I. INTRODUCTION

Although often considered a benign disease, acute gastroenteritis remains a

major cause of morbidity and mortality in children around the world, accounting for 1.8

million deaths annually in children younger than 5 years, or roughly 17% of all child

deaths. Because the severity of the disease can widely vary depending on the volume

of fluid loss, accurately assessing and treating dehydration in children presenting with

acute gastroenteritis remains a critical skill for every emergency physician. Luckily, most

cases of dehydration in children can be accurately diagnosed by a careful clinical

examination and treated with simple, cost-effective measures. Infections of the GI tract

are among the most common childhood illnesses. There are at least 1 billion episodes

of gastroenteritis in children around the world every year.

Anyone can get gastroenteritis. It is most common in children under age 5, in day cares,

among travelers, among the immune suppressed, and in places lacking clean food or

water.

Gastroenteritis is an infection of the bowel (intestines) that causes diarrhea and

sometimes vomiting. It is common in infants and children. It is more serious in infants

and young children than it is in adults. Diarrhea and vomiting can cause the loss of

important fluids and minerals the body needs (dehydration). Infants and children lose

fluids and minerals quicker than adults. Since water makes utmost of an infant's or

child's weight this can lead to serious illness and require hospitalization.

A. Background of the Study

Gastroenteritis (also known as stomach flu, although unrelated to influenza) is

inflammation of the gastrointestinal tract, involving both the stomach and the small

intestine and resulting in acute diarrhea. The inflammation is caused most often by

infection with certain viruses, less often by bacteria or their toxins, parasites, or adverse

reaction to something in the diet or medication. Worldwide, inadequate treatment of

gastroenteritis kills 5 to 8 million people per year, and is a leading cause of death

among infants and children under 5. At least 20% of cases, and the majority of severe

cases in children, are due to rotavirus. Other significant viral agents include adenovirus

and astrovirus.

Different species of bacteria can cause gastroenteritis, including Salmonella,

Shigella, Staphylococcus, Campylobacter jejuni, Clostridium, Escherichia coli, Yersinia,

and others. Some sources of the infection are improperly prepared food, reheated meat

dishes, seafood, dairy, and bakery products. Each organism causes slightly different

symptoms but all result in diarrhea.

Gastroenteritis is a catchall term for infection or irritation of the digestive tract,

particularly the stomach and intestine. It is frequently referred to as the stomach or

intestinal flu, although the influenza virus is not associated with this illness. Major

symptoms include nausea and vomiting, diarrhea, and abdominal cramps. These

symptoms are sometimes also accompanied by fever and overall weakness.

Gastroenteritis typically lasts about three days. Adults usually recover without problem,

but children, the elderly, and anyone with an underlying disease are more vulnerable to

complications such as dehydration.

B. Rationale for choosing the case

To study and describe the nature of the disease

To enhance our knowledge and increase our awareness in the development

or manifestation of the disease.

To implement interventions that would help the client overcome the effects of

the disease.

C. Significance of the Study

Nursing Students

Through this study, the students will be able to broaden their knowledge

regarding Acute Gastroenteritis. They will have a clear and better understanding

about the nature of the disease and the essence of having awareness about the

manifestation of it as well as to gain knowledge about its signs and symptoms

and treatment.

Client

This study may help the client’s S.O. to fully understand the disease and

its treatment.

D. Scope and Limitation

This study covers and focuses on the following:

A brief discussion of the nature of the disease and the anatomy and

physiology of the system involve.

Tracing the pathophysiology of Acute Gastroenteritis.

Introducing the patient, identifying the cause of the disease by determining

the client’s history of past illness.

Understanding the actions, contraindications, special precautions and nursing

interventions of the prescribed medicines of the patient.

Formulating an appropriate nursing interventions and plan for the patient.

Health teaching regarding the disease.

II. CLINICAL SUMMARY

A. Eclectic Model

1. Bio-demographic Data:

a. Name : Baby GC

b. Age : 2 months old

c. Sex : Female

d. Civil Status : Single

2. Source of Information

A. Primary Sources:

Mr. and Mrs. GC

Nurses on Duty

B. Secondary Sources:

Patient’s records and chart

3. Chief Complaint:

2 consecutive days of defecating loose-watery stool

4. History of the Present Illness:

According to her parents, after 2 months of feeding her with

lactose-intolerant milk, Baby GC began to defecate loose-watery stool. They

decided to change her milk but as wasn’t expected, Baby GC continued to

defecate the same.

