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Oral rehydration in infantile diarrhoea in the developed world
1Department of Gastroenterology, Royal Children's Hospital, Parkville, Australia.
Insights
Acute diarrhea in children is a significant health concern. Oral rehydration therapy is effective for most cases, reducing the need for intravenous fluids and preventing dehydration.
Area of Science:
- Pediatrics
- Infectious Diseases
- Gastroenterology
Background:
- Acute diarrhea remains a prevalent health issue, especially in young children globally.
- Viral pathogens like rotavirus and adenovirus are common, while bacterial causes such as Campylobacter jejuni and Salmonella are less frequent in developed nations.
- Dehydration is the most critical complication of diarrhea, necessitating prompt and appropriate fluid management.
Purpose of the Study:
- To review recent advancements in diarrhea management, focusing on oral rehydration therapy (ORT).
- To address controversies regarding sodium content in ORT solutions for developed countries and fluid administration routes for moderately severe dehydration.
- To evaluate the efficacy of ORT compared to intravenous rehydration in pediatric populations.
Main Methods:
- Analysis of four randomized controlled trials (RCTs) conducted in developed countries comparing oral versus intravenous rehydration.
- Review of current guidelines and recommendations for ORT composition and administration.
- Assessment of the role of ORT in preventing and treating dehydration in children with various diarrhea severities.
Main Results:
- RCTs confirm that most children without shock can be effectively rehydrated orally, significantly decreasing the need for intravenous fluid administration.
- Physiologically balanced ORT solutions with 2% glucose and 50-90 mmol/L sodium are recommended.
- Commercial ORT solutions are suitable for rehydration and maintenance, particularly for severe diarrhea and dehydration prevention.
Conclusions:
- Oral rehydration therapy is a safe and effective primary treatment for acute diarrhea in children, regardless of the causative pathogen.
- ORT substantially reduces the need for intravenous fluids and is crucial for preventing and managing dehydration.
- Education on proper ORT use is essential for successful implementation and achieving the ultimate goal of dehydration prevention.
Abstract:
Acute diarrhoea is an important health problem in developed countries, particularly in young children. The attack rates for viral diarrhoea are similar in developed and developing countries. Rotavirus is the most common pathogen, followed by adenovirus. Bacterial diarrhoea is less common in developed than developing countries. The 2 most common bacterial pathogens are Campylobacter jejuni and Salmonella. The most serious consequence of diarrhoea is dehydration, and the treatment for this is the same whatever the pathogen. Recently, there have been major changes in the management of diarrhoea with emphasis on oral rehydration and early feeding. Two controversial areas are the sodium content of solutions designed for developed countries and the best route of administration of fluids to children with moderately severe dehydration. There have been 4 randomised controlled trials in developed countries comparing oral and intravenous rehydration. The findings have confirmed the experience in developing countries that most children without shock can be rehydrated orally, thus substantially reducing the need for intravenous fluids. It is important to give physiologically balanced solutions which contain 2% glucose and 50 to 90 mmol/L of sodium. Many of the commercially available oral solutions are appropriate for rehydration and maintenance of hydration in infants with diarrhoea of all types. They are recommended particularly for the prevention of dehydration in children of all ages with severe diarrhoea and for the treatment of dehydration. Children with mild diarrhoea and no dehydration can be given commercial clear fluids diluted with water, or homemade solutions made with table sugar and water. Salt must not be used. Babies should continue on breast milk or formula with extra water. Education is the key to successful oral rehydration, and the ultimate aim should be the prevention of dehydration.