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Manthey CF, Epple HJ, Keller KM, Lübbert C, Posovszky C, Ramharter M, Reuken P, Suerbaum S, Vehreschild M, Weinke T, Addo MM, Stallmach A, Lohse AW. S2k-Leitlinie Gastrointestinale Infektionen der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS). ZEITSCHRIFT FUR GASTROENTEROLOGIE 2024; 62:1090-1149. [PMID: 38976986 DOI: 10.1055/a-2240-1428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Affiliation(s)
- Carolin F Manthey
- I. Medizinische Klinik und Poliklinik - Schwerpunkt Gastroenterologie; Sektionen Infektions- und Tropenmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
- Gemeinschaftspraxis Innere Medizin Witten, Witten, Deutschland
| | - Hans-Jörg Epple
- Antibiotic Stewardship, Vorstand Krankenversorgung, Universitätsmedizin Berlin, Berlin, Deutschland
| | - Klaus-Michael Keller
- Klinik für Kinder- und Jugendmedizin, Helios Dr. Horst Schmidt Kliniken, Klinik für Kinder- und Jugendmedizin, Wiesbaden, Deutschland
| | - Christoph Lübbert
- Bereich Infektiologie und Tropenmedizin, Medizinische Klinik I (Hämatologie, Zelltherapie, Infektiologie und Hämostaseologie), Universitätsklinikum Leipzig, Leipzig, Deutschland
| | | | - Michael Ramharter
- I. Medizinische Klinik und Poliklinik - Schwerpunkt Gastroenterologie; Sektionen Infektions- und Tropenmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Philipp Reuken
- Klinik für Innere Medizin IV (Gastroenterologie, Hepatologie, Infektiologie, Zentrale Endoskopie), Universitätsklinikum Jena, Jena, Deutschland
| | - Sebastian Suerbaum
- Universität München, Max von Pettenkofer-Institut für Hygiene und Medizinische Mikrobiologie, München, Deutschland
| | - Maria Vehreschild
- Medizinische Klinik II, Universitätsklinikum Frankfurt, Frankfurt, Deutschland
| | - Thomas Weinke
- Klinik für Gastroenterologie und Infektiologie, Klinikum Ernst von Bergmann, Potsdam, Deutschland
| | - Marylyn M Addo
- I. Medizinische Klinik und Poliklinik - Schwerpunkt Gastroenterologie; Sektionen Infektions- und Tropenmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
- Institut für Infektionsforschung und Impfstoffentwicklung Sektion Infektiologie, I. Med. Klinik, Zentrum für Innere Medizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Andreas Stallmach
- Klinik für Innere Medizin IV (Gastroenterologie, Hepatologie, Infektiologie, Zentrale Endoskopie), Universitätsklinikum Jena, Jena, Deutschland
| | - Ansgar W Lohse
- I. Medizinische Klinik und Poliklinik - Schwerpunkt Gastroenterologie; Sektionen Infektions- und Tropenmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
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Chaiyapak T, Sommai K, Banluetanyalak P, Sumboonnanonda A, Pattaragarn A, Piyaphanee N, Lomjansook K, Thunsiribuddhichai Y, Supavekin S. The incidence and factors associated with dysnatremia in children with acute gastritis/gastroenteritis. Pediatr Int 2024; 66:e15792. [PMID: 39076050 DOI: 10.1111/ped.15792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 03/19/2024] [Accepted: 05/07/2024] [Indexed: 07/31/2024]
Abstract
BACKGROUND The incidence of dysnatremia in children with acute gastritis/gastroenteritis varies, and factors associated with either dysnatremia or hyponatremia at presentation have not been identified clearly. METHODS This retrospective study included patients aged 1 month to 18 years hospitalized for community-acquired acute gastritis/gastroenteritis from January to October 2016. Factors associated with dysnatremia at presentation were identified using multivariable analysis. RESULTS Among the 304 children included, the median age was 2.2 (1.0, 4.2) years. The incidence of dysnatremia at presentation was 17.1% (hyponatremia 15.8%; hypernatremia 1.3%). Patients who had moderate (p = 0.03) and severe dehydration (p = 0.04) and presented with vomiting and diarrhea simultaneously (p = 0.03) were associated with dysnatremia at presentation. Patients presented with vomiting and diarrhea simultaneously was associated with hyponatremia at presentation (p = 0.02). CONCLUSIONS Dysnatremia was common in children with acute gastritis/gastroenteritis. Moderate to severe dehydration and the presence of vomiting and diarrhea simultanously were significantly associated with dysnatremia at presentation. Furthermore, presenting with vomiting and diarrhea silmutaneously was associated with hyponatremia at presentation. Serum electrolytes should be monitored in patients with those conditions.
