Administration Of Oral Rehydration Solution Research Articles

Comparison between Preoperative Overnight Fasting Versus Oral Rehydration Solution (ORS) Administration Until Two Hours before Abdominal Surgery Under General Anaesthesia

Background: Preoperative fasting is a major concern to protect the gastric aspiration which is very dangerous. However overnight fasting is uncomfortable and has many deleterious effects on the human body. In many countries fasting until 2 to 3 hours before surgery has been practiced but in Bangladesh, overnight fasting is still being practiced in routine cases.
 Objectives: The objective of this study was to compare the effectiveness between preoperative overnight fasting and oral rehydration solution administration until two hours before abdominal surgery under general anaesthesia.
 Methods: A total of 100 patients of ASA (American Society of Anesthesiologist) class I and II, age above 18 years, and BMI < 30 kg/m2 were scheduled for abdominal surgery under GA (General Anaesthesia) were included in this study. Then all patients were randomized into two groups as patients who were on overnight fasting for 10 hours (Group A-Controlled, n=50), and patients who were on ORS until 2 hours before abdominal surgery (Group B-ORS, n=50). All patients had their last meal at 11 AM before the day of surgery. Patients in group A will not take anything orally or via any route, except their ongoing vital medications if present. Patients in group B received 500 ml of standard ORS in the early morning on the day of surgery after waking up from bed (from 05 AM to 06 AM) and another 500 ml until 2 hours before the surgery (06 AM to 07 AM). As the primary outcome gastric residual volume and gastric fluid pH in both group was measured immediately after anaesthesia induction. Several physiological measures (thirst and hunger, nausea/vomiting, cognitive function) were measured with the help of a preformed questionnaire.
 Results: Mean gastric residual volume immediately after induction was statistically significant (p<0.05) between the two groups. However, the mean gastric fluid pH was statistically insignificant (p>0.05). The ORS group (Group B) became less thirsty before surgery (P=0.001). Postoperative nausea/vomiting (PONV) was less in group B (P=0.029) than in group A. The patient’s recovery time was significantly less in ORS group (P=0.003). Postoperative cognitive performance was better in group B (P=0.001).
 Conclusions: Oral rehydration solution administration until two hours before surgery is effective and can be considered routinely before abdominal surgery conducted under general anaesthesia except for delayed gastric emptying.
 J Shaheed Suhrawardy Med Coll 2022; 14(1): 20-27

Changes in fluid and acid-base status of diarrheic calves on different oral rehydration regimens

The administration of oral rehydration solutions (ORS) is an effective method to treat dehydration and acidosis in calves suffering from diarrhea. The ORS can be prepared in water or milk. The aim of the present study was to elucidate how fluid and acid-base balance change after feeding milk compared with ORS prepared in water or milk to diarrheic calves. Calves (n = 30) with naturally acquired diarrhea were sequentially assigned in a 2:1 ratio to the following pretreatments: milk and water-ORS (pretreatment 1; n = 20 calves) or milk-ORS (pretreatment 2; n = 10 calves), respectively. The assignment was done on the day of diarrhea diagnosis. On d 3 ± 1 following assignment to pretreatment group, and after a fasting period of 9 h, diarrheic calves were subjected to the following treatments: 2 L of milk (pretreatment 1; n = 10 calves), water-ORS (pretreatment 1; n = 10 calves), or milk-ORS (pretreatment 2; n = 10 calves). Blood samples were taken before and at several time points until 6 h after feeding. Plasma protein, osmolality, and electrolytes were determined and a blood gas analysis was performed. Change in plasma volume was calculated according to plasma protein, and water intake during the experimental period was recorded. Plasma volume was increased 30 min after feeding water-ORS or milk but the increase was less pronounced after feeding milk compared with water-ORS. After feeding milk-ORS, no significant increase in plasma volume could be detected. Because of the pretreatment, plasma osmolality was higher in calves fed milk-ORS, but no change in plasma osmolality after feeding was detected. No difference in water consumption between the treatment groups was noted within the observed 6-h period. The pH was increased after feeding milk-ORS, whereas water-ORS and milk-feeding did not increase pH in blood. Pretreatment with milk-ORS resulted in higher baseline d-lactate concentration, but feeding milk-ORS reduced d-lactate values after feeding. In calves with diarrhea, plasma volume increased more quickly and to a greater extent after feeding water-ORS; thus, we recommend treating diarrheic calves with water-ORS before supplying milk. Nevertheless, diarrheic calves need milk to fulfill their energy needs. The administration of ORS in milk combined with free water access is more advisable than feeding milk exclusively because milk has no alkalinizing ability and contains less sodium. However, the effects of milk-ORS feeding on d-lactate levels in diarrheic calves need further elucidation.

