Treatment Of Dehydration Research Articles

Diarrhoea and malnutrition

The relationship between diarrhoea and malnutrition is bidirectional: diarrhoea leads to malnutrition while malnutrition aggravates the course of diarrhoea. Many factors contribute to the detrimental effect of diarrhoea on nutrition. Reduced intake (due to anorexia, vomiting, and withholding of feeds), maldigestion, malabsorption, increased nutrient losses, and the effects of the inflammatory response are some of the factors involved. High volume stool losses (greater than 30 ml/kg/day) are associated with a negative balance for protein, fat, and sugar absorption. Enteric infections often cause increased loss of endogenous proteins, particularly after invasive bacterial infections. Initially, the major emphasis of treatment of acute diarrhoea in children is the prevention and treatment of dehydration, electrolyte abnormalities and comorbid conditions. The objectives of diarrhoeal disease management are to prevent weight loss, to encourage catch-up growth during recovery, to shorten the duration and to decrease the impact of the diarrhoea on the child’s health. Addressing only diarrhoea or only food security is unlikely to be successful in decreasing the prevalence of malnutrition. Existing evidence provides some guidelines as to the optimal nutritional management of children with diarrhoea and novel treatments may prove to be valuable in future.

A Case of Accidental Hypotension Caused by Drug Leakage through the Rubber Piston in a Prefilled Inovan Injection 0.3% Syringe

A Case of Accidental Hypotension Caused by Drug Leakage through the Rubber Piston in a Prefilled Inovan Injection 0.3% Syringe

Di-d-fructose Dianhydride-Enriched Products by Acid Ion-Exchange Resin-Promoted Caramelization of d-Fructose: Chemical Analyses

Caramelization commonly occurs when sugars, or products containing a high proportion of sugars, are heated either dry or in concentrated aqueous solutions, alone or in the presence of certain additives. Upon thermal treatment of sugars, dehydration and self-condensation reactions occur, giving rise to volatiles (principally 2-hydroxymethylfurfural, HMF), pigments (melanoidines) and oligosaccharidic material, among which di-D-fructose dianhydrides (DFAs) and glycosylated DFA derivatives of different degree of polymerization (DP) have been identified. This study reports a methodology to produce caramel-like products with a high content of DFAs and oligosaccharides thereof from commercial D-fructose based on the use of acid ion-exchange resins as caramelization promotors. The rate of formation of these compounds as a function of D-fructose concentration, catalyst proportion, temperature, catalyst nature and particle size has been investigated. The use of sulfonic acid resins allows conducting caramelization at remarkable low temperatures (70-90 degrees C) to reach conversions into DFA derivatives up to 70-80% in 1-2 h, with relative proportions of HMF < 2%.The relative abundance of individual DFA structures can be modulated by acting on the catalyst nature and reaction conditions, which offers a unique opportunity for nutritional studies of DFA-enriched products with well-defined compositions.

Modeling the transport of very short-lived substances into the tropical upper troposphere and lower stratosphere

Abstract. The transport of very short-lived substances into the tropical upper troposphere and lower stratosphere is investigated by a three-dimensional chemical transport model using archived convective updraft mass fluxes (or detrainment rates) from the European Centre for Medium-Range Weather Forecast's ERA-Interim reanalysis. Large-scale vertical velocities are calculated from diabatic heating rates. With this approach we explicitly model the large scale subsidence in the tropical troposphere with convection taking place in fast and isolated updraft events. The model calculations agree generally well with observations of bromoform and methyl iodide from aircraft campaigns and with ozone and water vapor from sonde and satellite observations. Using a simplified treatment of dehydration and bromine product gas washout we give a range of 1.6 to 3 ppt for the contribution of bromoform to stratospheric bromine, assuming a uniform mixing ratio in the boundary layer of 1 ppt. We show that the most effective region for VSLS transport into the stratosphere is the West Pacific, accounting for about 55% of the bromine from bromoform transported into the stratosphere under the supposition of a uniformly distributed source.

