474 MANAGEMENT OF ACUTE SECRETORY DIARRHEA SYNDROME

Abstract

ASDS is a clinical syndrome characterized by frequent, watery stools, rapid onset of dehydration, and lack of response to dietary restriction. The stools are mainly yellowish water and are produced almost continuously. Stool electrolytes show sodium above 70 mEq/L, chloride above 60 mEq/L, and potassium below 30 mEq/L. Diarrhea responsive to dietary restriction usually has sodium, potassium and chloride under 40 mEq/L. Stool volumes in ASDA are over 60 cc/kg/day leading to rapid onset of dehydration, hyponatremia, and shock. Treatment with exclusively I.V. fluids for as long as 8 days has no effect on fecal losses in ASDS. In 1977, 28 cases of ASDS were recognized at Texas Children's Hospital. Oral colistin was of no value in ASDS. Parenteral aminoglycoside therapy was associated with recovery of normal stool patterns in 4 to 5 days. Oral gentamicin was associated with recovery of normal consistency, frequency, and electrolyte concentrations in 24 to 36 hours. Thus, ASDS is characterized by cholera-like stooling, dehydration during the first days of illness, and an elevated stool sodium. This syndrome responds rapidly to oral gentamicin therapy. Supported by Children's Clinical Research Center NIH RR-00188, Kelsey-Seybold Fellowship Fund and Venezuelan National Academy of Sciences.