Cholera infantum" or acute toxic diarrhoea - In a very severe case rice water stools and symptoms of toxemia. Abrupt onset with high fever and extreme

depressed anterior fontanelle, loss of elasticity of skin and sunken abdomen Fever, restlessness, tachycardia and oliguria. Later symptoms of toxemia - apathy, staring sunken eyes, shallow respirations, uncountable pulse, cyanosis, acidotic breathing. Temperature high or sub-normal "Cholera infantum" or acute toxic diarrhoea - In a very severe case rice water stools and symptoms of toxemia. Abrupt onset with high fever and extreme prostration, vomiting, irritability, restlessness and often convulsions, collapse, suppression of urine and finally stupor and coma. Copious watery stool suggestive of toxigenic diarrhoea, small, frequent with tenesmus, blood and mucus in invasive infections - EEC, Salmonella, Shigella, amoebiasis. III. Parenteral diarrhoea - At onset of any acute infection e. g. acute otitis media and mastoiditis, infection of respiratory tract, acute pyelitis and meningitis. Probably same virus involves both systems as in measles. Management: I FLUIDS - (a) Solution used - (i) Ringer lactate - Full strength 1 ampoule with 5% glucose or 1/2 strength. (ii) Isolyte M is suitable rehydrating fluid in infants. (iii) Glucose-saline IV - 1/5th in newborns, 1/3 in older children use after initial rapid rehydration. (iv) Potassium chloride (1 ml =2mEq), add 1 ml of solution to 100 ml IV solution (maximum 2 ml) after patient starts passing urine. (b) Quantity - (i) Assessment of fluid loss -According to grade of dehydration: (a) Mild - Irritability, pallor, pink lips - <5%>