Influence of Heat Treatment on the Formation of Amadori Compounds in Carrots

The formation of Amadori products (APs) during heat treatment of carrot juice and dehydration of carrots was studied. APs were measured as the corresponding &lt;I&gt;N&lt;/I&gt;-furoylmethyl amino acids (FMAAs) after acid hydrolysis using RP-HPLC. Commercial samples of juices contained up to 108 mg furosine/100 g protein, 18 mg FM-Ala/100g protein, 13 mg FM-Val/100 g protein and 32 mg FM-GABA/100 g protein. The concentrations in dehydrated carrots were extensively higher with up to 1553 mg furosine/100 g protein, 1144 mg FM-Ala/100 g protein, 88 mg FM-Val/100 g protein and 908 mg FM-GABA/100 g protein. Heat treatment of fresh carrot juice caused only a marginal increase of Amadori compounds. Samples contained at most 16 mg furosine/100 g protein and 19 mg FM-GABA, respectively, while FM-Ala and FM-Val were not detectabele at all. In contrast, drying of carrots led to a significant increase of FMAAs. The dehydrated samples contained up to 989 mg furosine/100 g protein, 1201 mg FM-Ala/100 g protein and 969 mg FM-GABA/100 g protein, while FM-Val was not detectable.

Preventing and treating dehydration in the elderly during periods of illness and warm weather.

Translate the available knowledge on ageing and dehydration into main messages for clinical practice. Older people are more susceptible to dehydration than younger people. This is partly due to lack of thirst sensation and changes in the water and sodium balance that naturally occur as people age. It is also, to some degree, attributable to the fact that elderly people, both those living at home and those living in institutions, often have various impairments, disabilities and/or handicaps (comorbidity). They also tend to use numerous drugs and medication for these illnesses (polypharmacy). Multimorbidity and polypharmacy often overstress the normal age-related physiological changes in the water and sodium balance and therefore increase elderly people's risk of dehydration,especially during intercurrent infections or warm weather. Elderly people, whether they are living on their own or in an institution, and especially elderly people that can no longer take care of themselves because of cognitive, sensory, motor and/or ADL impairments, need extra help to stay hydrated. The most important strategy is simply a matter of ensuring that elderly people consume a sufficient amount of fluids (at least 1.7 liters every 24 hours). Additional strategies include making healthy drinks and water easily available and accessible at all times and reminding and encouraging the elderly to consume these fluids. Elderly people should not be encouraged to consume large amounts of fluids at once but rather small amounts throughout the day. When the recommended fluid intake cannot, for whatever reason, be realized, fluids can be administered via catheter or by hypodermoclysis. In more specific and severe cases, fluids can be administered intravenously. The prevention, signaling and treatment of dehydration in the elderly is an important multidisciplinary endeavor. Formal and informal care providers need to continuously be aware of the risk factors and signs of dehydration in the elderly, especially during periods of very warm weather and when older people are ill. Standard professional care for high risk patients is imperative.

En seks dager gammel pike med vektnedgang

Newborn children normally lose up to 10% of their birth weight during the first week of life. With greater weight loss one must consider low intake and pathological losses. We describe a 6-day-old girl with nearly 19% weight loss and hypertonic dehydration caused by hypogalactia. Principles for treatment of hypertonic dehydration and strategies for finding these children are discussed.

Prevalence, risk factors and strategies to prevent dehydration in older adults

The treatment of dehydration in older adults admitted from residential care to an acute hospital setting may lead to haemodynamic stability. There is however an increased risk for short or long term alterations in physiological, cognitive and psychological status and ultimately, decreased quality of life. Such acute care admissions could be decreased where preventative strategies tailored to address individual risk factors are combined with more frequent assessment of the degree of hydration. The questionable reliability of assessment criteria in older adults increases the need to use multiple signs and symptoms in the identification and differentiation of early and late stages of dehydration. This article reviews various risk factors, explores the reliability of clinical signs and symptoms and reinforces the need to use multiple patient assessment cues if nurses are to differentiate between, and accurately respond to, the various causes of dehydration. Specific strategies to maintain hydration in older adults are also identified.

Towards structural elucidation of eukaryotic photosystem II: Purification, crystallization and preliminary X-ray diffraction analysis of photosystem II from a red alga

