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Gastrointestinal and liver infections
Published in Michael JG Farthing, Anne B Ballinger, Drug Therapy for Gastrointestinal and Liver Diseases, 2019
Whenever possible fluid and electrolyte losses should be replaced orally in the form of oral rehydration therapy with a glucose-electrolyte oral rehydration solution (ORS).28 The scientific rationale for oral rehydration therapy centres around the principle of active, carrier-mediated sodium-glucose co-transport. In this energy-dependent process, glucose and sodium are absorbed together by the same transporter, a process that then promotes the absorption of chloride ions and water. The co-transporter is active in all diarrhoeal states, irrespective of whether diarrhoea is enterotoxin-mediated or it occurs as a result of intestinal damage, such as in rotavirus infection.29-32 ORS should be administered early during the course of acute diarrhoea, particularly in infants and young children, with the aim of preventing severe dehydration and acidosis (Table 6.4). In the developing world, the WHO-ORS (sodium concentration 90 mmol/1, osmolality 331 mOsm/kg) is still recommended, although there is increasing evidence that solutions with lower sodium concentrations (50-60 mmol/1) and lower osmolality (about 240 mOsm/kg) are equally effective as WHO-ORS in correcting dehydration and acidosis and have an added advantage in that they appear to be more effective in reducing faecal losses.33-36
Rotavirus
Published in Dongyou Liu, Handbook of Foodborne Diseases, 2018
Lijuan Yuan, Tammy Bui, Ashwin Ramesh
The most important and beneficial aspect of rotavirus treatment is appropriate rehydration therapy. Fatalities occur when intestinal water loss is severe enough to cause electrolyte imbalances and cardiovascular failure. WHO recommends the use of oral rehydration solution (ORS) in treatment of acute watery diarrhea of all causes. Use of ORS helps prevent life-threatening dehydration, though it does not alleviate symptoms of diarrhea or shorten duration. ORS contains glucose, electrolytes, and citrate in an hypo-osmolar formulation to replenish losses and reduce acidosis associated with diarrhea and vomiting.225 The basis of ORS therapy is that glucose stimulates water and salt absorption in the small intestine via the Na+/glucose cotransporter SGLT1.226 In situations where oral rehydration is not adequate enough to counteract dehydration, then intravenous fluid therapy is necessary.227
Malaria, tuberculosis and other infectious diseases
Published in Théodore H MacDonald, Noël A Kinsella, John A Gibson, The Global Human Right to Health, 2018
This can be remedied by administering a solution of oral rehydration salts (ORS), so long as the proportions are correctly observed. Once the solution has been prepared, it can be administered in small quantities every few minutes. This process is referred to as oral rehydration treatment (ORT). However, before discussing the details of this, we shall first consider the global impact of the condition.
Review of Ebola virus disease in children – how far have we come?
Published in Paediatrics and International Child Health, 2021
Devika Dixit, Kasereka Masumbuko Claude, Lindsey Kjaldgaard, Michael T. Hawkes
Oral rehydration solution (ORS) is the preferred method of fluid resuscitation whenever possible. Consideration of nasogastric tube administration of fluids may be appropriate, but challenging for children in a minimally supervised ETC environment. Therefore, parenteral (IV) hydration is often required in children to achieve adequate hydration as it is difficult for children to drink sufficient ORS to achieve euvolaemia. Also, children might be too unwell to take enough ORS and may need additional continuous support to achieve adequate volume intake. In the authors’ experience, this level of support was difficult to achieve in the ETC since parents may be ill, absent or unable to be in contact with an infectious child, nursing care was intermittent and care attendants (gardes malade) were not trained in how to administer ORS. IV lines and nasogastric tubes were difficult to maintain in the ‘red zone.’ Gardes malade were not consistently present and in many cases did not have nursing training, and unattended children often pulled out their IV lines.
Ileostomy diarrhea: Pathophysiology and management
Published in Baylor University Medical Center Proceedings, 2020
Kyle M. Rowe, Lawrence R. Schiller
Regardless of the cause of high output, volume status, electrolyte disturbances, and subsequent sequelae must be addressed first. This will most often require intravenous fluids or oral rehydration solutions depending on the severity of the volume depletion. Dehydration prophylaxis immediately after ileostomy creation should be considered. In a randomized controlled trial in patients after diverting ileostomy, patients receiving 1 L daily of a prophylactic oral rehydration solution had zero dehydration-related readmissions compared to 24% in the control group.51 The prophylactic group also showed significant improvements in markers of renal function over 40 days of follow-up. Other studies have suggested that oral rehydration solution actually decreases the output; however, this was not seen in the randomized setting.52 Total parenteral nutrition is generally not required in these patients, as nutrient absorption should not be impaired.
The management of persistent diarrhoea at Dhaka Hospital of the International Centre for Diarrhoeal Disease and Research: a clinical chart review
Published in Paediatrics and International Child Health, 2018
Shoeb Bin Islam, Tahmeed Ahmed, Mustafa Mahfuz, Ishita Mostafa, Mohammed Ashraful Alam, Kazi Nazmus Saqeeb, Shafiqul Alam Sarker, Mohammod Jobayer Chisti, Nur Haque Alam
PD is managed according to the hospital’s established management protocol (Table 1) which includes rehydration, control of infection and algorithm-based dietary intervention, micronutrients supplementation, nutritional rehabilitation and management of associated complications. Routine diarrhoeal care including correction of dehydration and replacement of ongoing stool loss with rehydration fluid is provided by nurses. A glucose-based, reduced osmolarity, oral rehydration salts solution (ORS) [16] is used to rehydrate children with some dehydration as well as to replace ongoing diarrhoeal stool losses. Intravenous fluid is given to children with severe dehydration and those with some dehydration with persistent vomiting or a high rate of purging [17]. Eight-hourly vital signs are recorded and stool and urine output measured. Antimicrobial therapy is not routinely prescribed, except for those in whom an enteric bacterial infection (e.g. shigellae, salmonellae, campylobacter and vibrio species) has been isolated. Eradication of these pathogens is required for both acute and persistent diarrhoea. In practice, most children admitted with PD also have severe acute malnutrition (SAM), sometimes associated with extra-intestinal infections such as urinary tract infection, respiratory tract or ear infections, which is treated with appropriate antimicrobial therapy [10]. In cases of SAM, parenteral ampicillin and gentamicin [18] are prescribed, and, for respiratory tract infections, oral amoxicillin or parenteral ampicillin and gentamicin according to pneumonia guidelines [19], and levofloxacin for urinary tract infections.