RESUMO
OBJECTIVE: To compare the safety and efficacy of an oral rehydration solution (ORS) containing 75 mmol/L of sodium and glucose each with the standard World Health Organization (WHO) ORS among Egyptian children with acute diarrhea. METHODS: One hundred ninety boys, aged 1 to 24 months, who were admitted to the hospital with acute diarrhea and signs of dehydration were randomly assigned to receive either standard ORS (311 mmol/L) or a reduced osmolarity ORS (245 mmol/L). Intake and output were measured every 3 hours. RESULTS: In the group treated with reduced osmolarity ORS, the mean stool output during the rehydration phase was 36% lower (95% confidence interval, 1%, 100%) than in those treated with WHO ORS. The relative risk of vomiting during the rehydration phase was significantly lower in children treated with reduced osmolarity ORS (relative risk, 2.4; 95% confidence interval, 1.2, 4.8). During the maintenance phase, stool output, mean intake of food and ORS, duration of diarrhea, and weight gain were similar in the treatment groups. The relative risk of treatment failure (need for unscheduled administration of intravenous fluids) was significantly increased in children receiving standard WHO ORS (relative risk, 7.9; 95% confidence interval, 1.1, 60.9). The mean serum sodium concentration at 24 hours was significantly lower in children receiving the reduced osmolarity ORS solution (134 +/- 6 mEq/L) than in children receiving the standard WHO ORS (138 +/- 7 mEq/L) (p < 0.001). The relative risk of the development or worsening of hyponatremia was not increased in children given the reduced osmolarity ORS, and urine output was similar in the treatment groups. CONCLUSION: The reduced osmolarity ORS has beneficial effects on the clinical course of acute diarrhea in children by reducing stool output, and the proportion of children with vomiting during the rehydration phase, and by reducing the need for supplemental intravenous therapy. These results provide support for the use of a reduced osmolarity ORS in children with acute noncholera diarrhea.
PIP: Between July 1993 and March 1994, clinical researchers in Egypt enrolled 190 male children aged 1-24 months with acute diarrhea at the Abu El Reeche Hospital in Cairo in a randomized double-blind clinical trial to evaluate the relative efficacy of a reduced osmolarity oral rehydration solution (ORS) containing 75 mmol/l of both sodium and glucose (total osmolarity, 245 vs. 311 mmol/l for the standard ORS recommended by the World Health Organization and UNICEF) for treating acute noncholera diarrhea. They measured intake and output every three hours. Over the entire course of the study, the mean stool output was significantly lower in the reduced osmolarity ORS group than the standard ORS group (4.3 vs. 5 g/kg/hour; p 0.05). During the rehydration phase, the mean stool output was 36% lower in the reduced osmolarity ORS group than in the standard ORS group (p 0.05). The proportion of children vomiting during rehydration was much lower in the reduced osmolarity ORS group than the standard ORS group (17% vs. 33%; relative risk [RR] = 2.4; p 0.01). During the maintenance phase, the two groups shared similar stool output, mean intake of food and ORS, duration of diarrhea, and weight gain. Treatment failure was significantly more common in the standard ORS group than the reduced osmolarity ORS group (8% vs. 1%; RR = 7.9; p 0.01). The mean serum sodium level at 24 hours were much lower in the reduced osmolarity ORS group (134 vs. 138 mEq/l; p 0.001) but remained within the normal range in both groups. Children in both groups developed hyponatremia or their hyponatremia worsened at the same rate. Urine output was about the same in both groups. These findings suggest that the reduced osmolarity ORS has advantages over the standard ORS as a treatment for acute noncholera diarrhea. This safe and effective rehydration treatment reduces stool output and vomiting during rehydration as well as reduces the need for supplemental intravenous therapy.
