Efficacy Of Oral Rehydration Therapy Research Articles

Social perceptions of childhood diarrhea in Lubumbashi, Democratic Republic of the Congo: A qualitative study

Introduction: Infantile diarrhea remains a public health problem in the Democratic Republic of the Congo, where infant mortality linked to this disease remains high despite the proven efficacy of oral rehydration therapy. This study aims to understand the social perceptions of childhood diarrhea among mothers in Lubumbashi, by examining how they diagnose and treat the disease through both popular and biomedical representations.Material and methods: The study was conducted in Lubumbashi, the capital of Haut-Katanga in the DRC, utilizing a qualitative methodology that involved semi-structured interviews with 32 randomly chosen mothers. Selection criteria encompassed the number of children, educational level, religion, and age range (18 to 60). Information was gathered through documents and interviews conducted in Swahili, subsequently translated into French, and analyzed utilizing Jean-Blaise Grize’s ‘natural logic’ to grasp social representations.Results: The study revealed that the majority of mothers associated diarrhea with physical signs such as dehydration, watery stools, depressed fontanel, and sunken eyes. Several mothers attributed the diarrhea to cultural causes, such as the consumption of certain foods by pregnant women (e.g. “kabambale”) or the practice of breastfeeding by pregnant mothers. Local diseases such as “lukunga” and “kilonda ntumbo” are considered to be specific forms of diarrhea in popular culture. Treatments include traditional remedies such as ash applications and sitz baths.Conclusion: Perceptions of childhood diarrhea in Lubumbashi reflect a tension between cultural beliefs and biomedical knowledge, where rehydration is often neglected. The study recommends raising community awareness of the effectiveness of ORT while respecting local beliefs.

FRECUENCIA DE HIPONATREMIA EN PACIENTES CON GASTROENTERITIS AGUDA TRATADA CON LÍQUIDOS INTRAVENOSOS EN EL HOSPITAL DEL NIÑO DR. JOSÉ RENÁN ESQUIVEL ENERO A DICIEMBRE 2016

Introducción: La gastroenteritis aguda es una de las principales causas de morbilidad y mortalidad en la infancia. Numerosos estudios han confirmado la seguridad y eficacia de la terapia de rehidratación oral, sin embargo, la rehidratación intravenosa se continúa utilizando en escenarios donde no es posible hidratar al paciente por vía enteral. Durante la última década, se han acumulado pruebas que sugieren que la administración de un líquido de mantenimiento intravenoso hipotónico en niños hospitalizados aumenta el riesgo de hiponatremia. Objetivo general: Determinar la frecuencia de hiponatremia en pacientes con gastroenteritis que reciben soluciones salina hipotónicas en la salas Pediatría del Hospital del Niño Doctor José Renán Esquivel entre enero a diciembre del 2016. Materiales y Métodos: Realizaremos un estudio de cohorte retrospectivo, descriptivo. Examinaremos los expedientes clínicos de niños sin antecedentes patológicos previos de 1 mes a 15 años que habían ingresado a sala de pediatría del Hospital del Niño Doctor José Renán Esquivel de enero a diciembre de 2016, con diagnóstico de gastroenteritis aguda. Para la obtención de la muestra utilizamos un 95% de Confianza, la muestra obtenida fue de 190 pacientes y fue calculada utilizando el programa Epi Info versión 7.0 Resultados: No hubo diferencias significativas en el desarrollo de hiponatremia secundario al uso de soluciones salinas hipotónicas Conclusión: No se registró hiponatremia en pacientes con gastroenteritis aguda que reciben soluciones salinas hipotónicas en la salas de Pediatría del Hospital del Niño Doctor José Renán Esquivel.

Bisphosphonates can be safely given to patients with hypercalcemia and renal insufficiency secondary to multiple myeloma

A critical appraisal and clinical application of Itou K, Fukuyama T, Sasabuchi Y, et al. Safety and efficacy of oral rehydration therapy until 2 h before surgery: a multicenter randomized controlled trial. Journal of Anesthesia. 2012;26(1):20-27. doi: 10.1007/s00540-011-1261-x.

Systematic review with meta-analysis: ondansetron for vomiting in children with acute gastroenteritis.

