuru gyae mpofirim bere a ne yafunu ahonhon te sɛ sanku a ɛyɛ den, ɛyɛ mmerɛw fɛfɛɛfɛ bere a wɔde ne nsa ka no kakra, na ɛne ne koma bɔ denneennen ne atiridiinini kɛse anaasɛ ɔhyew a ɛba fam ka ho a, susuw sɛ toxic megacolon anaa intestinal perforation, a ɛhwehwɛ sɛ wɔyɛ oprehyɛn mu nhwehwɛmu ntɛm ara.

Nnuru a ahobammɔ wom ho mmara: nea ɛboa ne nea epira¶

Ahwɛfo pii a wɔwɔ adwempa ma nyarewa a wonya fi aduan mu no yɛ kɛse denam ofie nnuru a wɔde di dwuma wɔ nkuku mu a wɔtaa de di dwuma a wɔde di dwuma no so. Di ayaresabea akwankyerɛ ahorow yi akyi pɛpɛɛpɛ:

• Bere a ɛsɛ sɛ wokwati Loperamide (Imodium) ne Diphenoxylate: Nnuru a wɔtɔn a ɛko tia ntini a ɛkɔ nipadua no mu no yɛ adwuma denam opioid agyefo a ɛwɔ awotwaa no fasu mu a ɛkyekyere no so, na ɛma ntini a ɛyɛ mmerɛw (peristalsis) a ɛpam nsu mu no yɛ mmerɛw. Mfa loperamide mma mmofra a wonnii mfe 6 da (na mmofra ayarehwɛfo dodow no ara tu fo sɛ ɛnsɛ sɛ wɔde ma wɔ mmofra a wonnii mfe 12 kosi 18 nyinaa mu esiane asiane ahorow a ɛwɔ paralytic ileus, nna, ne megacolon a awuduru wom nti). Wɔ mpanyimfo mu no, mfa loperamide nni dwuma da sɛ wowɔ atiridiinini, mogya anaa mucoid nsu, anaa yafunu mu yaw kɛse. Ebia mpanyimfo a wɔwɔ apɔwmuden de ahwɛyiye bedi dwuma ama akisikuru a emu nyɛ den, nsu, ɛnyɛ mogya, atiridii nnim nkutoo bere a wɔretu kwan anaa wɔreyɛ adwuma no.
• Bere a ɛsɛ sɛ wokwati Bismuth Subsalicylate (Pepto-Bismol, Kaopectate): Bismuth subsalicylate no wɔ salicylate aduru bi a ɛne aspirin wɔ abusuabɔ wɔ nnuru mu. Mfa bismuth subsalicylate mma nkokoaa, mmofra, anaa mmabun a wonnii mfe 18 a wɔrenya ahoɔden afi ɔyare mmoawa a wɔde yafunu mu yare mu esiane asiane a ɛwɔ hɔ sɛ wobenya Reye’s syndrome (mmerɛbo a ɛyɛ mmerɛw ne amemene a ɛho ahonhon a edi awu) nti da. Hyɛ no nsow nso sɛ bismuth ne sulfur kakraa bi a ɛwɔ wo nnompe ne wo nsu mu yɛ adwuma ma ɛyɛ bismuth sulfide, a ɛma wo tɛkrɛma ne wo nsu nyinaa dan jet black bere tiaa bi; eyi betumi akata yafunu mu mogya a ɛtɔ ankasa (melena) so anaasɛ asuasua no wɔ ɔkwan a asiane wom so.
• Kwati NSAIDs (Ibuprofen, Naproxen, Aspirin) bere a nsuo atɔ wo: Nnuru a ɛnyɛ steroid a ɛko tia ɔyareɛ no siw prostaglandins a ɛma mogya ntini a ɛkɔ w’asaabo mu no trɛw bere a nsuo reyera no. Ibuprofen anaa naproxen a wɔnom ma atiridii anaa nipadua mu yaw bere a nsu nnim esiane ɔfe ne akisikuru nti no taa de nnuru a wɔde ma Acute Kidney Injury (AKI) ba. Sɛ ɛho hia sɛ wɔde aduru a ɛtew atiridii so bere a nsu a wɔnom no akɔ fam akyi a, paracetamol (acetaminophen) yɛ nea asiane biara nni ho ma asaabo no, sɛ mmerɛbo mu yare biara nni hɔ a.
• Aduruyɛ Ondansetron (Zofran) ne Zinc a wɔde ma: Wɔ ɔhwɛ a egye ntɛmpɛ ne ntɛmpɛ dwumadibea ahorow mu no, ondansetron a wɔde ano nom a egyina mu duru so no gyae ɔfe a ennyae wɔ mmofra a wɔadi boro asram 6 ne mpanyimfo mu dwoodwoo, na ɛma anom nsu a wɔde ma no di nkonim a enhia sɛ wɔde IV line di dwuma. Wɔ mmofra a wɔwɔ mmeae a nneɛma kakraa bi na ɛwɔ hɔ anaasɛ wɔn atiridiinini bere tenten fam no, Wiase Nyinaa Akwahosan Ahyehyɛde no kamfo kyerɛ sɛ wɔmfa zinc a wɔnom no miligram 10 kosi 20 da biara da nnafua 10 kosi 14**, a esiesie nkwammoaa a ɛwɔ dwensɔtwaa mu no na ɛtew mprempren tebea no mu den ne nea ɛbɛsan aba daakye no nyinaa so wɔ asram 3 a edi hɔ no mu.