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Affiliation(s)
- Thanaporn Chaiyapak
- Division of Nephrology, Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kanokwan Sommai
- Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pantira Banluetanyalak
- Division of Nephrology, Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Achra Sumboonnanonda
- Division of Nephrology, Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Anirut Pattaragarn
- Division of Nephrology, Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nuntawan Piyaphanee
- Division of Nephrology, Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kraisoon Lomjansook
- Division of Nephrology, Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Yarnarin Thunsiribuddhichai
- Division of Nephrology, Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Suroj Supavekin
- Division of Nephrology, Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Sakkongviseth W, Sommai K, Sumboonnanonda A, Pattaragarn A, Supavekin S, Piyaphanee N, Lomjansook K, Thunsiribuddhichai Y, Chaiyapak T. Dysnatremia and subsequent sodium level changes following various intravenous treatments in infants with acute gastroenteritis. Eur J Pediatr 2023; 182:4741-4748. [PMID: 37581625 DOI: 10.1007/s00431-023-05151-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 08/01/2023] [Accepted: 08/06/2023] [Indexed: 08/16/2023]
Abstract
Acute gastroenteritis is one of the main causes of electrolyte imbalance in infants. We aimed to determine the frequency of and factors associated with dysnatremia at presentation and establish the ideal intravenous treatment scheme. The records of hospitalized infants aged 1-12 months with community-acquired acute gastroenteritis between January 2017 and March 2021 were retrospectively reviewed. Factors associated with dysnatremia at presentation were analyzed by multivariable logistic regression analysis. Subsequent sodium levels 4-24 h after intravenous fluid treatments, which were categorized into 2 groups, were determined in the subgroup of infants with normal sodium levels at presentation. A total of 347 infants with a median age of 8.0 (5.0-10.0) months were included. The frequency of dysnatremia at presentation was 14% (hyponatremia 12% and hypernatremia 2.0%). Severe dehydration was associated with dysnatremia at presentation (p = 0.048). Among 68 infants with normal sodium levels at presentation, the median sodium change was highest in the 5% dextrose in saline group, with changes of + 3 (0.5-5) and + 1 (- 2 to 2) mmol/L in infants who received 5% dextrose in saline and 5% dextrose in 1/3-1/2 saline, respectively (p = 0.001). Four out of 47 infants (8.5%) developed hyponatremia while receiving 5% dextrose in 1/3-1/2 saline. None of those who received 5% dextrose in saline developed subsequent dysnatremia. Conclusion: The frequency of dysnatremia at presentation among infants with acute gastroenteritis was 14%. Severe dehydration was associated with dysnatremia at presentation, so electrolyte levels need to be assessed in these patients. The use of isotonic solution did not promote acquired dysnatremia. This study supports once more that current guidelines recommending isotonic solution for children, and, especially, infant rehydration, are important also for infants in Thailand. What is Known: • There were a wide variation in the incidence of dysnatremia at presentation in children with acute gastroenteritis in previous pediatric series. • The AAP guidelines recommend using isotonic solution in children with acute illness from 28 days to 18 years of age to prevent acquired hyponatremia. What is New: • The incidence of dysnatremia at presentation in infants with acute gastroenteritis was 14% (hyponatremia 12% and hypernatremia 2.0%). • The use of isotonic solution did not promote acquired dysnatremia in infants with acute gastroenteritis.