5. Current Health Status:

a. Body Movement

Baby GC flexes her upper and lower extremities well.

b. Affect and Mood

Baby GC is fairly active while she’s awake and usually cries when

she’s irritable.

6. Activities of Daily Living

a. Nutrition

Baby GC receives incomplete nutritional diet for her age because she

is not directly breastfed by her mother because her nipple is inverted.

b. Elimination

Baby GC urinates usually about 330 ml per day and defecates twice a

day.

c. Hygiene, Grooming and Body Odor

Baby GC usually cleaned by her mother every morning and dressed

her neatly and has no foul odor.

d. Rest and Sleep

Baby GC is fairly and quietly sleeping for long period of time.

7. Past Biophysical Health

a. Allergies

No allergies noted.

b. Immunization

BCG has already given to Baby GC.

d. Growth and Development

Baby GC has decreased weight from 3.9 kg to 3.2 kg.

e. Foreign Travel

No noted foreign travel so far.

f. Family Health History

Baby GC’s father has a history of hypertension and gets used to smoking,

while her mother has no history of any disease.

8. Spiritual

a. Religious Belief and Practice

Baby GC’s family is a Roman Catholic and practice to go to church every

Sunday and they believe in “herbularios” or “hilots”.

B. Physical Assessment

1. General Observation (Day 1-Nov. 27, 2008)

a. General Appearance and Behavior

Pallor

Weak Cry

Fairly Weak

b. Vital Signs

4pm

T- 36.7°C

P- 136 bpm

R- 38 breaths/min.

8pm

T- 36.8°C

P- 128 bpm

R- 40 breaths/min

c. Height and Weight

Height: (Normal Value: 50 cm or 20”) Result: 38.1 cm

Weight: (Normal Value: 2.7- 3.8 kg) Result: 3.9 kg

Complete Physical Examination

SKIN

Cyanotic

Poor skin turgor

No lesions

HEAD

Symmetrical

Sunken fontanels

FACE

Symmetrical

EYES

Symmetrical

Sunken eyeball

Lower Conjunctiva is pale.

Absence of tears when crying.

EARS

Symmetrically aligned to the outer cantus of the eye

No discharge

NOSE

Symmetrical

No discharge

MOUTH

Pale and dry lips

Uvula in midline

CHEST

Shape: symmetrical

Respiration: spontaneous

Heart: (-) murmur

ABDOMEN

Tender

With gargling bowel sounds

EXTREMITIES

Grossly normal

Cyanotic

Capillary refill (5-6 sec.)

ANUS

Patent

General Observation (Day 2-Nov. 28, 2008)

a. General Appearance and Behavior

Pallor

Weak Cry

Fairly Weak

b. Vital Signs

4pm

T- 38.1°C

P- 142 bpm

R- 56 breaths/min

8pm

T- 37.4°C

P- 124 bpm

R- 34 breaths/min.

c. Height and Weight

Height: (Normal Value: 50 cm or 20”) Result: 38.1 cm

Weight: (Normal Value: 2.7- 3.8 kg) Result: 3.5 kg

Complete Physical Examination

SKIN

Slight cyanotic

Poor skin turgor

No lesions

HEAD

Symmetrical

Sunken fontanels

FACE

Symmetrical

EYES

Symmetrical

Sunken eyeball

Lower Conjunctiva is pale.

Absence of tears when crying

EARS

Symmetrically aligned to the outer cantus of the eye

No discharge

NOSE

Symmetrical

No discharge

MOUTH

Pale and dry lips

Uvula in midline

CHEST

Shape: symmetrical

Respiration: spontaneous

Heart: (-) murmur

ABDOMEN

Tender

With gargling bowel sounds

EXTREMITIES

Grossly normal

Cyanotic

Capillary refill (3-4 sec.)

ANUS

patent

General Observation (Day 3-Nov. 29, 2008)

a. General Appearance and Behavior

Good cry

Fairly active

Irritable

b. Vital Signs

4pm

T- 37°C

P- 126 bpm

R- 38 breaths/min.

8pm

T- 36.9°C

P- 122 bpm

R- 36 breaths/min

c. Height and Weight

Height: (Normal Value: 50 cm or 20”) Result: 38.1 cm

Weight: (Normal Value: 2.7- 3.8 kg) Result: 3.2 kg

Complete Physical Examination

SKIN

Good skin turgor

No lesions

HEAD

Symmetrical

Sunken fontanels

FACE

Symmetrical

EYES

Symmetrical

Presence of tears when crying

Lower conjunctiva is pink.