Crystal structure of photosystem II (PSII) has been reported from prokaryotic cyanobacteria but not from any eukaryotes. In the present study, we improved the purification procedure of PSII dimers from an acidophilic, thermophilic red alga Cyanidium caldarium, and crystallized them in two forms under different crystallization conditions. One had a space group of P222 1 with unit cell constants of a = 146.8 Å, b = 176.9 Å, and c = 353.7 Å, and the other one had a space group of P2 12 12 1 with unit cell constants of a = 209.2 Å, b = 237.5 Å, and c = 299.8 Å. The unit cell constants of both crystals and the space group of the first-type crystals are different from those of cyanobacterial crystals, which may reflect the structural differences between the red algal and cyanobacterial PSII, as the former contains a fourth extrinsic protein of 20 kDa. X-ray diffraction data were collected and processed to a 3.8 Å resolution with the first type crystal. For the second type crystal, a post-crystallization treatment of dehydration was employed to improve the resolution, resulting in a diffraction data of 3.5 Å resolution. Analysis of this type of crystal revealed that there are 2 PSII dimers in each asymmetric unit, giving rise to 16 PSII monomers in each unit cell, which contrasts to 4 dimers per unit cell in cyanobacterial crystals. The molecular packing of PSII within the unit cell was constructed with the molecular replacement method and compared with that of the cyanobacterial crystals.

Abnormal Computed Tomography Findings Among Children With Viral Gastroenteritis and Symptoms Mimicking Acute Appendicitis

To evaluate computed tomography (CT) findings in pediatric patients with viral gastroenteritis who presented with clinical features of acute abdomen. During 2 seasons of viral gastroenteritis from 2005 to 2007, 302 children with acute gastrointestinal symptoms were admitted to our center for treatment of dehydration and associated complications. Stool specimens obtained from 130 of the 302 were tested for norovirus with the reverse transcriptase-polymerase chain reaction method. Among the 130 patients, 44 tested positive for norovirus, 34 for rotavirus, and 1 for adenovirus. In the remaining 51, except one with Campylobacter jejuni, no viral or bacterial pathogen was detectable. An abdominal CT scan was performed in 4 patients with norovirus and in 1 with rotavirus for suspected acute abdomen including acute appendicitis. Computed tomography (CT) findings were similar among the 5 patients, including thickening of the bowel wall and fluid-filled bowel loops in the small intestine with no pathological findings in the stomach, appendix, or colon. Anatomical changes in the small intestine were shown by CT in 5 children with viral gastroenteritis who presented with acute abdomen. These imaging features of viral gastroenteritis may be useful in differential diagnosis of acute abdomen to avoid unnecessary surgery.

Persistent Fever, Mediastinal Mass in a 5-year-old Boy

&lt;P&gt;This 5-year-old boy was transferred from an outside hospital for evaluation of persistent fever and a mediastinal mass. He was in his usual state of good health until 2 days prior to admission, when he developed fever, abdominal pain, chest pain, vomiting, and diarrhea. There were no complaints of dyspnea, cough, orthopnea, or fatigue. He was admitted to an outside hospital for treatment of gastroenteritis and dehydration. At the time of admission, laboratory findings included hemoglobin 7.2 g/dL, MCV 59, white blood cell count 13,000/mm&lt;sup&gt;3&lt;/sup&gt; with 71% polymorphonuclear cells, 21% lymphocytes, 7% monocytes; platelet count 160,000/mm&lt;sup&gt;3&lt;/sup&gt;. Because of the microcytic anemia, a lead level was obtained, which was 32 mcg/dL. While looking for lead chips in the abdomen, x-ray revealed a left lower lobe infiltrate. Two days later, a chest x-ray demonstrated cardiomegaly. This finding prompted echocardiography, which revealed a moderate to severe circumferential pericardial effusion. Ultimately, 220 cc of serosanguineous pericardial fluid was removed. The cell count had 70,000 red blood cells, 3,000 white blood cells that were 70% neutrophils, and 12% lymphocytes. Acid-fast bacterial stains were negative. The pericardial fluid glucose was 76 mg/dL, and protein was 5 g/dL. The pericardial fluid culture was negative. Several days later, follow-up echocardiogram revealed an echogenic density in the wall of the right atrium at the superior vena cava-right atrial junction. A cardiac magnetic resonance image (MRI) demonstrated a 6.5 × 3.0 cm mass in the pericardial space, abutting the anterolateral aspect of the right atrium.&lt;/P&gt; &lt;H4&gt;Key Learning Points&lt;/H4&gt; &lt;OL&gt; &lt;LI&gt;Anemia of chronic inflammation is generally normocytic, but may be microcytic at times.&lt;/LI&gt; &lt;LI&gt;The normal age groups in which iron deficiency is seen are between 9 to 24 months and in the early teenage years, particularly in menstruating young women. Outside these age ranges, physicians must consider an alternate etiology of iron deficiency, such as occult gastrointestinal blood loss or iron malabsorption.&lt;/LI&gt; &lt;LI&gt;Immune myofibroblastic tumors are a spectrum of proliferative lesions that range from a benign, reactive process to a true malignancy. They often present with high fevers and refractory anemia as a result of prostaglandin release.&lt;/LI&gt; &lt;/OL&gt; &lt;H4&gt;ABOUT THE AUTHOR&lt;/H4&gt; &lt;P&gt;Dr. Listernick is Professor of Pediatrics at Feinberg School of Medicine, Northwestern University, and Director of the Diagnostic and Consultation Service, Division of General Academic Pediatrics, Children’s Memorial Hospital, Chicago, IL.&lt;/P&gt;