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Affiliation(s)
- Wattanaporn Sakkongviseth
- Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kanokwan Sommai
- Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Achra Sumboonnanonda
- Division of Nephrology, Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Anirut Pattaragarn
- Division of Nephrology, Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Suroj Supavekin
- Division of Nephrology, Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nuntawan Piyaphanee
- Division of Nephrology, Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kraisoon Lomjansook
- Division of Nephrology, Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Yarnarin Thunsiribuddhichai
- Division of Nephrology, Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Thanaporn Chaiyapak
- Division of Nephrology, Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
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Mora-Capín A, López-López R, Guibert-Zafra B, de Ceano-Vivas La Calle M, Porto-Abad R, Molina-Cabañero JC, Gilabert-Iriondo N, Ferrero-García-Loygorri C, Montero-Valladares C, García-Herrero MÁ. Recommendation document on rapid intravenous rehydration in acute gastroenteritis. An Pediatr (Barc) 2022; 96:523-535. [PMID: 35624005 DOI: 10.1016/j.anpede.2021.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 04/30/2021] [Indexed: 10/18/2022] Open
Abstract
INTRODUCTION The efficacy and safety of the Rapid Intravenous Rehydration (RIR) guidelines in children affected by dehydration secondary to acute gastroenteritis is supported by current scientific evidence, but there is also great variability in its use in clinical practice. OBJECTIVE To prepare a document with evidence-based recommendations about RIR in paediatric population. METHODS The project was developed based on GRADE methodology, according to the following work schedule: Working Group training; creation of a catalogue of questions about research and definition of "relevant outcomes"; score and selection criteria for each item; bibliographic review; scientific evidence evaluation and synthesis (GRADE); review, discussion and creation of recommendations. 10 clinical questions and 15 relevant outcomes were created (7 about efficacy and 8 about security). RESULTS 16 recommendations were set up, from which we can highlight as the main ones: 1) RIR is safe for children affected by mild-moderate dehydration secondary to acute gastroenteritis, unless expressly contraindicated or acute severe comorbidity (strong recommendation, moderate evidence). 2) Its use is recommended in this situation when oral rehydration has failed or due to contraindication (strong, high). 3) Isotonic fluids are recommended (strong, high), suggesting saline fluid as the first option (light, low), supplemented by glucose (2.5%) in those patients showing normoglycemia and ketosis (strong, moderate). 4) A rhythm of 20cc/kg/h is recommended (strong, high) during 1-4 h (strong, moderate). CONCLUSIONS This document establishes consensus recommendations, based on the available scientific evidence, which could contribute to the standardisation of the use of RIR in our setting.
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Affiliation(s)
- Andrea Mora-Capín
- Urgencias Pediátricas, Hospital materno-infantil Gregorio Marañón, Madrid, Spain.
| | | | - Belén Guibert-Zafra
- Urgencias Pediátricas, Hospital Universitario General de Alicante, Alicante, Spain
| | | | - Raquel Porto-Abad
- Urgencias Pediátricas, Hospital Universitario Puerta de Hierro, Madrid, Spain
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Mora-Capín A, López-López R, Guibert-Zafra B, de Ceano-Vivas La Calle M, Porto-Abad R, Molina-Cabañero JC, Gilabert-Iriondo N, Ferrero-García-Loygorri C, Montero-Valladares C, García-Herrero MÁ. [Recommendation document on rapid intravenous rehydration in acute gastroenteritis]. An Pediatr (Barc) 2021; 96:S1695-4033(21)00190-9. [PMID: 34167904 DOI: 10.1016/j.anpedi.2021.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/26/2021] [Accepted: 04/30/2021] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION The efficacy and safety of the rapid intravenous rehydration (RIR) guidelines in children affected by dehydration secondary to acute gastroenteritis is supported by current scientific evidence, but there is also great variability in its use in clinical practice. OBJECTIVE To prepare a document with evidence-based recommendations about RIR in paediatric population. METHODS The project was developed based on GRADE methodology, according to the following work schedule: Working Group training; creation of a catalogue of questions about research and definition of «relevant outcomes»; score and selection criteria for each item; bibliographic review; scientific evidence evaluation and synthesis (GRADE); review, discussion and creation of recommendations. 10 clinical questions and 15 relevant outcomes were created (7 about efficacy and 8 about security). RESULTS Sixteen recommendations were set up, from which we can highlight as the main ones: (1) RIR is safe for children affected by mild-moderate dehydration secondary to acute gastroenteritis, unless expressly contraindicated or acute severe comorbidity (strong recommendation and moderate evidence). (2) Its use is recommended in this situation when oral rehydration has failed or due to contraindication (strong and high). (3) Isotonic fluids are recommended (strong and high), suggesting saline fluid as the first option (light and low), supplemented by glucose (2.5%) in those patients showing normoglycemia and ketosis (strong and moderate). (4) A rhythm of 20 cc/kg/h is recommended (strong and high) during 1-4 h (strong and moderate). CONCLUSIONS This document establishes consensus recommendations, based on the available scientific evidence, which could contribute to the standardisation of the use of RIR in our setting.
