Search

In children, the treatment of acute diarrhoea with the World Health Organization (WHO) standard oral rehydration solution (ORS) provides effective rehydration but does not reduce the severity of diarrhoea. In community practice, carob bean has been used to treat diarrhoeal diseases in Anatolia since ancient times. In order to test clinical antidiarrhoeal effects of carob bean juice (CBJ), 80 children, aged 4-48 months, who were admitted to SSK Tepecik Teaching Hospital with acute diarrhoea and mild or moderate dehydration, were randomly assigned to receive treatment with either standard WHO ORS alone or a combination of standard WHO ORS and CBJ. Three patients were excluded from the study because of excessive vomiting. In the children receiving ORS + CBJ the duration of diarrhoea was shortened by 45%, stool output was reduced by 44% and ORS requirement was decreased by 38% compared with children receiving ORS alone. Weight gain was similar in the two groups at 24 h after the initiation of the study. Hypernatraemia was detected in three patients in the ORS group but in none of those in the ORS + CBJ group. The use of CBJ in combination with ORS did not lead to any clinical metabolic problem. We therefore conclude that CBJ may have a role in the treatment of children's diarrhoea after it has been technologically processed, and that further studies would be justified. [ABSTRACT FROM AUTHOR]

Reviews and synthesizes evidence in the published literature on the safety and efficacy of oral rehydration therapy (ORT) among young children with pediatric gastroenteritis in developed nations. Failure rate among children treated in outpatient settings; Risks of iatrogenic hypernatremia or hyponatremia; ORT's potentials for improving medical treatment of children with acute gastroenteritis.

Assesses the effects of glucose (G)-oral rehydration solution (ORS), rice dextrin (RD)-ORS and rice flour (RF)-ORS on fluid intake, rapidity of rehydration and stool output of children with acute diarrhea and mild or moderate dehydration. Initial examination, randomization and rehydration solutions; Treatment protocol; Diagnostic examinations.

Compares the efficacy of an oral rehydration solution (ORS) containing short polymers of glucose derived from rice (amylyte-ORS) and five times the caloric density of ORS to the standard glucose-ORS of the World Health Organization (WHO) in the treatment of acute diarrhea in children. Thermophilic amylase; Glucose polymers; Components of ORS.

Identifies potential barriers to the use of oral rehydration therapy (ORT) by pediatric practitioners. Survey of physicians' ORT knowledge, attitudes, and practice; Compliance with guidelines of the American Academy of Pediatrics for the use of oral therapy; Factors that influence the degree of importance of ORT in physicians' practice; Recommendations for improving use of ORT.

Presents commentaries on several issues related to pediatric care. Discussion on the use and misuse of oral therapy for diarrhea; Risk of neuroleptic malignant syndrome in children; Information on congenital glaucoma.

Abstract. Oral rehydration solutions containing 50 to 90 mmol/L of sodium have recently been recommended for the treatment of diarrhea in both hospitalized and ambulatory children in the United States. Few data are available, however, from ambulatory US children. Therefore, we conducted a randomized double-blind study comparing the use of four different oral rehydration solutions with differing concentrations of sodium, glucose, and base. Ambulatory children less than 2 years of age with acute diarrhea (N = 140) were randomly chosen to receive solutions containing sodium at 90 (solution A), 50 (solution B), and 30 mmol/L (solutions C and D). All oral rehydration solutions contained 20 g/L of glucose except solution D which contained 50 g/L of glucose. Solution A contained bicarbonate as its base source whereas the other three contained citrate. All but three (98%) children were treated uneventfully according to the study protocol, and there were no differences among groups in measurements of clinical outcome. It was concluded that in ambulatory US children, oral rehydration solutions containing 90, 50, or 30 mmol/L of sodium can be used safely for the treatment of mild acute diarrhea and that citrate is as efficacious as bicarbonate in the correction of acidosis. [ABSTRACT FROM AUTHOR]

Focuses on the appropriate implementation of oral hydration therapy in a developed country. Discussion on oral rehydration as a strategy to treat diarrheal diseases in infants; Indications for oral rehydration solutions; Information on oral solutions for maintenance of hydration or prevention of dehydration; Recommendation for premixed oral solution.