Ntɛm a wɔsan de ma: nea enti a "BRAT aduan" a ɛyɛ katee no atwam¶

Mfe du du pii no, wɔka kyerɛɛ mmusua sɛ wɔmfa ɔkɔm nkum yafunu mu yare nnɔnhwerew 24 kosi 48 na afei wonni BRAT aduan (Bananas, Rice, Applesauce, ne Toast) nkutoo. Mprempren akwankyerɛ ahorow a efi Wiase Nyinaa Akwahosan Ahyehyɛde, Amerika Mmofra Ayaresa Sukuu (AAP), ne European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) hɔ si so dua sɛ aduada a wɔde di dwuma bere tenten ne aduan a anohyeto wom a BRAT nkutoo na ɛwom no ma awotwaa mu ayaresa brɛ ase efisɛ dwensɔtwaa mu enterocyte nkwammoaa hia luminal nutrients na ama wɔatumi asan ayɛ foforo na esiane sɛ BRAT nnuan a ɛyɛ katee nni protein, apɔwmuden srade a ɛwɔ aduan mu, ne aduannuru nketenkete.

1. Kɔ so ma nufu ne nkokoaa aduan a wɔde ma daa a wontwa mu: Nnyae akokoaa a ɔwɔ yafunu mu yare a emu yɛ den nufu da; nufusu mu nufusu wɔ IgA antibodies a ɛbɔ kokoam ne nneɛma a ɛko tia mmoawa bere a ɛnyɛ den sɛ wɔbɛyam no. Ɛsɛ sɛ nkokoaa a wɔma wɔn aduan toa mu no san kɔ nkokoaa aduan a ahoɔden nyinaa wom a wɔmfa nsu nhyɛ mu no mu ntɛm ara wɔ nnɔnhwerew 4 ORS rehydration fã a edi kan no akyi (sɛ wɔde nsu foforo afra mu a, ɛma akokoaa no kɔm de calories ne electrolytes).
2. San fi ase di nnuan a ɛyɛ den a ɛfata mfe a woadi wɔ nnɔnhwerew 4 kosi 6 akyi bere a woasan anya nsu: Sɛ ɔfe no ano brɛ ase na wɔsesa nnɔnhwerew 4 ORS a edi kan no a, fa nnuan nketenkete a wɔtaa di ma nnɔnhwerew 3 kosi 4 biara.
3. Nnuan a eye sen biara a ɛsɛ sɛ wudi bere a wo ho atɔ wo: Paw carbohydrates a ɛyɛ den a wɔde protein a ɛnyɛ den ne abɔde mu potassium aka ho: aburow fitaa a ɛnyɛ den, ɛmo a wɔanoa anaa wɔayam a nkyene kakraa bi wom, oatmeal, krak a ɛnyɛ den, noodles a wɔde akokɔ anaa nhabannuru nsu a emu da hɔ, akokɔ anaa akokɔ nufu a wɔato, nkesua a wɔanoa, banana a abere, apɔw-mu-teɛteɛ, ne live-culture plain yogurt (a ɛma abɔde mu lactase enzymes ne mmoawa a mfaso wɔ so).
4. Nnuan a ɛsɛ sɛ wokwati nnafua 3 kosi 5: Kwati nnuan a srade wom, nea wɔayam, anaa srade pii wom (a ɛkyɛ yafunu mu da mpan na ɛkanyan akisikuru), chili peppers a ɛyɛ nnuhwam, caffeine ne nsa (a ɛkanyan awotwaa no tumi na ɛyɛ adwuma sɛ nea ɛma obi ho yɛ hyew), ahwiesa anaa anom a asikre nnim a sorbitol, xylitol, anaa mannitol wom (a ɛde osmotic diarrhea a emu yɛ den ba), ne nantwi nufusu a ɛyɛ nsu a wɔanwene nkuruwa akɛse sɛ lactose a wontumi nnye ntom bere tiaa bi wɔ ɔyare mmoawa akyi no ma obi ho popo na mframa bɔ a.