Vomiting in children with acute gastroenteritis is a common symptom, and it is considered to be the main cause of failure of oral rehydration therapy. To systematically update evidence on the effects of ondansetron (5-HT3 serotonin antagonist) for vomiting in children with acute gastroenteritis. The Cochrane Library, MEDLINE and EMBASE databases were searched up to April 2016, with no language restrictions, for randomised controlled trials (RCTs). Reference lists of reviews and included studies were examined. Ten RCTs involving 1215 participants were included. Treatment with ondansetron compared with placebo increased the chance for vomiting cessation up to 1 h after drug administration, relative risk, RR, 1.49 (95% confidence interval 1.17-1.89), but there was no difference between the groups after 4, 24 and 48 h. Treatment with ondansetron compared with placebo reduced the risk of failure of oral rehydration therapy, RR 0.5 (0.37-0.69), increased the intake of oral rehydration solution in 1 h and 4 h, mean difference: 43 mL/1 h (15.5-70.5), and 91 mL/4 h (35-147), respectively, reduced the risk of hospitalisation, RR 0.53 (0.29-0.97), and reduced the need for intravenous rehydration, RR 0.45 (0.31-0.63); however, it had no effect on the need for return visits to the emergency department, RR 1.14 (0.72-1.8). Adverse effects were similar in both groups. Compared with placebo, ondansetron administration for vomiting in children with acute gastroenteritis can improve the efficacy of oral rehydration therapy.

PTH-260 Oral rehydration therapy to restore the water and electrolyte balance post-colectomy: results from a placebo-controlled randomised cross-over trial

Introduction We have demonstrated metabolic disturbances and poor quality of life post-colectomy in patients with Familial Adenomatous Polyposis (FAP). We aimed to evaluate the efficacy of oral rehydration therapy (ORT) in restoring water and electrolyte balance post-colectomy. Method A blinded placebo-controlled randomised cross-over trial was undertaken. Thirty patients with demonstrated hyperaldosteronism from on-going observational study were recruited. Patients were randomised to receive either placebo or ORT first in a cross-over trial with an intervening washout period. Patients attended clinical investigation day (CID) three times. CID Fasting urine and blood samples were collected to measure sodium loss, hydration status and renin-angiotensin-aldosterone system (RAAS) activation. Quality of life (QoL) was assessed using SF-36 and FACIT-F questionnaires. Full ethics approval was obtained and the trial has been registered ([ISRCTN76735966][1]). Results i) Observational study: 70 patients who had undergone colectomy were recruited. 34 patients (49%) demonstrated fasting hyperaldosteronism (>250pmol/L) leading to higher urinary losses of potassium ( p = 0 .03) and creatinine ( p = 0 .01). ii) Cross-over RCT Biochemistry results Data acquired so far in 16 patients (n = 48 CIDs) have demonstrated fasting plasma aldosterone concentration post-ORT to be significantly lower compared to baseline [189.25 (7.24) vs. 536.25 (12.56) pmol/L; p = 0 .05]. QoL results SF-36 –Post-ORT, patients reported an improvement in six of the eight dimensions of health (role physical, bodily pain, vitality, general health, social functioning and role emotional) with an overall improvement in both composite scores (physical and mental component summary scores) FACIT-F –Post-ORT, patients reported higher scores on four of the five scales (physical well-being, social well-being, emotional well-being and fatigue scale) with higher total scores. Conclusion Metabolic disturbances are common after colectomy leading to a poor quality of life. ORT forms a safe and effective intervention to correct the metabolic disturbances post-colectomy resulting in a positive impact on quality of life. SOURCES OF FUNDING Miss S Mallappa has been awarded a two year Royal College of Surgeons of England Surgical Research Fellowship funded by the IA support group (2012–2014). Miss S Mallappa has also received seedcorn grants from St Mark’s Academic Institute. Disclosure of interest None Declared. [1]: /external-ref?link_type=ISRCTN&access_num=ISRCTN76735966

Efficacy of oral rehydration therapy (ort) in restoring water and electrolyte balance post-colectomy – A blinded placebo-controlled randomised cross-over trial

Efficacy of oral rehydration therapy (ort) in restoring water and electrolyte balance post-colectomy – A blinded placebo-controlled randomised cross-over trial

Safety and efficacy of oral rehydration therapy until 2 h before surgery: a multicenter randomized controlled trial

