Gastric acid secretion rate and buffer content of the stomach after a rice- and a wheat-based meal in normal subjects and patients with duodenal ulcer

The study describes gastric acid secretory response to a rice-based and a wheat-based meal over a prolonged period of five hours and buffer content of the stomach in five normal and seven duodenal ulcer subjects from the rice-eating eastern Indian population. The results suggest that (1) the meal-mediated gastric acid secretory response in duodenal ulcer subjects is much higher than in the controls, even though the histamine stimulated response is similar, (2) the type of meal, whether rice and fish based or wheat and meat based, does not influence the acid secretory response, and (3) the duodenal ulcer subjects in this area, two hours after a meal, have a buffer capacity similar to the controls.

Malabsorption of water miscible vitamin A in children with giardiasis and ascariasis

Vitamin A absorption was studied using a water-miscible oral preparation of vitamin A in 19 children ages 1 1/2 to 9 years old with giardiasis and/or ascariasis, both before and after their eradication with appropriate therapy, and in three children without parasites. Marked impairment of vitamin A absorption was noted when administered in a water miscible form in children with 1) combined infection with Giardia lamblia and Ascaris lumbricoides, 2) giardiasis alone, and 3) in a proportion of children with ascariasis alone. In children with both giardiasis and ascarasis eradication of the infections promptly lead to a significant improvement in vitamin A absorption and restored it to normal. Children with giardiasis alone also showed improved vitamin A absorption after therapy. In children with ascariasis alone successful therpay did not lead to a statistically significant improvement.

Histamine and insulin dose-response studies of gastric secretion in Indian control subjects and patients with duodenal ulcer in the Ganges delta

The gastric secretory responses to various doses of histamine and insulin have been studied in 11 control and 12 duodenal ulcer subjects belonging to the Ganges delta of India where the incidence of duodenal ulcer disease is known to be high. A dose of 0.04 mg/kg body weight of histamine acid phosphate was sufficient to produce peak gastric acid output both in the control and duodenal ulcer subjects. However, a dose as low as 0.025 U insulin/kg body weight was enough to produce peak rates of gastric acid output in duodenal ulcer subjects, whereas in the controls a minimum dose of 0.05 U insulin/kg body weight was sufficient. A greater proportion of the duodenal ulcer patients also showed a peak acid secretory response in the first hour after administration of insulin. Furthermore, increasing doses of insulin in this population did not produce lower levels of blood glucose but did produce increasingly high acid output as subjects do in the West. K values derived from the intravenous glucose tolerance test showed that 75% of duodenal ulcer patients and 54% of the controls had variable degrees of intolerance to glucose. Gastric acid secretion in response to a bolus of 50 ml 50% intravenous glucose was also studied in a separate group of 16 duodenal ulcer and 13 control subjects. A sharp rise in the volume, titratable acidity, and total acid output was observed in the early part of the fourth hour in the control and duodenal ulcer subjects. In a separate group of controls a bolus of intravenous hypertonic saline produced no such increase in gastric acid secretion.

Oral rehydration in infantile diarrhoea. Controlled trial of a low sodium glucose electrolyte solution

The paper describes the first controlled trial of an oral glucose electrolyte solution designed on the basis of the optimum pathophysiological needs for rehydration in infantile diarrahoea. The solution, having a sodium concentration of 50 mmol/l, was tried in a group of 20 infants with moderate to severe dehydration due to acute diarrhoea and was compared with a matched group of 19 infants predominantly under 2 years of age taking a 'standard' oral solution with a sodium concentration of 90 mmol/l. They could be hydrated as well with a low sodium oral solution alone as with the standard solution. Intravenous fluid was not required in either group. The group treated with the high soldium 'standard' solution appeared to develop hypernatraemia and/or periorbital oedema more frequently than the other group. Also, the low sodium solution eliminated the need for additional free water orally.