Ofie mu nyarewa ano aduru: norovirus ne mmoawa a wɔtrɛw mu a wobegyae¶

Sɛ ofie no muni biako fi ase fe akuturuku anaasɛ onya dwensɔtwaa a ɛde ɔyare mmoawa ba a, anammɔn a wɔfa so yi obi fi nnipa mu ntɛm ara na wɔde kum mmoawa no mma abusua mũ no nyinaa nhwe ase bere koro mu:

• Fa samina ne nsu hohoro nsa simma 20 a edi mũ: Nsa gel a wɔde nsa ayɛ (a ɛwɔ ethanol 70% mpo) ntumi mma mmoawa a wɔmfa nkata so te sɛ norovirus anaa mmoawa mmoawa te sɛ Clostridioides difficile nyɛ adwuma wɔ ɔkwan a wotumi de ho to so. Fa samina ne nsuo hohoro nsa ho yie wɔ aguaree biara a wobɛkɔ, asesa mpaboa, ne ansa na wode wo nsa aka aduane no.
• Hyɛ nsateaa ne akatawia ansa na woahohoro ɔfe ho: Projectile fe a efi norovirus mu no tow mmoawa nketenkete ɔpepem pii gu mframa mu a ɛkɔtra brɔs a ɛbɛn wo sẽ, counter, ne apon nsa so. Hyɛ nitrile anaa latex nsateaa a wɔtow gu ne oprehyɛn anaa N95 akataso, fa krataa mpopaho popa nsu a ɛyɛ fĩ brɛoo (mmfa vacuum anaa popa ɔfe a ayow da), na fa nwura to plastic bag a wɔakyekyere mu ansa na wode agu abɔnten nwura mu.
• Fa chlorine bleach solution a emu duru yɛ 1,000 kosi 5,000 ppm kum mmoawa: Fa ofie chlorine bleach a enni huam (mililita 75 kosi 375) nkaribo 5 kosi 25 (mililita 75 kosi 375) fra nsu lita 3.8 (galɔn 1) biara mu, fa gu nneɛma a ɛyɛ den a enni abon (tiafi nkuruwa, hohoro nsa, faucets, tile fam, ne apon ano nhama), gyaw ma ɛda adi sɛ ɛyɛ nsu anyɛ yiye koraa no simma 5 kosi 10, na afei fa nsu pa hohoro.
• Hohoro ntadehoro a ɛho agu fĩ wɔ gya a ano yɛ den so ntɛm ara: Yi ntama a ɛho agu fĩ, mpopaho, ne ntade a ɛho agu fĩ no yiye a worenwosow wɔ mframa mu. Fa aduru a wɔde hohoro hohoro wɔn wɔ kyinhyia a ɛware sen biara mu wɔ nsu a ɛyɛ hyew sen biara a ɛyɛ anyɛ yiye koraa no digrii Celsius 60 (digrii Fahrenheit 140) mu, na fa aduru a wɔde hohoro hohoro, na fa ɔhyew a ɛkorɔn sen biara no mu ma ɛyow kosi sɛ ɛbɛyow koraa.
• Fa nnɔnhwerew 48 a wɔayi afi adididan mu ho mmara no nni dwuma: Ɛnsɛ sɛ obiara a ne ho tɔ no wɔ ɔfe a ɛyɛ hu anaa akisikuru mu no siesie aduan ma afoforo, di nsukyenee anaa nkuku a wɔkyɛ ho dwuma, guare wɔ ɔmanfo atare mu, anaasɛ ɔsan kɔ aduan-dwuma, akwahosan, anaa mmofra hwɛ adwuma mu kosi sɛ anyɛ yiye koraa no ** nnɔnhwerew 48 kosi 72 wɔ wɔn ɔfe anaa atiridiinini a etwa to koraa no akyi**.