EARS

Symmetrically aligned to the outer cantus of the eye

No discharge

NOSE

Symmetrical

No discharge

MOUTH

Pink and moist lips

Uvula in midline

CHEST

Shape: symmetrical

Respiration: spontaneous

Heart: (-) murmur

ABDOMEN

soft

No gargling bowel sounds

EXTREMITIES

Grossly normal

Cyanotic

Capillary refill (2-3 sec.)

ANUS

patent

C. Laboratory and Diagnostics Examination

Clinical Chemistry

November 24, 2008

Type of Exam

Clinical Chemistry

TEST NORMAL

VALUE

RESULT INTERPRETATION SIGNIFICANCE

OF THE

RESULT

Sodium 135-

155meq/L

137meq/L NORMAL

Potassium 3.4-

5.3meq/L

2.40meq/L BELOW NORMAL Decrease

potassium

indicates

chronic

diarrhea

November 27, 2008

Type of Exam

Clinical Chemistry

TEST NORMAL

VALUE

RESULT INTERPRETATION SIGNIFICANCE

OF THE

RESULT

Sodium 135-155meq/L 137.5meq/L NORMAL

Potassium 3.4-5.3meq/L 2.40meq/L BELOW NORMAL Decrease

potassium

indicates

chronic

diarrhea

November 23, 2008

Type of Exam

Gross Examination

FECALYSIS

Color: Yellow

Consistency: Mushy

Occult Blood: None

MICROSCOPIC

Red blood cells: 0-1

Ova or parasite: None found

OTHERS

Bacteria: Moderate

Fat Globules: Many

November 27, 2008

Type of Exam

Gross Examination

FECALYSIS

Color: Yellow brown

Consistency: Soft

Ova or parasite: None (no intestinal parasite found)

OTHERS

Bacteria: Moderate

Fat Globules: Rare

Significance of the Result:

Presence of fat globules indicates malabsorption syndrome due to undigested

milk.

D. Course in the Ward

November 25, 2008, Baby GC, a 2 month old child was admitted to Gastro

room in Pediatric Ward of the Laguna Provincial Hospital with the chief complaint

of loose watery stool and impaired bowel movement.

On the third day of her admission, November 27, Ms. Ma. Katrina

Panisan, our Clinical Instructress, endorsed us Baby GC. We received her at

2pm with an IV fluid of D5 0.3NaCl ½ liter at 280cc and 10meqs of KCl via

soluset at 10cc to run at 32-33µgtts/min. which was inserted at the right

metacarpal vein not infusing well. We referred Baby GC to Ma’am Panisan for

edema on her IV site. We’ve performed thorough physical assessment, checked

and monitored her vital signs every four hours, attended her needs as well as

monitored her urine and stool output. She defecated 3x during our shift. Her due

medication was given by the NOD.

On the fourth day of admission, November 28, 2008, we received her with

an IVF of D5 0.3NaCl ½ liter at 355cc and 10 meqs of KCl via soluset at 68cc,

inserted at the right metatarsal infusing well. Still, we monitored her vital signs

every four hours, maintained and regulated her IVF. By this time, she defecated

twice with yellow-greenish mushy stool during our shift.

On the fifth day of admission, November 29, 2008, her abdomen was not

distended and tender at all. She had no IVF when we received her and her bowel

pattern was in normal condition according to her mother. They could go home

anytime according to the doctor.

III. CLINICAL DISCUSSION OF THE DISEASE

A. Anatomy and Physiology

THE DIGESTIVE SYSTEM OF INFANTS

Infants growing digestive system leaves

them vulnerable for all kinds of gastro-intestinal

problems. Infants simply can’t digest foods as

effectively as adults, whose own systems really

can’t handle the garbage that passes for food

nowadays. Interestingly, infants possess unique

enzymes in their mouths which are not evident in

adults. When your baby feeds, these enzymes start

breaking down fats in the breastmilk while it’s still in

their mouth as a kind of head start on the digestive

process. By the time food gets to your child’s

stomach, it’s already broken down a little so it’s

easier to digest.