Evaluation of anti-nociceptive activity of Cissus quadrangularis on albino mice

Th roughout the history, man has used several forms of therapy for relief of pain; among them, medicinal herbs have gained popularity because of its wide use and less side eff ects. Cissus quadrangularis, for example, is a commonly used folklore medicine in India to hasten the fracture healing process; in Cameroon, the whole plant is used for the treatment of oral dehydration, while in Africa and Asia, the leaves, stems and roots are utilized for the treatment of various ailments. Th e plant extract were prepared by using chloroform and distilled water in proportion (20:80), macerated for 72 h with occasional stirring and concentrated under dry vacuum. Th e extract of Cissus quadrangularis was examined for centrally acting analgesics by using the hot plate method, formalin test and acetic acidinduced writhing method for peripherally acting analgesics. Th e doses administered were 250 mg/kg and 350 mg/kg. Th e animal that administered both the doses showed signifi cant analgesic activity. Th e animal that administered a dose of 350 mg/kg has shown the maximum analgesic activity which is comparable to the standard. Key words: Analgesic, Cissus quadrangularis, formalin, writhing

Optimal Treatment of Campylobacter Dysentery

A 9 day old Caucasian female infant was admitted to a general pediatric floor from an outside hospital for a 23 hour observation and treatment of dehydration associated with severe diarrhea. Parents reported frequent stools for 4 days prior to admission with possible hematochezia 1 day prior to admission. Stools were occurring every 15 to 20 minutes at times. No vomiting or fever accompanied the diarrheal episodes. The child’s formula was changed 3 days prior to admission with no improvement in symptoms. Her birth history included an uncomplicated vaginal delivery at 38 weeks, with a birth weight of 2.93 kg. No medical problems or abnormalities had been identified prior to this hospital admission. She had no previous contact with sick individuals or exposure to pets. The patient’s mother has alpha I antitrypsin deficiency, but no other pertinent family history was identified. On admission, the patient weighed 2.77 kg and the physical exam revealed soft and flat fontanelles, and pink, wet oral mucosa. Bowel sounds were present throughout and the abdomen was soft and non-distended. Stools were sent to the lab for culture and sensitivity. The

Effectiveness of a Practice-Based, Multimodal Quality Improvement Intervention for Gastroenteritis Within a Medicaid Managed Care Network

Acute gastroenteritis results in 220,000 hospitalizations yearly in the United States. The substantial geographic variation in gastroenteritis care, coupled with the evidence of effective treatment of dehydration in nonhospital settings, suggests that the majority of these hospitalizations are avoidable. We sought to decrease hospitalizations for gastroenteritis by using practice-based, multimodal quality improvement methods that target multiple care processes to make them consistent with evidence-based guidelines. We used a controlled before/after study design to evaluate a quality improvement intervention in a 20-practice Medicaid network. All 20 practices participated in continuing education sessions; received free oral rehydration solution, patient education materials, and performance feedback; and participated in a follow-up conference call. Three practices were chosen to develop and pilot office-process changes. These practices formed interdisciplinary teams to develop and test changes and collaborated with project faculty and each other. They shared their learning with the other 17 practices via a conference call and toolkit. We compared before/after gastroenteritis hospital admissions for children <5 years old covered by Medicaid in the intervention practices with all other Medicaid recipients in North Carolina using claims data from 2000-2002. The 3 high-intensity practices all made numerous changes to care processes. Most of the 17 low-intensity practices reported changes in their gastroenteritis care processes. Gastroenteritis admission rates declined 45% in high-intensity practices and 44% in low-intensity practices during the study compared with 11% in the control practices. A practice-based, multimodal quality improvement intervention that targets multiple care processes on the basis of evidence-based guidelines lowered rates of gastroenteritis hospitalization in a Medicaid network. This approach could lower costs attributable to gastroenteritis for Medicaid programs.