This article presents the World Health Organization's recommendations for the rehydration treatment of acute diarrhea in children with inexpensive oral fluids in developing countries. Every patient with watery diarrhea has some dehydration and will need fluid. Dehydration may be mild or severe. Patients with mild dehydration appear almost normal yet they may have already lost half of the fluid (50 milliliters per kg body weight) necessary to produce severe dehydration (100 milliliters per kg body weight). As further fluid is lost, signs of dehydration rapidly become prominent. This is why it is very important to treat dehydration while it is mild and the patient still appears well. Otherwise, dehydration may get worse rapidly and become more difficult to treat.

To identify child feeding behavior and household hygiene practices that are risk factors for prolonged diarrheal illness, a longitudinal community study was conducted over a 14-month period among 920 children aged 3–37 months who lived in an urban slum settlement in Nairobi, Kenya. Morbidity surveillance was done by home visits every third day in the absence of diarrhea and daily during diarrheal illness until termination of the episode. In-home observations were made to characterize maternal hygiene, cooking, and child feeding practices. Overall, 1,496 episodes of diarrhea were detected. The average diarrheal incidence was 3.5 episodes/child-year, and the incidence of diarrhea ≥14 days was 3 episodes/100 child-years. Cox regression was used to examine the independent effects of covariates on time to recovery from a diarrheal episode. Adjusted behavioral factors that were observed to influence recovery from diarrhea included: uncovered water containers (rate ratio (RR) = 0.77, 95% confidence interval (Cl) 0.64–0.94); giving no fluids (as opposed to oral rehydration solutions (ORS)/sugar salt solutions (SSS)) (RR = 1.42, 95% Cl 1.14–1.77); and administration of diluted cow's milk during the first 3 days of an episode (RR = 1.23, 95% Cl 1.00–1.52). These associations remained significant after adjusting for diarrheal severity. The authors recommend, among other measures, improvement of water storage and promotion of continued feeding with cereal-milk mix during diarrhea. [ABSTRACT FROM AUTHOR]

The article provides an answer to a question on comparison between ultrarapid intravenous rehydration with standard methods of rehydration in children with dehydration secondary to gastroenteritis.

The article investigates whether ultrarapid intravenous rehydration is an effective intervention in children who are dehydrated from viral gastroenteritis compared to other methods of rehydration. Results of randomized studies are discussed including the different methods for administering ultrarapid intravenous rehydration in the outpatient setting, the primary outcome of clinical rehydration, and the number and proportion of children who were rehydrated, and the safety of the intervention.

Aim To evaluate changes in glomerular filtration rate in acute gastroenteritis. Methods The correlation between two clinical diagnostic scales and glomerular filtration rate has been investigated in 113 children with acute gastroenteritis in a paediatric emergency setting. Results A significant reduction of GFR was found in 10% children less than, and 5% children higher than, 2 years of age with acute gastroenteritis. Conclusion The differences observed as for risk of renal hypoperfusion suggests to consider the age of children as an important determinant to consider the dehydration status in acute gastroenteritis. [ABSTRACT FROM AUTHOR]

The article discusses a study which explores the vital role of ondansetron in improving outcome in dehydrated children with gastroenteritis. The study found that ondansetron is capable to reduce the presence of vomiting episodes in children with gastroenteritis during oral rehydration therapy (ORT). The study also assessed statistical difference in the number of patients vomiting during ORT, where only 14% of patients treated with ondansetron and 35% with placebo.

Reports on the findings of the 2003 National Sentinel Surveillance System on the increase of severe rotavirus gastroenteritis cases among children in Jamaica. Discussion on the need for additional education of caregivers regarding the treatment for gastroenteritis; Investigation on the number of diarrheal deaths among children in the country; Recommendation for oral rehydration therapy for the treatment of the disease.