Normal Digestive Tract Phenomena

Gastrointestinal function varies with maturity; what is a physiologic event in a

newborn or infant might be a pathologic symptom at an older age. A fetus can swallow

amniotic fluid as early as 12 wk gestation, but nutritive sucking in neonates 1st develops

at about 34 wk gestation. The coordinated oral and pharyngeal movements necessary

for swallowing solids develop within the 1st few months of life. Before this time, the

tongue thrust is upward and outward to express milk from the nipple, instead of a

backward motion, which propels solids toward the esophageal inlet. By 1 month of age,

infants appear to show preferences for sweet and salty foods. Infants' interest in solids

increases at about 4 months of age.

HUMAN DIGESTION PROCESS

Phases of Gastric Secretion

Cephalic phase - This phase occurs before food enters the stomach and

involves preparation of the body for eating and digestion. Sight and thought

stimulate the cerebral cortex. Taste and smell stimulus is sent to the

hypothalamus and medulla oblongata. After this it is routed through the vagus

nerve and release of acetylcholine. Gastric secretion at this phase rises to 40%

of maximum rate. Acidity in the stomach is not buffered by food at this point and

thus acts to inhibit parietal (secretes acid) and G cell (secretes gastrin) activity

via D cell secretion of somatostatin.

Gastric phase - This phase takes 3 to 4 hours. It is stimulated by

distention of the stomach, presence of food in stomach and increase in pH.

Distention activates long and myentric reflexes. This activates the release of

acetylcholine which stimulates the release of more gastric juices. As protein

enters the stomach, it binds to hydrogen ions, which raises the pH of the

stomach to around pH 6. Inhibition of gastrin and HCl secretion is lifted. This

triggers G cells to release gastrin, which in turn stimulates parietal cells to

secrete HCl. HCl release is also triggered by acetylcholine and histamine.

Intestinal phase - This phase has 2 parts, the excitatory and the

inhibitory. Partially-digested food fills the duodenum. This triggers intestinal

gastrin to be released. Enterogastric reflex inhibits vagal nuclei, activating

sympathetic fibers causing the pyloric sphincter to tighten to prevent more food

from entering, and inhibits local reflexes.

Oral cavity

In humans, digestion begins in the oral cavity where food is chewed. Saliva is

secreted in large amounts (1-1.5 litres/day) by three pairs of exocrine salivary glands

(parotid, submandibular, and sublingual) in the oral cavity, and is mixed with the chewed

food by the tongue. There are two types of saliva. One is a thin, watery secretion, and

its purpose is to wet the food. The other is a thick, mucous secretion, and it acts as a

lubricant and causes food particles to stick together and form a bolus. The saliva serves

to clean the oral cavity and moisten the food, and contains digestive enzymes such as

salivary amylase, which aids in the chemical breakdown of polysaccharides such as

starch into disaccharides such as maltose. It also contains mucin, a glycoprotein which

helps soften the food into a bolus.

Swallowing transports the chewed food into the esophagus, passing through the

oropharynx and hypopharynx. The mechanism for swallowing is coordinated by the

swallowing center in the medulla oblongata and pons. The reflex is initiated by touch

receptors in the pharynx as the bolus of food is pushed to the back of the mouth.

Esophagus

The esophagus is a narrow muscular tube about 25 centimeters long which starts

at pharynx at the back of the mouth, passes through the thorax and thoracic diaphragm,

and ends at the cardiac orifice of the stomach. The wall of the esophagus is made up of

two layers of smooth muscles, which form a continuous layer from the esophagus to the

oten and contract slowly, over long periods of time. The inner layer of muscles is

arranged circularly in a series of descending rings, while the outer layer is arranged

longitudinally. At the top of the esophagus, is a flap of tissue called the epiglottis that

closes during swallowing to prevent food from entering the trachea (windpipe). The

chewed food is pushed down the esophagus to the stomach through peristaltic

contraction of these muscles. It takes only about seven seconds for food to pass

through the esophagus and no digestion takes place.

Stomach

The stomach is a small, “J”-shaped pouch with walls made of thick, elastic

muscles, which stores and helps break down food. Food enters the stomach through

the cardiac orifice where it is further broken apart and thoroughly mixed with gastric

acid, pepsin and other digestive enzymes to break down proteins. The acid itself does

not break down food molecules, rather it provides an optimum pH for the reaction of the

enzyme pepsin and kills many microorganisms that are ingested with the food. The

parietal cells of the stomach also secrete a glycoprotein called intrinsic factor which

enables the absorption of vitamin B-12. Other small molecules such as alcohol are

absorbed in the stomach, passing through the membrane of the stomach and entering

the circulatory system directly. Food in the stomach is in semi-liquid form.

