Short Bowel Syndrome
John K. DiBaise, Carol Rees Parrish, Jon S. Thompson in Short Bowel Syndrome Practical Approach to Management, 2017
Jejunal mucosa is more permeable to water, sodium, and chloride than is ileal mucosa. It allows back-diffusion through leaky intercellular junctions so the jejunal contents become iso-osmolar. Thus, water movement in response to an osmotic gradient in the jejunum is 9 times [36] and sodium fluxes 2 times [37] as great as in the ileum. As such, sodium absorption in the jejunum can occur only against a small concentration gradient, depends upon water movement, and is coupled to the absorption of glucose and some amino acids [38]. When the small bowel is intubated and perfused with solutions containing different amounts of sodium, absorption of sodium from the perfusate occurs mainly when the sodium concentration is 90 mmol/L or more, while secretion of sodium into the lumen occurs when the concentration is less. Several studies have shown that maximal jejunal absorption of sodium from a perfused solution occurs at a concentration around 120 mmol/L [39–41]. These studies formed the basis for the development of oral rehydration solutions (ORS). In contrast, the ileum can absorb sodium against a concentration gradient and movement of sodium is not coupled with glucose or other nutrients. The ileum is important in conserving sodium and water when the body becomes depleted since, unlike the jejunum, the ileal mucosa can increase its sodium absorption in response to aldosterone [42].
Gastrointestinal and liver infections
Michael JG Farthing, Anne B Ballinger in 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
Vibrio
Dongyou Liu in Handbook of Foodborne Diseases, 2018
As a severe, acute, dehydrating diarrheal disease, V. cholerae infection is characterized by dehydration and loss of electrolytes. Therefore, the first line of treatment is rapid fluid and electrolyte replacement, optimally in the form of oral rehydration solution containing salts, sugar, and water (e.g., WHO/UNICEF ORS standard sachet). The use of rice-based oral rehydration solution helps decrease volume of stools and is indicated for patients 6 months and older. Intravenous administration of isotonic fluids is necessary for those with severe dehydration or unable to tolerate oral fluid replacement. Antibiotic use (e.g., tetracycline) is essential for disease treatment in severe cholera, as it will shorten the duration of V. cholerae excretion and reduce the volume of rehydration fluids needed. However, widespread application of antibiotic therapy should be avoided due to the possible emergence of antibiotic-resistant V. cholerae.
Drug development and acute gastrointestinal infections
Published in Expert Opinion on Investigational Drugs, 2018
Hania Szajewska, Maciej Kołodziej, Jan Łukasik
The mortality rate from diarrhea for children younger than 5 years has decreased from almost five million in the 1980s to over 600,000 in 2015. This remarkable decrease was achieved through the introduction of oral rehydration therapy. Almost 40 years later, equally effective and safe therapy has not been introduced, and oral rehydration therapy with a hypotonic solution remains central to the management of acute diarrhea [1]. For prevention, a success story has been the introduction of rotavirus vaccines. They have had a major effect on rotavirus infection severity and hospitalization rates in all introduced settings [2]. Here, we briefly summarize novel interventions for the management of acute gastrointestinal infections identified through searching PubMed (May 2017) for reports published in the last 3 years and registers for clinical trials (www.clinicaltrials.gov, www.clinicaltrialsregister.eu). The principal search text word terms and MESH headings used were diarrhea/diarrhoea, and gastrointestinal infection. New developments in vaccines and antimicrobial drugs are not reviewed. For examples of early stage randomized controlled trials (RCTs) on acute diarrhea treatment, see Table 1.
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.
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.
Related Knowledge Centers
- Dehydration
- Hyperkalemia
- Hypernatremia
- Potassium
- Sodium
- Vomiting
- Diarrhea
- Fluid Replacement
- Nasogastric Intubation
- Zinc