A higher level of ketonaemia does not predict oral rehydration failure in vomiting paediatric patients and routine measurement is unnecessary.

This study determined if blood levels of beta-hydroxybutyrate were associated with the rate of failure in oral rehydration in paediatric patients with vomiting. This was a prospective observational study that was carried out from December 1, 2015 to November 30, 2016 in the Rio Hortega University Hospital, Valladolid, Spain. The study cohort were patients up to 14years old who attended the emergency department with three or more vomiting episodes in the last four hours and glycaemia higher than 45mg/dL. Blood was measured for beta-hydroxybutyrate levels prior to the administration of oral rehydration solution for 90minutes. Two or more vomiting episodes during this period were considered failed oral rehydration. We analysed 248 patients, with a median age of four years and 7.5months and 233 (94%) of the parents took part. The median number of vomiting episodes in the previous four hours was five and oral rehydration was successful in 183 (78.5%) patients. The multivariate analysis showed that the initial beta-hydroxybutyrate blood level was not associated with the failure of oral rehydration. Blood levels of beta-hydroxybutyrate had no predictive value for oral rehydration failure in young patients with vomiting and this routine measurement is unnecessary.

Oral Ondansetron versus Domperidone for Acute Gastroenteritis in Pediatric Emergency Departments: Multicenter Double Blind Randomized Controlled Trial.

The use of antiemetics for vomiting in acute gastroenteritis in children is still a matter of debate. We conducted a double-blind randomized trial to evaluate whether a single oral dose of ondansetron vs domperidone or placebo improves outcomes in children with gastroenteritis. After failure of initial oral rehydration administration, children aged 1–6 years admitted for gastroenteritis to the pediatric emergency departments of 15 hospitals in Italy were randomized to receive one oral dose of ondansetron (0.15 mg/kg) or domperidone (0.5 mg/kg) or placebo. The primary outcome was the percentage of children receiving nasogastric or intravenous rehydration. A p value of 0.014 was used to indicate statistical significance (and 98.6% CI were calculated) as a result of having carried out two interim analyses. 1,313 children were eligible for the first attempt with oral rehydration solution, which was successful for 832 (63.4%); 356 underwent randomization (the parents of 125 children did not give consent): 118 to placebo, 119 to domperidone, and 119 to ondansetron. Fourteen (11.8%) needed intravenous rehydration in the ondansetron group vs 30 (25.2%) and 34 (28.8%) in the domperidone and placebo groups, respectively. Ondansetron reduced the risk of intravenous rehydration by over 50%, both vs placebo (RR 0.41, 98.6% CI 0.20–0.83) and domperidone (RR 0.47, 98.6% CI 0.23–0.97). No differences for adverse events were seen among groups. In a context of emergency care, 6 out of 10 children aged 1–6 years with vomiting due to gastroenteritis and without severe dehydration can be managed effectively with administration of oral rehydration solution alone. In children who fail oral rehydration, a single oral dose of ondansetron reduces the need for intravenous rehydration and the percentage of children who continue to vomit, thereby facilitating the success of oral rehydration. Domperidone was not effective for the symptomatic treatment of vomiting during acute gastroenteritis.