The transverse section of the alimentary canal reveals four distinct and well developed

layers within the stomach:

Serous membrane, a thin layer of mesothelial cells that is the outermost

wall of the stomach.

Muscular coat, a well-developed layer of muscles used to mix ingested

food, composed of three sets running in three different alignments. The

outermost layer runs parallel to the vertical axis of the stomach (from top to

bottom), the middle is concentric to the axis (horizontally circling the stomach

cavity) and the innermost oblique layer, which is responsible for mixing and

breaking down ingested food, runs diagonal to the longitudinal axis. The inner

layer is unique to the stomach, all other parts of the digestive tract have only the

first two layers.

Submucosa, composed of connective tissue that links the inner muscular

layer to the mucosa and contains the nerves, blood and lymph vessels.

Mucosa is the extensively folded innermost layer filled with connective

tissue and covered in gastric glands that may be simple or branched tubular, and

secret mucus, hydrochloric acid, pepsinogen and renin. The mucus lubricates the

food and also prevents hydrochloric acid from acting on the walls of the stomach.

Small intestine

After being processed in the stomach, food is passed to the small intestine via

the pyloric sphincter. The majority of digestion and absorption occurs here after the

milky chyme enters the duodenum. Here it is further mixed with three different liquids:

Bile, which emulsifies fats to allow absorption, neutralizes the chyme and

is used to excrete waste products such as bilin and bile acids.

Pancreatic juice made by the pancreas.

Intestinal enzymes of the alkaline mucosal membranes. The enzymes

include maltase, lactase and sucrase (all three of which process only sugars),

trypsin and chymotrypsin.

As the pH level changes in the small intestines and gradually becomes basic,

more enzymes are activated further that chemically break down various nutrients into

smaller molecules to allow absorption into the circulatory or lymphatic systems. Small,

finger-like structures called villi, each of which is covered with even smaller hair-like

structures called microvilli improve the absorption of nutrients by increasing the surface

area of the intestine and enhancing speed at which nutrients are absorbed. Blood

containing the absorbed nutrients is carried away from the small intestine via the

hepatic portal vein and goes to the liver for filtering, removal of toxins, and nutrient

processing.

The small intestine and remainder of the digestive tract undergoes peristalsis to

transport food from the stomach to the rectum and allow food to be mixed with the

digestive juices and absorbed. The circular muscles and longitudinal muscles are

antagonistic muscles, with one contracting as the other relaxes. When the circular

muscles contract, the lumen becomes narrower and longer and the food is squeezed

and pushed forward. When the longitudinal muscles contract, the circular muscles relax

and the gut dilates to become wider and shorter to allow food to enter.

Large intestine

After the food has been passed through the small intestine, the food enters the large

intestine. The large intestine is roughly 1.5 meters long, with three parts: the cecum at the

junction with the small intestine, the colon, and the rectum. The colon itself has four parts: the

ascending colon, the transverse colon, the descending colon, and the sigmoid colon. The

large intestine absorbs water from the bolus and stores feces until it can be egested. Food

products that cannot go through the villi, such as cellulose (dietary fiber), are mixed with other

waste products from the body and become hard and concentrated feces. The feces is stored in

the rectum for a certain period and then the stored feces is egested due to the contraction and

relaxation through the anus. The exit of this waste material is regulated by the anal sphincter.

Fat digestion

The presence of fat in the small intestine produces hormones which stimulate the

release of lipase from the pancreas and bile from the gallbladder. The lipase (activated

by acid) breaks down the fat into monoglycerides and fatty acids. The bile emulsifies the

fatty acids so they may be easily absorbed.

Short- and some medium chain fatty acids are absorbed directly into the blood via

intestine capillaries and travel through the portal vein just as other absorbed nutrients

do. However, long chain fatty acids and some medium chain fatty acids are too large to

be directly released into the tiny intestinal capillaries. Instead they are absorbed into the

fatty walls of the intestine villi and reassembled again into triglycerides. The triglycerides

are coated with cholesterol and protein (protein coat) into a compound called a

chylomicron.

Within the villi, the chylomicron enters a lymphatic capillary called a lacteal, which

merges into larger lymphatic vessels. It is transported via the lymphatic system and the

thoracic duct up to a location near the heart (where the arteries and veins are larger).

The thoracic duct empties the chylomicrons into the bloodstream via the left subclavian

vein. At this point the chylomicrons can transport the triglycerides to where they are

needed.