ABSTRACT. Background/Objective. Treatment of dehydrating gastroenteritis, a major cause of morbidity in children, remains controversial. Practice parameters issued by the American Academy of Pediatrics (AAP) recommend oral rehydration therapy (ORT) as the preferred treatment for losses from both mild and moderate dehydration. The objective of this study was to test the hypothesis that awareness of the AAP practice parameters would be associated with a higher rate of use of ORT among emergency physicians. Methods. A national random survey of emergency physicians selected from the mailing list of the AAP Section on Emergency Medicine was conducted. Respondents were asked about level of awareness of AAP guidelines and preferred route of rehydration for scenarios representing mild (≤ 5%), moderate (6%-9%), and severe (≥ 10%) dehydration. Respondents who were very familiar with the AAP practice parameters were designated as the familiar group; those who were less familiar were designated as the unfamiliar group. Differences in proportions of dichotomous variables were tested by χ² or Fisher exact test as appropriate. Univariate logistic regression modeling was used to determine the independent influence of awareness of AAP guidelines on the use of ORT. Results. A total of 176 physicians responded (73% response rate). Most were board certified in 1 or more specialties: pediatrics (89%), pediatric emergency medicine (84%), and adult emergency medicine (63%). Median duration of practice was 16 years. Thirty-seven percent of respondents were very familiar with the AAP practice parameters. In contrast to the unfamiliar group, the familiar group was more likely to use ORT in scenarios of mild dehydration (81% vs 66%) and moderate dehydration (25% vs 10%). Logistic regression analysis confirmed that this familiar group overall was nearly 3 times more likely to use ORT (odds ratio: 2.85; 95% confidence interval: 2.46-3.24). Conclusions. This is the first... [ABSTRACT FROM AUTHOR]

Summarizes guidelines for the treatment of acute diarrhea in children proposed by the working group of the Italian Society of Pediatric Gastroenterology. Comparison of the effectiveness of oral rehydration solution (ORS) and intravenous therapy in rehydrating patients; Absence of effect of ORS on stool volume, stool frequency and duration of diarrhea; Refeeding after rehydration'.

The article analyzes the efficiency of oral rehydration solutions for the treatment of acute watery diarrhea. Topics include a comparison between the impact of polymer-based and glucose-based solutions on electrolyte imbalances, osmolarity factor of the solutions, and recommendation of low-osmolarity solutions for children.

Comments on the use of rational oral glucose-electrolyte therapy. Earliest physiologic therapy for dehydration; Influence of product marketing; Formulation of the World Health Organization solution; Assertion that the acceptance of the therapy in the United States should have come more readily if not for the commercial misadventure in the 1950s.

The article discusses the results of an oral rehydration therapy program undertaken in Southern Thailand. Diarrheal diseases are the most common cause of death among children aged 1 to 4 years. To fight the disease, the National Control of Diarrheal Diseases Program was undertaken by the public health ministry. The program featured the promotion of oral rehydration therapy (ORT) and distribution of oral rehydration salts (ORS). Due to limited training of village health volunteers, only 11 percent of the cases were treated with ORS. The low impact suggests that more training is needed by health volunteers combined with mobilization of village leaders to promote ORT.

Examines the effects of oral rehydration fluid with breast feeding on the course and outcome of acute diarrhea. Beneficial effects of breast feeding; Belief that breast feeding a child with diarrhea makes the condition of the child worse; Conclusion that breast feeding during early phase of diarrhea does not exacerbate the clinical course of diarrhea.

Presents an article related to the health and survival of disadvantaged children. Reasons for the limited success of the campaign launched by the United Nations Children's Fund called the Child Survival Resolution; Analysis of the oral rehydration therapy; Fundamental causes of the death of children.

Focuses on the use of oral rehydration therapy (ORT) to prevent death in children due to diarrhea in the United States. Prevalence of diarrhea among children; Processes involved in ORT; Factors that influence the implementation of ORT; Costs of ORT implementation.

The article focuses on diarrhea management and prevention via Zinc, Oral Rehydration Solution, Diet, Immunization, Antibiotics and Adjuncts, and Cleanliness (ZODIAC). Topics discussed include diarrhea as one of the leading causes of child mortality in India; need for ORS for prevention of dehydration leading to child mortality; and exposure to a diarrheogenic microbe due tom lack of cleanliness.

The article discusses the management of diarrhea and oral rehydration solution (ORS) which was covered in the 2013 Lancet Series on Childhood Diarrhea and Pneumonia.

A letter to the editor is presented concerning the risks associated with the use of oral rehydration solution for gastroenteritis in children.

The author examines a study by M. M. Hossain et al published within the issue, which compares the outcome of managed care provided to severely malnourished children based on the Institute of Child and Mother Health (ICMH) protocol with that provided based on World Health Organization (WHO) guidelines. She expresses doubt about the safety and efficacy of ICMH feeding and rehydration process. She states that the sample size of the study is too small to detect an increased mortality risk. She explains the rapid weight gain of the ICMH children.