MECHANISMS OF ANTIDIARRHEAL EFFECT BY PROBIOTICS

Gastroenteritis is a major cause of morbidity and mortality worldwide. Several microbial pathogens cause secretory diarrhea such as Vibrio cholerae and enterotoxigenic Escherichia coli as well as enteric viruses such as Rotavirus (RV) and Norovirus and parasites including Cryptosporidium. Other agents induce inflammatory diarrhea such as Clostridium difficile, Shigella and selected strains of pathogenic E. coli.Gastroenteritis is the result of multiple mechanisms that may mainly be summarized in enterotoxic (secretory diarrhea) or cytotoxic (osmotic diarrhea) as a consequence of ion secretion and epithelial damage, respectively. Other indirect mechanisms of infectious diarrhea include inflammation or altered regulatory processes involving hormones and neurotransmitters.The first‐line treatment of acute gastroenteritis in children is the administration of oral rehydration solution (ORS) but this neither shortens the duration of diarrhea nor reduces the frequency of stool outputs. Therefore, active therapies are now recommended in adjunct to ORS for children with gastroenteritis.The use of the specific probiotic strains, namely Lactobacillus rhamnosus GG (LGG) and Saccharomyces boulardii, is included ESPGHAN/ESPID guidelines for the management of children with AGE as an adjunct to rehydration therapy.Antidiarrheal drugs act at the luminal side of intestinal epithelium and modulate apical pathways, induce ion absorption or limit secretion, influence microbiome, modulate permeability, bind secretory moieties such as enterotoxins or bile acids. Probiotics are not drugs, but are rapidly effective in acute diarrhea reducing its duration and their effects have been linked to intestinal permeability and the modulation of intestinal microbiota and‐ indirectly‐ of inflammation. Those mechanisms are not consistent with the rapid effects of probiotics observed in children with acute diarrhea within hours since their initial administration. Evidence exists in favor of direct effects induced by probiotics on the enterocyte. Saccharomyces boulardii secreted moieties prevented RV‐induced oxidative stress and chloride secretion in human enterocytes. LGG exerted an ion proabsorptive effect through a direct antioxidant mechanisms and also promoted cell growth and differentiation acting on MAPKs. Those data indicate that the rapid and effective clinical effects by probiotics on acute diarrhea are probably the results of the direct microbe‐enterocyte rather than to the microbe‐microbiota or microbe‐immune interaction. This data provide an entirely new scenario for understanding the antidiarrheal mechanisms of probiotics in diarrhea.

Management strategies in the treatment of neonatal and pediatric gastroenteritis

Acute gastroenteritis, characterized by the onset of diarrhea with or without vomiting, continues to be a major cause of morbidity and mortality in children in mostly resource-constrained nations. Although generally a mild and self-limiting disease, gastroenteritis is one of the most common causes of hospitalization and is associated with a substantial disease burden. Worldwide, up to 40% of children aged less than 5 years with diarrhea are hospitalized with rotavirus. Also, some microorganisms have been found predominantly in resource-constrained nations, including Shigella spp, Vibrio cholerae, and the protozoan infections. Prevention remains essential, and the rotavirus vaccines have demonstrated good safety and efficacy profiles in large clinical trials. Because dehydration is the major complication associated with gastroenteritis, appropriate fluid management (oral or intravenous) is an effective and safe strategy for rehydration. Continuation of breastfeeding is strongly recommended. New treatments such as antiemetics (ondansetron), some antidiarrheal agents (racecadotril), and chemotherapeutic agents are often proposed, but not yet universally recommended. Probiotics, also known as “food supplement,” seem to improve intestinal microbial balance, reducing the duration and the severity of acute infectious diarrhea. The European Society for Paediatric Gastroenterology, Hepatology and Nutrition and the European Society of Paediatric Infectious Diseases guidelines make a stronger recommendation for the use of probiotics for the management of acute gastroenteritis, particularly those with documented efficacy such as Lactobacillus rhamnosus GG, Lactobacillus reuteri, and Saccharomyces boulardii. To date, the management of acute gastroenteritis has been based on the option of “doing the least”: oral rehydration-solution administration, early refeeding, no testing, no unnecessary drugs.