Nsɛm a wɔtaa bisa¶

Sources a wɔhwɛɛ mu¶

• Wiase Akwahosan Ahyehyɛde (WHO) ne UNICEF: Atiridiinini a Wɔsa: Nhoma a Wɔde Ma Nnuruyɛfo ne Akwahosan Ho Adwumayɛfo Afoforo a Nkwakoraa ne mmerewa (ayaresa mu nsu a ɛho ayɛ fĩ nkyekyem, ORS a wɔatew osmolarity so, nkyene-asikre aduru a wɔyɛ wɔ fie, ne mmofra zinc a wɔde ma ho nhyehyɛe).
• Infectious Diseases Society of America (IDSA, United States): Ayaresabea Nneyɛe Akwankyerɛ a ɛfa Nhwehwɛmu ne Nneyɛe a Wɔde Di Dwuma wɔ Atiridiinini a Wɔde Nyarewa Ba Ho (pathogen incubation tables, STEC antibiotic and anti-motility contraindications, ne nsu mu nhwehwɛmu gyinapɛn).
• Asoɛe a Ɛhwɛ Nyarewa So na Wɔsiw Ano (CDC, United States): Nnyarewa ne Nyarewa a Ɛfiri Aduan Mu, Norovirus a Ɛpae So ne Bleach Nkonimdie Akwankyerɛ, ne Ayaresabea Akwankyerɛ a Ɛfa Botulism ne Hemolytic Uremic Syndrome (HUS) ho.
• Ɔman Asoɛe a Ɛhwɛ Akwahosan ne Ɔhwɛ a Ɛyɛ Paara So (NICE, United Kingdom) ne Ɔman Akwahosan Dwumadibea (NHS, United Kingdom): Atiridii ne Ɔfe a Yafunu mu Yare De Ba wɔ wɔn a wonnii mfe 5 mu: Nhwehwɛmu ne ne di (CG84) ne mpanyimfo yafunu mu yare hydration triage gyinapɛn ahorow.
• Europa Kuo a ɛhwɛ Mmofra Yafunu mu Nyarewa, Hepatology ne Aduandi so (ESPGHAN): Akwankyerɛ a egyina Adanse so a wɔde di dwuma wɔ Mmofra a wɔyɛ yafunu mu yare a emu yɛ den mu wɔ Europa (mfitiaseɛ sanba ho nhyehyɛeɛ ne ondansetron/probiotic adanseɛ).

Akwankyerɛ ahorow a ɛfa ho¶

• Awuduru a wɔde ma
• Sepsis ne septic shock a ɛyɛ hu
• Aduan a asɛe ne frigye mu anyinam ahoɔden a atwa
• Nsuo ahobammɔ ne boil ho amanneɛbɔ