The article reports on the study that focuses on the cost-effective analysis of strategies for child health. According to the analysis of the Sub-Saharan African and South East Asian regions, micronutrient fortification, measles immunization, case management of pneumonia, and oral rehydration therapy for diarrhea are the most cost-effective interventions in reducing child mortality by 2015.

Discusses several pediatrics-related research on gastroenterology and nutrition. Follow up on the negative results of antiendomysial antibodies; Comparison of oral versus intravenous rehydration of moderately dehydrated children; Breastfeeding rates in the U.S.

Reports on the use of rice-electrolyte oral rehydration solution (ORS) for the treatment of diarrhea in children. Preparation of the solution; Composition of the World Health Organization glucose-based ORS.

Focuses on oral rehydration therapy for the treatment of diarrhea. Estimation of the number of children's lives save every year; Use of the therapy by the United Nations Children's Fund in child survival revolution; Promotion of the therapy in different countries.

Examines the use of honey in oral rehydration solution in infants and children with gastroenteritis. Influence of honey on the duration of acute diarrhea; Importance of honey as glucose substitute in oral rehydration; Presence of electrolytes in oral rehydration.

Describes viral infections of diarrhea in children. Accounts on rotavirus as the commonest cause of acute diarrhea in childhood; Symptoms of the disease; Association of Norwalk virus with diarrhea; Effectiveness of oral rehydration as treatment for the disease.

The article focuses on new program Zinc Alliance for Child Health (ZACH) led by the United Nations Children's Fund (UNICEF) Canada and the zinc producing company Teck Resources Ltd. for children dying from diarrhea in India. It focuses on the main objectives of the initiative including educating families and health professionals about the importance of zinc and oral rehydration salts, increasing the use of zinc supplementation and strengthen health care system.

A letter to the editor is presented in response to the article "Diagnosis and Management of Dehydration in Children" in the October 1, 2009 issue.

Abstract: Acute infectious diarrhea in children remain still a frequent cause of morbidity. 50 % of them are due to rotavirus. Oral rehydratation therapy and early realimentation have drastically reduced their mortality and morbidity. Beside oral or eventually IV rehydratation therapy no medication has proven its efficacy based on the main HMO criteria (reduction of over 30 % of the stool output) except racecadotril and loperamide which is contre-indicated for the last one in children less than 2 years old. Other medications such as silicates or some probiotics have shown efficacy on diarrhea duration or stool consistancy but not on stool output. They have so no formal indication in infectious diarrhea and should be considered as "comfort" treatment. Antibiotics, beside their indication in shigella, cholera and amibiasis could be used in invasive diarrhea in some debilating conditions or infants less than 3 months. [Copyright &y& Elsevier]

This article discusses diarrhoeal illnesses among malnourished young children. A large percentage of diarrhoeal episodes are caused by bacteria, viruses, and parasites, and result in potentially fatal dehydration, especially in less-developed countries where mortality rates resulting from diarrhoeal dehydration are extremely high. Diarrhea greatly affects the absorption of nutrients from food, and can lead to immunodeficiency. An important step in lowering these rates has been the advocation of oral rehydration. Trials have displayed the benefits of zinc supplements during the treatment of diarrhea. Understanding the effects and treatment of diarrhea is extremely important because it accounts for a large percentage of growth retardation among children worldwide.

The author suggests that it may be possible that approaches used to treat calves, which are radically different from those used by paediatricians, could benefit children. The practical problems of treating calf diarrhoea on farms are not very different from those of treating cholera in primitive surroundings. Oral rehydration for acute diarrhoea was first suggested by W. B. O'Shaughnessy in 1831. The World Health Organization's oral rehydration solution converted cholera from a fatal disease into one routinely treated orally. Veterinary oral rehydration solutions initially followed human formulations.

Intravenous maintenance fluid is widely used in general paediatric practice and more children who come into hospital receive intravenous fluid than in the past. The intravenous route is frequently used because enteral maintenance or rehydration treatment is more labor intensive and uses valuable staff time; furthermore modern pumps for delivery of fluids are safe. Nevertheless in developing countries the enteral route is still more widely used even for sick dehydrated children. The dangers of intravenous fluids is that there is a possibility of miscalculation of infusion rates and also the potential for mistakes in terms of dosing errors with additives.