Dietary management of childhood diarrhea in low- and middle-income countries: a systematic review

BackgroundCurrent WHO guidelines on the management and treatment of diarrhea in children strongly recommend continued feeding alongside the administration of oral rehydration solution and zinc therapy, but there remains some debate regarding the optimal diet or dietary ingredients for feeding children with diarrhea.MethodsWe conducted a systematic search for all published randomized controlled trials evaluating food-based interventions among children under five years old with diarrhea in low- and middle-income countries. We classified 29 eligible studies into one or more comparisons: reduced versus regular lactose liquid feeds, lactose-free versus lactose-containing liquid feeds, lactose-free liquid feeds versus lactose-containing mixed diets, and commercial/specialized ingredients versus home-available ingredients. We used all available outcome data to conduct random-effects meta-analyses to estimate the average effect of each intervention on diarrhea duration, stool output, weight gain and treatment failure risk for studies on acute and persistent diarrhea separately.ResultsEvidence of low-to-moderate quality suggests that among children with acute diarrhea, diluting or fermenting lactose-containing liquid feeds does not affect any outcome when compared with an ordinary lactose-containing liquid feeds. In contrast, moderate quality evidence suggests that lactose-free liquid feeds reduce duration and the risk of treatment failure compared to lactose-containing liquid feeds in acute diarrhea. Only limited evidence of low quality was available to assess either of these two approaches in persistent diarrhea, or to assess lactose-free liquid feeds compared to lactose-containing mixed diets in either acute or persistent diarrhea. For commercially prepared or specialized ingredients compared to home-available ingredients, we found low-to-moderate quality evidence of no effect on any outcome in either acute or persistent diarrhea, though when we restricted these analyses to studies where both intervention and control diets were lactose-free, weight gain in children with acute diarrhea was shown to be greater among those fed with a home-available diet.ConclusionsAmong children in low- and middle-income countries, where the dual burden of diarrhea and malnutrition is greatest and where access to proprietary formulas and specialized ingredients is limited, the use of locally available age-appropriate foods should be promoted for the majority of acute diarrhea cases. Lactose intolerance is an important complication in some cases, but even among those children for whom lactose avoidance may be necessary, nutritionally complete diets comprised of locally available ingredients can be used at least as effectively as commercial preparations or specialized ingredients. These same conclusions may also apply to the dietary management of children with persistent diarrhea, but the evidence remains limited.

経口補水液の前投与は、経腸栄養剤の胃排出を促進する:～ 13 C呼気ガス診断を応用した胃排出能検査法を用いた検討から～

経口補水液の前投与は、経腸栄養剤の胃排出を促進する:～ 13 C呼気ガス診断を応用した胃排出能検査法を用いた検討から～

Clinical application of oral rehydration solution

The administration of oral rehydration solution (ORS) has rescued the lives of people with diarrhea. Although diarrhea mortality rates have dropped by 75% from 1980 to 2008 in worldwide, diarrhea continues to be a major cause of child death, especially in children younger than 5 years. The clinical application of the standard WHO-ORS in large-scale campaigns resulted in decreased mortality associated with acute diarrheal disease in children. Many clinical trials on variants of ORS such as hypo-osmolar solutions, rice-based solutions, zinc supplementation, and the addition on other advantageous substances have been performed to improve outcomes of diarrheal treatment. This paper reviews the pathophysiologic base and history of ORS, composition of ORS, and its clinical use for acute diarrhea and other intestinal diseases.

Correct Preparation and Administration of Oral Rehydration Solution: Essential for Safe and Effective Home Treatment of Diarrhea in Indonesia

Diarrhea-related dehydration is a leading cause of childhood death in developing countries such as Indonesia, despite being largely preventable and treatable through use of Oral Rehydration Solution (ORS). While the extent to which ORS is used in Indonesia has been explored in earlier studies, the issue of whether it is being used correctly has not been adequately investigated. The purpose of this study was to assess mothers' ORS preparation and administration practices and to determine their source of instruction for these practices. A structured questionnaire was administered orally to 100 mothers of children under the age of 5 years, in a rural village of West Java, Indonesia. Only 23.7% of mothers were found to have correctly prepared ORS, and none exhibited fully correct administration practices. Primary sources of instruction were health workers (62.9%), package instructions (23.7%), and family members or friends (12.4%). Resulting recommendations include education of health care workers, community health education programs, reallocation of health care resources, and revision of ORS packaging guidelines.