PurposeIn many countries, patients are generally allowed to have clear fluids until 2–3 h before surgery. In Japan, long preoperative fasting is still common practice. To shorten the preoperative fasting period in Japan, we tested the safety and efficacy of oral rehydration therapy until 2 h before surgery.MethodsThree hundred low-risk patients scheduled for morning surgery in six university-affiliated hospitals were randomly assigned to an oral rehydration solution (ORS) group or to a fasting group. Patients in the ORS group consumed up to 1,000 ml of ORS containing balanced glucose and electrolytes: 500 ml between 2100 the night before surgery and the time they woke up the next morning and 500 ml during the morning of surgery until 2 h before surgery. Patients in the fasting group started fasting at 2100 the night before surgery. Primary endpoints were gastric fluid volume and pH immediately after anesthesia induction. Several physiological measures of hydration and electrolytes including the fractional excretion of sodium (FENa) and the fractional excretion of urea nitrogen (FEUN) were also evaluated.ResultsMean (SD) gastric fluid volume immediately after anesthesia induction was 15.1 (14.0) ml in the ORS group and 17.5 (23.2) ml in the fasting group (P = 0.30). The mean difference between the ORS group and fasting group was −2.5 ml. The 95% confidence interval ranged from −7.1 to +2.2 ml and did not include the noninferior limit of +8 ml. Mean (SD) gastric fluid pH was 2.1 (1.9) in the ORS group and 2.2 (2.0) in the fasting group (P = 0.59). In the ORS group, mean FENa and FEUN immediately after anesthesia induction were both significantly greater than those in the fasting group (P < 0.001 for both variables). The ORS group reported they had been less thirsty and hungry before surgery (P < 0.001, 0.01).ConclusionsOral rehydration therapy until 2 h before surgery is safe and feasible in the low-risk Japanese surgical population. Physicians are encouraged to use this practice to maintain the amount of water in the body and electrolytes and to improve the patient’s comfort.

Enhancing clinical efficacy of oral rehydration therapy: Is low osmolality the key?

Many empirical clinical trials have used complex carbohydrate as substrate in oral rehydration solutions (ORSs) instead of glucose and have shown a number of important clinical benefits. Foremost among these are reduced stool volumes, shorter duration of diarrheal illness, and lower ORS intake. The underlying mechanisms to explain this clinical advantage have not been fully established, but a number of possible factors have been proposed: (1) increased substrate availability, (2) a “kinetic advantage” for glucose absorption by glucose polymer, (3) differential handling of glucose monomer and polymer by the small intestine, (4) low osmolality, (5) a separate effect of peptides and amino acids on solute-linked sodium absorption, (6) an antisecretory moiety in rice, and (6) enhanced mucosal repair and regeneration by luminal nutrients. In this report, we assess the relative contribution of these factors using evidence from laboratory-based studies, mainly in disease-related intestinal perfusion systems in animals and humans, and the relevant clinical studies available to date. We advance the hypothesis that of all the possible mechanisms proposed to underlie the enhanced clinical efficacy of complex carbohydrate ORSs, their hypotonicity plays the dominant role. If confirmed, this concept could guide future development of glucose and complex carbohydrate-based ORSs. GASTROENTEROLOGY 1998;114:197-210

Efficacy of Glucose-based Oral Rehydration Therapy

This article reviews and synthesizes evidence in the published literature on the safety and efficacy of oral rehydration therapy (ORT) among young children with pediatric gastroenteritis in developed nations. We searched the literature for randomized, controlled trials comparing the safety and efficacy of ORT with intravenous (IV) rehydration treatment and/or oral rehydration solutions (ORSs) of different sodium content. We combined the failure rates of each set of studies in statistical meta-analyses and conducted tests of homogeneity of treatment effect over all the studies and for subgroups of children defined by the trial type, the sodium content of the ORS, and the setting of care. We also conducted a multivariate logistic regression on the probability of failure to determine the relative importance of these factors, controlling for other characteristics of the trials. Other outcomes were also tabulated and discussed. These include the relative incidence of hypernatremia and hyponatremia induced by treatment; weight gain; the volume, frequency, and duration of diarrhea; for inpatient trials, the length of stay; and for outpatient trials, rates of hospitalization. The evidence suggests that among pediatric patients with gastroenteritis in developed countries, failure of ORT, defined as the need to rehydrate children intravenously, is infrequent. We found a combined overall ORT failure rate of 3.6%. We found no statistically significant difference in failure rates by trial type or the sodium content of the ORS. However, we did find some supporting evidence for a lower failure rate among children treated in outpatient settings. In addition, compared with patients rehydrated intravenously, pediatric patients treated with ORT were not found to be at higher risk of iatrogenic hypernatremia or hyponatremia. The evidence from the literature fails to show a consistent trend in favor of either high- or low-sodium solutions for rehydration of pediatric patients. There seems to be a great potential for improving the medical treatment of children with acute gastroenteritis by the greater use of ORT.