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Affiliation(s)
- Andrea Mora-Capín
- Urgencias Pediátricas, Hospital materno-infantil Gregorio Marañón, Madrid, España.
| | | | - Belén Guibert-Zafra
- Urgencias Pediátricas, Hospital Universitario General de Alicante, Alicante, España
| | | | - Raquel Porto-Abad
- Urgencias Pediátricas, Hospital Universitario Puerta de Hierro, Madrid, España
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Posovszky C, Buderus S, Classen M, Lawrenz B, Keller KM, Koletzko S. Acute Infectious Gastroenteritis in Infancy and Childhood. DEUTSCHES ARZTEBLATT INTERNATIONAL 2020; 117:615-624. [PMID: 33263539 PMCID: PMC7805585 DOI: 10.3238/arztebl.2020.0615] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 01/26/2020] [Accepted: 06/29/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Despite the introduction of vaccination against rotavirus, and even though it can often be treated on an outpatient basis, acute infectious gastroenteritis is nevertheless the second most common non-traumatic cause of emergency hospitaliza - tion in children aged 1 to 5 years, accounting for approximately 9% of cases (39 410 cases in 2017). The most common path - ogens are viruses (47% rotavirus, 29% norovirus, and 14% adenovirus). METHODS This review is based on publications retrieved by a selective search in PubMed employing the terms "acute gastro - enteritis children" AND "dehydration" OR "rehydration" OR "prevention," and by manual searching (based, for example, on reference lists and expert knowledge), with subsequent evaluation including consideration of the relevant guidelines. RESULTS The degree of dehydration can be judged from weight loss and other clinical findings. In 17 randomized controlled trials conducted on a total of 1811 children with mild or moderate dehydration, oral rehydration with oral rehydration solution was just as effective as intravenous rehydration with respect to weight gain, duration of diarrhea, and fluid administration, and was associated with shorter hospital stays (weighted mean difference, -1.2 days; 95% confidence interval [-2.38; -0.02]). Oral rehydration therapy failed in 4% of patients [1; 7]. In children who are vomiting or who refuse oral rehydration solution, continuous nasogastric application is just as effective as intravenous rehydration and is the treatment of first choice. CONCLUSION In Germany, children with mild or moderate dehydration are often hospitalized for intravenous rehydration therapy, despite the good evidence supporting ambulatory oral rehydration. Obstacles to intersectoral care, the nursing shortage, and inadequate reimbursement must all be overcome in order to reduce unnecessary hospitalizations and thereby lessen the risk of nosocomial infection.
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Affiliation(s)
- Carsten Posovszky
- Department of Pediatric and Adolescent Medicine, University Medical Center Ulm
| | - Stephan Buderus
- Department of Pediatrics, GFO-Kliniken Bonn, St. Marienhospital Bonn
| | - Martin Classen
- Department of Pediatric and Adolescent Medicine, Klinikum Links der Weser and Klinikum Bremen-Mitte, Bremen
| | | | | | - Sibylle Koletzko
- Department of Pediatric and Adolescent Medicine, Dr. von Hauner Children’s Hospital, LMU Klinikum der Universität München
- Department of Pediatrics, Gastroenterology and Nutrition, School of Medicine Collegium Medicum University of Warmia and Mazury, Olsztyn, Poland
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Korkmaz MF, Tutanç M, Bostancı M, Korkmaz M, Salihoğlu TE. Red blood cell distribution width as a useful marker for severity in pediatric acute gastroenteritis. Pediatr Int 2019; 61:1109-1113. [PMID: 31529745 DOI: 10.1111/ped.14010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 07/21/2019] [Accepted: 09/13/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Acute gastroenteritis (AGE) in children is still one of the most important causes of mortality and morbidity in developing countries. Therefore, it is very important for clinicians to detect the presence and severity of acute gastroenteritis. Red cell distribution width (RDW) is thought to have the potential for AGE evaluation in children. We sought to investigate the value of RDW for severity assessment in children with AGE. METHODS A total of 97 AGE patients were included in a prospective observational study. Complete blood count, serum C-reactive protein, and stool examinations were carried out. Modified Vesikari score (MVS) was evaluated to determine severity. RESULTS Median age was 19 months (min-max, 1-198 months). The male/female ratio was 1.55 (59/38). Rotavirus was detected in 31 of 97 children (32%). median MVS was 9 points (min-max, 5-24 points). A total of 32 (33%), 43 (44%) and 22 patients (23%) were classified in the mild-, moderate-, and high-severity groups, respectively. There were no significant differences between rotavirus-positive and rotavirus-negative children. Hemoglobin, mean corpuscular volume, and RDW differed significantly according to severity. RDW had the highest area under the curve when the high-severity group was compared with the combination of low- and moderate-severity groups on receiver operating characteristic analysis. CONCLUSIONS Red cell distribution width increased with the increase in severity of AGE. RDW may offer additional severity stratification in children with AGE.