Shigella infections in children: New insights

Shigellosis , the acute enteric infection caused by bacteria of the genus Shigella , has a worldwide distribution with an estimated annual incidence of 164.7 million cases, of which 163.2 million occur in developing countries, and 1.1 million deaths. Sixty-nine percent of all episodes and 61 percent of all Shigella -related deaths involve children younger than 5 years old. In the United States, 10,000 to 15,000 cases of shigellosis are reported each year. Although usually confined to the colonic mucosa, shigellosis sometimes can cause extraintestinal complications. Recent publications have shed light on the clinical characteristics of Shigella -induced bacteremia, surgical complications, urogenital symptoms, and neurologic manifestations, and on the unique manifestations in the neonatal period. The mainstay of treatment of shigellosis in children is correction of the fluid and electrolyte loss, which often is achieved by the administration of oral rehydration solutions. Appropriate antibiotic therapy shortens the duration of both clinical symptoms and fecal excretion of the pathogen. However, the increasing antimicrobial resistance of shigellae worldwide constitutes a major problem. Regarding the pathophysiology of shigellosis and its complications, recent data not only elucidated the molecular mechanisms involved but also linked manifestations of disease to the interplay of bacterial virulence factors and host responses. The improved understanding of the pathophysiology is hoped to lead to innovative therapeutic approaches against shigellosis and new generations of vaccine candidates.

Effectiveness of Nasogastric Rehydration in Hospitalized Children with Acute Diarrhea

Summary:The American Academy of Pediatrics recommends oral rehydration and early refeeding for management of infants with diarrhea and mild to moderate dehydration. However, intravenous rehydration is still widely used for treatment of infants hospitalized for dehydration. The administration of oral rehydration solution via continuous infusion through a nasogastric tube facilitates its delivery in hospitalized children. The purpose of this study is to compare intravenous and nasogastric rehydration in children hospitalized for mild to moderate dehydration. Infants who failed attempts at oral rehydration and were hospitalized for dehydration due to acute diarrheal illness were randomized to receive intravenous or nasogastric rehydration. Following rehydration, infants received soy formula and a maintenance oral electrolyte solution to replace ongoing stool losses, as directed by the attending physician. Patients were discharged from the hospital once oral feeding was tolerated, and the vomiting and diarrhea resolved. Twenty‐four patients, from 2 to 19 months of age, were enrolled in the study. Rehydration was successful in 11 of 12 patients in the nasogastric rehydration group and in all 12 patients who received intravenous rehydration. The degree of dehydration, severity of vomiting and diarrhea, and duration of rehydration were similar in both groups. The duration and cost of hospitalization were less for patients receiving nasogastric rehydration compared to those who were rehydrated intravenously. Rehydration by infusion of oral rehydration solution via a nasogastric tube is a safe and effective treatment for infants with mild to moderate dehydration. Rehydration with infusion of oral rehydration solution through a nasogastric tube should be considered for in‐patient management of infants with diarrhea.