Assuntos
Diarreia Infantil/terapia , Hidratação/métodos , Glucose/análise , Soluções para Reidratação/química , Soluções para Reidratação/uso terapêutico , Sódio/análise , Doença Aguda , Método Duplo-Cego , Egito , Humanos , Lactente , Masculino , Concentração Osmolar , Risco , Resultado do Tratamento , Organização Mundial da SaúdeRESUMO
OBJECTIVE: In a randomized, double-blind, controlled clinical trial we compared the efficacy of adding 90 mmol/L L-glutamine to the standard World Health Organization oral rehydration salts (WHO-ORS). SUBJECTS: One hundred twenty male infants, > 1 month and < 1 year of age, with acute non-cholera diarrhea and dehydration were randomly assigned to one of the two treatment groups. METHODS: Patients were kept in a metabolic unit where body weight, ORS, water and food intake, as well as stool, urine and vomitus output were recorded at 6-hour intervals. Laboratory evaluation, including blood gases and electrolytes, were monitored during hospitalization. RESULTS: Diarrheal stool output, duration of diarrhea and volume of ORS required to achieve and maintain hydration was not significantly different between the treatment groups. CONCLUSION: This study demonstrated that a glutamine-based ORS did not provide any additional therapeutic advantage over the standard WHO-ORS during treatment of dehydration in infants with acute non-cholera diarrhea.
Assuntos
Diarreia Infantil/terapia , Hidratação , Glutamina/uso terapêutico , Soluções para Reidratação/uso terapêutico , Doença Aguda , Administração Oral , Bicarbonatos/administração & dosagem , Bicarbonatos/uso terapêutico , Desidratação/etiologia , Desidratação/terapia , Diarreia Infantil/complicações , Método Duplo-Cego , Glucose/administração & dosagem , Glucose/uso terapêutico , Glutamina/administração & dosagem , Humanos , Lactente , Masculino , Cloreto de Potássio/administração & dosagem , Cloreto de Potássio/uso terapêutico , Soluções para Reidratação/administração & dosagem , Cloreto de Sódio/administração & dosagem , Cloreto de Sódio/uso terapêuticoRESUMO
Population-based data on deaths due to diarrhoea among children less than 5 years of age were obtained from areas of Brazil (227 deaths), Senegal (531), Bangladesh (236) and India (146). Fatal episodes of diarrhoea were classified as either acute diarrhoea, dysentery, or persistent diarrhoea based on their duration and on the presence or absence of blood in the stools. Persistent diarrhoea accounted for over 60% of infant diarrhoeal deaths in Brazil, 47% in India, 36% in Senegal, and 26% in Bangladesh. In the latter two studies, over one-half of infant diarrhoeal deaths were due to acute watery episodes. Among children 1-4 years old dying from diarrhoea, persistent episodes were the most common in Senegal and India, whereas dysentery was the leading pattern in Bangladesh. These differences may be related to the use of oral rehydration therapy and the utilisation of health care, as well as to environmental characteristics, and are relevant for planning control strategies. Further data are required from other parts of the less developed world.
Assuntos
Diarreia Infantil/mortalidade , Diarreia/mortalidade , Bangladesh/epidemiologia , Brasil/epidemiologia , Pré-Escolar , Diarreia/epidemiologia , Diarreia Infantil/epidemiologia , Humanos , Índia/epidemiologia , Lactente , Recém-Nascido , Senegal/epidemiologiaRESUMO
There is concern that feeding full-strength animal milk to infants aged less than 6 months with diarrhoea may have adverse consequences. We assessed the effects on clinical course of two feeding regimens in 159 Guatemalan and Brazilian infants aged 2 weeks to 6 months who had had acute diarrhoea for 120 h or less, showed signs of mild to moderate dehydration, and had no complications. After correction of dehydration, infants were assigned randomly to receive continued full-strength milk feeding or initial feeding with diluted milk with regrading to full-strength milk over 48 h. There were no significant differences between feeding groups in rate of treatment failures (-1%, 95% Cl -14 to 12%) or mean (SD) total stool output (full-strength milk 335 [268] g/kg, diluted milk 338 [354] g/kg) and duration of diarrhoea (92 [50] vs 92 [44] h). A significant association was found between presence of reducing substances in stools and treatment failure (OR 4.3, 95% CI 1.1 to 16.8), but reducing substances in stools were common both in treatment successes (61%) and in failures (87%). Our study supports the conclusion that, for infants under 6 months of age with diarrhoea whose only food is animal milk or formula, the milk or formula normally given should be provided in full strength as soon as dehydration has been corrected.