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Affiliation(s)
- Muhammet Furkan Korkmaz
- Department of Pediatrics, Yüksek İhtisas Education and Research Hospital, University of Health Sciences, Bursa, Turkey
| | - Murat Tutanç
- Department of Pediatrics, Yüksek İhtisas Education and Research Hospital, University of Health Sciences, Bursa, Turkey
| | - Muharrem Bostancı
- Department of Pediatrics, Yüksek İhtisas Education and Research Hospital, University of Health Sciences, Bursa, Turkey
| | - Merve Korkmaz
- Department of Pediatrics, Dörtçelik Children's Hospital, Bursa, Turkey
| | - Tuna Ercan Salihoğlu
- Department of Pediatrics, Yüksek İhtisas Education and Research Hospital, University of Health Sciences, Bursa, Turkey
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Qadori M, Flem E, Bekkevold T, Døllner H, Gilje AM, Rojahn A, Størdal K. Hypoglycaemia was common in acute gastroenteritis in a prospective hospital-based study, but electrolyte imbalances were not. Acta Paediatr 2018. [PMID: 29532511 DOI: 10.1111/apa.14318] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM Using routine blood sampling in a gastroenteritis diagnostic workup is debatable. This study examined the relationship between the severity of acute gastroenteritis and blood test abnormalities. METHODS We prospectively enrolled children under five years of age referred for outpatient or inpatient management for gastroenteritis from February 2014 to April 2016. The four study hospitals cared for 30% of Norwegian children. The severity of gastroenteritis was assessed using Vesikari scores. Blood samples were analysed at each hospital. RESULTS The 659 children had a median age of 19 months. The rotavirus was found in 314/514 children with stool samples (61%). Severe gastroenteritis, indicated by a Vesikari score of ≥11, was found in 392/549 (71%) with completed scores, but only 40 of 649 (6%) assessed for dehydration were more than 5% dehydrated. None had sodium <130 mmol/L. Glucose of 3.0-3.3 mmol/L was detected in 52/578 (9%) and <3.0 mmol/L in 33/578 (6%). Hypoglycaemia, elevated urea, low bicarbonate and negative base excess were associated with disease severity. The duration of vomiting and the rotavirus infection were associated with hypoglycaemia. Elevated urea, low bicarbonate and negative base excess had high specificities, but low sensitivities. CONCLUSION Hypoglycaemia was common in acute gastroenteritis, but major electrolyte disturbances were infrequent.
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Affiliation(s)
- Mohammed Qadori
- Department of Paediatrics; Ostfold Hospital Trust; Grålum Norway
| | - Elmira Flem
- Infection Control and Environmental Health; Norwegian Institute of Public Health; Oslo Norway
| | - Terese Bekkevold
- Infection Control and Environmental Health; Norwegian Institute of Public Health; Oslo Norway
| | - Henrik Døllner
- Institute of Laboratory Medicine; Children's and Women's Health; Norwegian University of Science and Technology; Trondheim Norway
- Department of Paediatrics; St Olavs University Hospital; Trondheim Norway
| | - Ann Marit Gilje
- Department of Paediatrics; Stavanger University Hospital; Stavanger Norway
| | - Astrid Rojahn
- Department of Paediatrics; Oslo University Hospital; Ullevaal Norway
| | - Ketil Størdal
- Department of Paediatrics; Ostfold Hospital Trust; Grålum Norway
- Child Health; Norwegian Institute of Public Health; Oslo Norway
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den Bakker E, Gemke RJBJ, Bökenkamp A. Endogenous markers for kidney function in children: a review. Crit Rev Clin Lab Sci 2018; 55:163-183. [DOI: 10.1080/10408363.2018.1427041] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Emil den Bakker
- Department of Pediatric Nephrology, VU Medical Centre, Amsterdam, The Netherlands
| | | | - Arend Bökenkamp
- Department of Pediatric Nephrology, VU Medical Centre, Amsterdam, The Netherlands
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Armstrong LE, Kavouras SA, Walsh NP, Roberts WO. Diagnosing dehydration? Blend evidence with clinical observations. Curr Opin Clin Nutr Metab Care 2016; 19:434-438. [PMID: 27583707 DOI: 10.1097/mco.0000000000000320] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The purpose of the review is to provide recommendations to improve clinical decision-making based on the strengths and weaknesses of commonly used hydration biomarkers and clinical assessment methods. RECENT FINDINGS There is widespread consensus regarding treatment, but not the diagnosis of dehydration. Even though it is generally accepted that a proper clinical diagnosis of dehydration can only be made biochemically rather than relying upon clinical signs and symptoms, no gold standard biochemical hydration index exists. Other than clinical biomarkers in blood (i.e., osmolality and blood urea nitrogen/creatinine) and in urine (i.e., osmolality and specific gravity), blood pressure assessment and clinical symptoms in the eye (i.e., tear production and palpitating pressure) and the mouth (i.e., thirst and mucous wetness) can provide important information for diagnosing dehydration. SUMMARY We conclude that clinical observations based on a combination of history, physical examination, laboratory values, and clinician experience remain the best approach to the diagnosis of dehydration.