Refractory hyponatremia

Refractory hyponatremia

Osmotic Demyelination and Hypertonic Dehydration in a 9-Year-Old Girl: Changes in Cerebrospinal Fluid Myelin Basic Protein

A 9-year-old girl was admitted for the treatment of hyper-natremic dehydration. Her history was significant for psychogenic polydipsia, hyponatremia, and a renal concentrating defect. She presented with a 2-day history of altered mental status, ataxia, lethargy, fever, nausea, vomiting, and diarrhea. Meningitis was ruled out. Over the course of her illness, slow rehydration was maintained with a gradual decrease (10 mEq per 24 hours) of the serum sodium. Despite this care, she developed quadriparesis, and magnetic resonance imaging performed on day 6 of her illness was consistent with osmotic demyelination (central pontine myelinolysis). To rule out an excessively rapid correction of hypernatremia as the etiology of the problem, a myelin basic protein was measured in the cerebrospinal fluid that had been obtained on hospital day 1. The myelin basic protein was 649.50 ng/mL (normal, 0.07-4.10 ng/mL). The current literature is presented regarding the postulated pathogenesis of central pontine myelinolysis and suggested therapies, previous reports of central pontine myelinolysis in children are reviewed, and the potential role of myelin basic protein in its diagnosis is discussed.

Enteral fluid therapy in large animals

Enteral fluids administered alone, or in conjunction with intravenous fluids, are reported to be useful for the treatment of dehydration and electrolyte loss associated with diarrhoea in a number of species, following exercise in horses and for feed impaction of the large intestine of horses. Enteral fluids are suitable for treatment of mild to moderately dehydrated patients with some intact intestinal epithelium and motile small intestine. In patients that will drink voluntarily or tolerate nasal intubation the use of enteral fluids may avoid the complications associated with intravenous fluid administration. However the labour costs associated with repeated nasal intubation in intensively managed patients requiring large volumes of fluids may make the use of enteral fluids less economical than intravenous fluid administration. Enteral fluid use alone is contraindicated in patients that are severely dehydrated and/or in hypovolaemic shock, however, if used in conjunction with intravenous fluids, the effects of villous atrophy and malnutrition may be ameliorated and the duration of hospitalisation shortened. There is a variety of commercially available enteral fluids available to veterinary practitioners. While the key components of these fluids are sodium, chloride and carbohydrates, the amounts of ions and other ingredients such as potassium, alkalising agents, amino acids and shortchain fatty acids may vary. The species of the animal, the underlying condition, and the constituents of the fluid, should influence the choice of an enteral fluid.

Acute thiamine deficiency in diabetic ketoacidosis: Diagnosis and management

Persistent encephalopathy in a patient with diabetic ketoacidosis is often feared as a sign of cerebral edema. Although thiamine deficiency is a rare diagnosis in children, marginal nutritional status and osmotic diuresis may be risk factors. The objective was to describe a heretofore unreported cause of encephalopathy in a child with diabetic ketoacidosis and review the mechanisms and pathophysiology of thiamine deficiency in this clinical scenario. Case report and review of the literature. Pediatric intensive care unit of a tertiary care pediatric hospital. A 13-yr-old girl. Treatment of dehydration and hyperglycemia, osmotherapy, and intravenous thiamine administration. The patient presented with new-onset diabetes mellitus, severe diabetic ketoacidosis, and significant encephalopathy. Despite biochemical improvement with treatment of dehydration and hyperglycemia, her encephalopathy persisted. Computed tomography did not show cerebral edema and she showed no response to osmotherapy. Quantitative and functional assays revealed severe thiamine deficiency. The patient showed an immediate and dramatic response to intravenous thiamine administration. The clinical improvement as well as lab investigations suggests that thiamine deficiency was the cause of this child's encephalopathy. Because potential mechanisms exist for thiamine deficiency in diabetes mellitus and institution of insulin and glucose therapy may stress thiamine body stores, thiamine deficiency should be considered in children with diabetic ketoacidosis whose encephalopathy does not improve with improvement of biochemical status.

Appropriate Management of Severe Malnutrition Greatly Contributes to the Reduction of Child Mortality Rate

Appropriate Management of Severe Malnutrition Greatly Contributes to the Reduction of Child Mortality Rate

Acute Hepatitis and Liver Failure Associated With Influenza A Infection in Children

Acute Hepatitis and Liver Failure Associated With Influenza A Infection in Children