Pharmacoeconomics of the therapy of diarrhoeal disease.

We review the pathophysiology of intestinal water and electrolyte transport leading to diarrhoea, the currently available pharmacological strategies for its treatment, and the economic implications of such treatments. Diarrhoea occurs most frequently and is associated with highest mortality in children under 5. Oral rehydration therapy (ORT) is the cornerstone of its management. The safety and efficacy of ORT in the prevention of death from dehydration, both in field and also in hospital settings, are now well established. Because it is also inexpensive, ORT is widely applicable worldwide. More recently, rice-based ORT has emerged, based on well known traditional remedies for diarrhoea in southeast Asia and the Far East. Rice-based ORT has the advantage of being more culturally acceptable, readily available even in rural homes in developing countries, and is more effective in reducing stool output and the duration of diarrhoea, compared with conventional glucose-electrolyte solutions such as World Health Organization ORT. For infants, the well known antidiarrhoeal properties of human milk needs emphasis for a variety of reasons including economic ones. Data concerning the economic benefits to a nations' health budget as a result of nationwide implementation of oral rehydration solution (ORS) use are limited. Available data from individual centres in developing countries, if projected to national level, would incur considerable economic advantage. Except for a few notable infections such as shigellosis, cholera, amoebiasis and giardiasis, the widespread use of antibiotics in acute diarrhoea, still a common practice in many developing countries, has no proven value and may be detrimental. The economic implications of antibiotic abuse in the treatment of diarrhoea in developing countries is enormous. Despite the availability of a wide spectrum of pharmacological agents for diarrhoea reviewed in this article, only a few such agents are of proven clinical efficacy: corticosteroids, aminosalicylates and immunosuppressants in the treatment of inflammatory bowel disease and opioid derivatives such as loperamide which may be useful in protracted diarrhoea in children and in disorders where rapid gastrointestinal transit is the main cause of diarrhoea. Opioids are not recommended for acute infective diarrhoea in childhood. Octreotide, a somatostatin analogue, is reported to be useful in the treatment of secretory diarrhoea due to noninfective causes and in the treatment of intractable diarrhoea associated with AIDS. Its high cost and need for parenteral administration prevent its wider application.(ABSTRACT TRUNCATED AT 400 WORDS)

Effect of bicarbonate on efficacy of oral rehydration therapy: studies in an experimental model of secretory diarrhoea.

In situ perfusion of rat intestine was used to evaluate the effect of bicarbonate on the efficacy of a low sodium (35 mmol/l) glucose-electrolyte oral rehydration solution in normal and cholera toxin-treated rat small intestine. In normal intestine, absorption of water was greater (108 (8.1) microliters/min/g; p less than 0.01) and sodium secretion less (-4.3 (0.3) mumol/min/g; p less than 0.01) from the oral rehydration solution containing bicarbonate than from the solution in which bicarbonate was replaced by chloride ions (59.5 (7.2) microliters/min/g and -7.8 (0.8) mumol/min/g, respectively). Glucose absorption in normal intestine was similar with both solutions. In the secreting intestine, both oral rehydration solutions reversed net water secretion to absorption, but inclusion of bicarbonate resulted in significantly less net absorption of both water (2.18 (6.9) microliters/min/g; p less than 0.05) and glucose (18.7 (2.1) mumol/min/g; p less than 0.001) compared with bicarbonate free oral rehydration solution (19.4 (3.9) microliters/min/g and 35.8 (3.7) mumol/min/g, respectively). Net sodium secretion occurred in normal and secreting intestine but was significantly less with the bicarbonate containing oral rehydration solution. These findings suggest that the demonstrable advantage of bicarbonate in promoting water absorption from this oral rehydration solution in normal rat intestine does not apply to cholera toxin treated secreting intestine.

Passive movement of water and sodium across the human small intestinal mucosa.

Passive movement of water and sodium across the human small intestinal mucosa.