Quality of home use of oral rehydration solutions: Results from seven healthcom sites

This study examined the volume of oral rehydration solutions given to children during diarrhea and the length of time the solutions are administered. It also attempted to test the importance of individual and contextual factors—especially mothers' knowledge—in explaining the administration of oral rehydration solutions. Data about the treatment of an episode of child diarrhea within the last three months were collected from large samples of mothers in seven sites in Africa, Asia, and Latin America. The results showed that oral rehydration solutions were given in smaller volumes and for shorter periods of time than recommended. The majority of children received at least a glass (200–250 ml) of solution on the first day, but few received more than that. Daily administration of packet-based solutions or of sugar-salt solutions (promoted in two of the countries) during diarrhea was generally quite low, ranging from 16 to 60% of cases given an oral rehydration solution. However, in four out of six sites, at least half of the children with diarrhea for more than one day were given an oral rehydration solution for more than one day. The majority of children were given some form of other fluids (e.g. more water, special teas, or continued breastfeeding), but their value in preventing dehydration was not clear because the volume of other fluids given could not be assessed. Few of the hypothesized predictors of administration explained the variation in volume or duration of ORS/SSS administration within any specific country or across sites. The research points to the need for more information on the decision process used by mothers when treating their children's diarrhea and on outside factors influencing this process.

Hypernatremic Diarrheal Dehydration Treated with Oral Glucose‐Electrolyte Solution Containing 90 or 75 mEq/L of Sodium

Summary: Of 33 infants with hypernatremic dehydration (serum Na' of ≥ 150 mEq/L) 7 were excluded, 6 because severe alteration of the level of consciousness or shock precluded oral rehydration and 1 because he was given glucose‐electrolyte solution plus water. We studied the remaining 27 infants. Twenty (group A) were treated with the World Health Organization‐recommended oral rehydration solution (90 mEq/L Na') and seven (group B) were treated with Pedialyte‐RS (Abbott Laboratories Ltd.: 75 mEq/L Na'). The rehydrating solutions were administered in a volume equivalent to twice the clinically estimated fluid deficit. Initial serum sodium was 156.7 × 0.9 mEq/L for group A and 155.8 × 1.8 mEq/L for group B (mean × SEM). The mean time to achieve rehydration was 14.3 and 16.6 h for groups A and B, respectively. Twenty‐four hours after commencing oral rehydration. Serum Na' had decreased to 144.8 × 1.8 mEq/L for group A and 144.5 × 0.9 mEq/L for group B. In two patients in group A, the serum Na', which, had not decreased to <150 mEq/L at 24 h, did so at 48 h. Only in one case (group A) did the serum Na' increase. This patient had high stool output and failed to become rehydrated after 24 h of unsuccessful oral rehydration. None of the patients had seizures or persistent CNS dysfunction. We conclude that the slow administration of oral rehydration solutions containing either 90 or 75 mEq/L Na' is a safe and effective treatment of hypernatremic dehydration.

Hypernatremic diarrheal dehydration treated with oral glucose-electrolyte solution containing 90 or 75 mEq/L of sodium.

Of 33 infants with hypernatremic dehydration (serum Na+ of greater than or equal to 150 mEq/L) 7 were excluded, 6 because severe alteration of the level of consciousness or shock precluded oral rehydration and 1 because he was given glucose-electrolyte solution plus water. We studied the remaining 27 infants. Twenty (group A) were treated with the World Health Organization-recommended oral rehydration solution (90 mEq/L Na+) and seven (group B) were treated with Pedialyte-RS (Abbott Laboratories Ltd.; 75 mEq/L Na+). The rehydrating solutions were administered in a volume equivalent to twice the clinically estimated fluid deficit. Initial serum sodium was 156.7 +/- 0.9 mEq/L for group A and 155.8 +/- 1.8 mEq/L for group B (mean +/- SEM). The mean time to achieve rehydration was 14.3 and 16.6 h for groups A and B, respectively. Twenty-four hours after commencing oral rehydration, serum Na+ had decreased to 144.8 +/- 1.8 mEq/L for group A and 144.5 +/- 0.9 mEq/L for group B. In two patients in group A, the serum Na+, which, had not decreased to less than 150 mEq/L at 24 h, did so at 48 h. Only in one case (group A) did the serum Na+ increase. This patient had high stool output and failed to become rehydrated after 24 h of unsuccessful oral rehydration. None of the patients had seizures or persistent CNS dysfunction. We conclude that the slow administration of oral rehydration solutions containing either 90 or 75 mEq/L Na+ is a safe and effective treatment of hypernatremic dehydration.