Evaluation of a sucrose/electrolyte solution for oral rehydration in acute infantile diarrhoea

An oral sucrose/electrolyte solution brought about complete hydration in 19 out of 20 consecutive children with a median age of 1 year with moderate to severe dehydration due to acute diarrhoea (1 child did not respond and needed intravenous therapy). Vomiting, abdominal distension, and appearance of sugar in the stools during oral hydration did not interfere with its success. A satisfactory response was shown by weight gain (mean +/- S.E. = 9-2 +/- 0-6%), restoration of plasma-bicarbonate to normal levels, falls in the haematocrit values and in the plasma specific gravity, and complete clinical recovery. Disaccharidases in jejunal mucosal biopsy specimens in the acute phase showed reduced lactase in 75% and reduced sucrase in 18%; maltase levels were adequate. Except for the child who did not respond, all showed a satisfactory rise of blood-sugar after sucrose and glucose tolerance tests. Sucrose is cheap and easily obtained; its use instead of glucose in electrolyte solutions would be a considerable gain.

Vitamin A absorption in ascariasis

Vitamin A absorption was studied in a group of 28 adult patients with ascariasis and 12 healthy adult controls, using a simplified vitamin A absorption test. In over 70% of the patients with ascariasis malabsorption of vitamin A was demonstrated. Stool egg counts for ascaris were not related to the degree of vitamin A malabsorption. Of the 23 patients in whom a D-xylose absorption test was performed, seven showed excretion less than 20% in 5 hr. Immediately after expulsion of the worms, vitamin A absorption improved in 13 out of 14 patients tested (in nine to normal level). The results of this study suggest that ascariasis in populations on marginal intakes of vitamin A and its precursors is an important contributing factor in producing clinical vitamin A deficiency.

T and B lymphocyte rosetting in undernourished children

T and B lymphocyte rosetting values were obtained for 18 children with kwashiorkor, marasmus, or nutritional edema. T cell values were subnormal in all malnutrition classes, but were lowest in children with kwashiorkor. Four of five malnourished children who were sensitized with 2,4-dinitrochlorobenzene (DNCB) before refeeding failed to respond to repeated subsequent challenges; five of six children who were sensitized after refeeding responded strongly to the first challenge.

The use of Ringer's lactate in the treatment of children with cholera and acute noncholera diarrhoea

Two regimens of fluid and electrolyte therapy were studied in children with severe cholera and noncholera diarrhoea. In one, lactated Ringer's solution was the sole intravenous fluid, additional water, glucose, and potassium being given by mouth. In the other, three different intravenous solutions were employed to meet all fluid and electrolyte requirements. The response to therapy was satisfactory with each regimen. Because of prolonged stupor or vomiting about 15% of children treated by the first regimen were unable to ingest a sufficient quantity of glucose solution by mouth, and intravenous supplementation with a hypotonic glucose-saline solution was necessary. It is concluded that lactated Ringer's solution is suitable as the sole intravenous solution for children with acute cholera and noncholera diarrhoea provided oral supplementation, as described, is possible. The study also provides useful observations on the means of evaluating fluid requirements in such children and specific guidelines for such therapy.

Intraperitoneal fluid therapy in cholera and non-cholera diarrhoea: with special emphasis on the treatment of infants and children

Because of the relative difficulty in maintaining continuous intravenous infusions in small children suffering from cholera, a simpler method of maintenance fluid therapy would be useful. With this in mind, the role of intraperitoneal fluid administration was evaluated in 8 adults and 26 children (aged 6 years or less) having moderate to severe cholera or cholera-like diarrhoeal disease.In adults intraperitoneal fluid was found to be of no significant value in maintenance therapy because peritoneal absorption was not sufficiently rapid to replace expected stool losses. In children, however, this form of therapy was considerably more successful. In 16 of 19 children with cholera and in all 7 with non-cholera diarrhoea, intraperitoneally administered fluid was absorbed rapidly enough to replace a major part of the initial fluid deficit on admission and all subsequent stool losses. No complications of intraperitoneal puncture were encountered.