Digestive hormones

There are at least four hormones that aid and regulate the digestive system:

Gastrin - is in the stomach and stimulates the gastric glands to secrete

pepsinogen(an inactive form of the enzyme pepsin) and hydrochloric acid.

Secretion of gastrin is stimulated by food arriving in stomach. The secretion is

inhibited by low pH .

Secretin - is in the duodenum and signals the secretion of sodium

bicarbonate in the pancreas and it stimulates the bile secretion in the liver. This

hormone responds to the acidity of the chyme.

Cholecystokinin (CCK) - is in the duodenum and stimulates the release of

digestive enzymes in the pancreas and stimulates the emptying of bile in the gall

bladder. This hormone is secreted in response to fat in chyme.

Gastric inhibitory peptide (GIP) - is in the duodenum and decreases the

stomach churning in turn slowing the emptying in the stomach. Another function

is to induce insulin secretion.

Significance of pH in digestion

Digestion is a complex process which is controlled by several factors. pH plays a

crucial role in a normally functioning digestive tract. In the mouth, pharynx, and

esophagus, pH is typically about 6.8, very weakly acidic. Saliva controls pH in this

region of the digestive tract. Salivary amylase is contained in saliva and starts the

breakdown of carbohydrates into monosaccharides. Most digestive enzymes are

sensitive to pH and will not function in a low-pH environment like the stomach. A pH

below 7 indicates an acid, while a pH above 7 indicates a base; the concentration of the

acid or base, however, does also play a role.

pH in the stomach is very acidic and inhibits the breakdown of carbohydrates while

there. The strong acid content of the stomach provides two benefits, both serving to

denature proteins for further digestion in the small intestines, as well as providing non-

specific immunity, retarding or eliminating various pathogens.

In the small intestines, the duodenum provides critical pH balancing to activate digestive

enzymes. The liver secretes bile into the duodenum to neutralise the acidic conditions

from the stomach. Also the pancreatic duct empties into the duodenum, adding

bicarbonate to neutralize the acidic chyme, thus creating a neutral environment. The

mucosal tissue of the small intestines is alkaline, creating a pH of about 8.5, thus

enabling absorption in a mild alkaline in the environment.

B. ECOLOGICAL MODEL

HYPOTHESIS:The cause of illness of the body is due to unclean environment and the parents are

lack of knowledge about sanitation and proper preparation of food for the child.

PREDISPOSING FACTORS:a. Agent- contaminated feeding bottleb. Host- Baby God-Centeredc. Environmental- Unclean environment, and the presence of bacteria

NURSING MODEL:Florence Nightingale Environmental Adaptation Model

According to Florence Nightingale, in order for the patient/ client to be in the best possible condition, we should change or manipulate the environment. Also, she emphasized the importance of providing the client with pure/ fresh water, practice of cleanliness and assessing the client’s diet.

ANALYSIS:Based on the assessment done on the client and interview of the parents, their environment is not clean enough, although they use distilled water for the milk formula, the mother was not aware of proper cleaning of the feeding bottle. The illness of the child may be due to dirty environment and unhygienic practices of the parents.

INTERPRETATION:If only the parents would practice cleanliness in their environment and will be aware of proper cleaning of materials needed for the preparation of the food of the child, the child will be healthy and illness will be prevented.

C. Pathophysiology and Symptomatology

PATHOPHYSIOLOGY OF ACUTE GASTROENTERITIS

Production of gas (mixture of H, CO2, methane)

PREDISPOSING FACTORS:

Contaminated Feeding bottle Lactose intolerance

Absence of enzyme to digest lactose (lactase)

Presence of bacteria in the feeding bottle

Ingestion of bacteria Lactose is not digested nor absorbed into the blood stream

Lactose passes into the colon

Bacteria enter the intestinal tract and excrete exotoxin

Damages the intestinal mucosa causing inflammation

Enteric bacteria try to digest lactose

Fermentation of lactose

Most particles of lactose still undigested

Abdominal distention

Flatulence

Fever

Presence of bacteria in stool

Water is pulled in into the intestine by the unabsorbed particles of lactose

Gastrointestinal motility is increased

Diarrhea

Intestinal absorption becomes impaired

Increase in osmotic pressure in the intestine

Fluids and electrolytes secreted at fast rates

Sunken Fontanels

Sunken eyeballsDry skinCyanoticPoor skin turgorDry lips

DehydrationHypokalemia