Parenteral fluid regimens in the treatment of severe diarrhea in infants

Abstract

Summary The efficacy of three methods of parenteralfluid therapy in the repair of abnormalities of fluid and electrolyte balance accompanying severe diarrhea has been evaluated in 53 infants, all less than 15 months of age. Methods studied include a modification of Hartmann's regimen and those of Butler-Talbot and of Darrow. Serial observations before and during treatment with regard to clinical effects, blood pH, and plasma levels of base bicarbonate, sodium, and potassium are compared. The modified Hartmann method was found to be the most effective of the methods in promptness of relief of severe acidemia and acidosis, but frequently produced alkalemia and alkalosis during the second day of treatment. Deficits of potassium were not adequately repleted and were aggravated in a high percentage of the patients, and levels of plasma sodium frequently rose above the normal range in patients whose pretreatment values were normal or subnormal. In infants treated by the Butler-Talbotplan, acidemia, acidosis, and hyponatremia persisted over prolonged periods of time. Low levels of plasma potassium rapidly rose to normal, and subnormal pretreatment levels of potassium were often elevated above the normal range. The moderately elevated levels of potassium were unaccompanied by clinical evidence of hyperkalemia. Levels of blood pH and plasma base bicarbonate in infants treated by the Darrow regimen were slower in returning to the normal range than were those of the patients treated by the modified Hartmann method. Acidemia and acidosis were not so prolonged, however, as in the group treated by the Butler-Talbot regimen. Tendencies to overshoot the normal ranges for blood pH, plasma base bicarbonate, sodium, and potassium were not evident. Low levels of plasma sodium and potassium were effectively repaired by the use of this method. Hypernatremic infants in all three groupsstudied (regardless of which treatment method was used) responded to therapy in a similar manner with respect to clinical course and level of plasma electrolytes. All these infants were slow in returning to normalcy. The advantages and disadvantages of each method of treatment are discussed, and reommendations are made for their modification in accordance with findings of the study.