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Affiliation(s)
- Lawrence E Armstrong
- aHuman Performance Laboratory, University of Connecticut, Storrs, Connecticut bHydration Science Lab, University of Arkansas, Fayetteville, Arkansas, USA cExtremes Research Group, Bangor University, Bangor, Wales, UK dDepartment of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota, USA
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Brandt KG, Antunes MMDC, da Silva GAP. Acute diarrhea: evidence‐based management. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2015. [DOI: 10.1016/j.jpedp.2015.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Brandt KG, Castro Antunes MMD, Silva GAPD. Acute diarrhea: evidence-based management. J Pediatr (Rio J) 2015; 91:S36-43. [PMID: 26351768 DOI: 10.1016/j.jped.2015.06.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 06/05/2015] [Accepted: 06/08/2015] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES To describe the current recommendations on the best management of pediatric patients with acute diarrheal disease. DATA SOURCE PubMed, Scopus, Google Scholar. DATA SUMMARY There has been little progress in the use of oral rehydration salts (ORS) in recent decades, despite being widely reported by international guidelines. Several studies have been performed to improve the effectiveness of ORS. Intravenous hydration with isotonic saline solution, quickly infused, should be given in cases of severe dehydration. Nutrition should be ensured after the dehydration resolution, and is essential for intestinal and immune health. Dietary restrictions are usually not beneficial and may be harmful. Symptomatic medications have limited indication and antibiotics are indicated in specific cases, such as cholera and moderate to severe shigellosis. CONCLUSIONS Hydration and nutrition are the interventions with the greatest impact on the course of acute diarrhea.
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Affiliation(s)
- Kátia Galeão Brandt
- Centro de Ciências da Saúde (CCS), Universidade Federal de Pernambuco (UFPE), Recife, PE, Brazil.
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Cheuvront SN, Kenefick RW. Dehydration: physiology, assessment, and performance effects. Compr Physiol 2014; 4:257-85. [PMID: 24692140 DOI: 10.1002/cphy.c130017] [Citation(s) in RCA: 270] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
This article provides a comprehensive review of dehydration assessment and presents a unique evaluation of the dehydration and performance literature. The importance of osmolality and volume are emphasized when discussing the physiology, assessment, and performance effects of dehydration. The underappreciated physiologic distinction between a loss of hypo-osmotic body water (intracellular dehydration) and an iso-osmotic loss of body water (extracellular dehydration) is presented and argued as the single most essential aspect of dehydration assessment. The importance of diagnostic and biological variation analyses to dehydration assessment methods is reviewed and their use in gauging the true potential of any dehydration assessment method highlighted. The necessity for establishing proper baselines is discussed, as is the magnitude of dehydration required to elicit reliable and detectable osmotic or volume-mediated compensatory physiologic responses. The discussion of physiologic responses further helps inform and explain our analysis of the literature suggesting a ≥ 2% dehydration threshold for impaired endurance exercise performance mediated by volume loss. In contrast, no clear threshold or plausible mechanism(s) support the marginal, but potentially important, impairment in strength, and power observed with dehydration. Similarly, the potential for dehydration to impair cognition appears small and related primarily to distraction or discomfort. The impact of dehydration on any particular sport skill or task is therefore likely dependent upon the makeup of the task itself (e.g., endurance, strength, cognitive, and motor skill).
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Affiliation(s)
- Samuel N Cheuvront
- Thermal and Mountain Medicine Division, U.S. Army Research Institute of Environmental Medicine, Natick, Massachusetts
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Hoxha TF, Azemi M, Avdiu M, Ismaili-Jaha V, Grajqevci V, Petrela E. The usefulness of clinical and laboratory parameters for predicting severity of dehydration in children with acute gastroenteritis. Med Arch 2014; 68:304-7. [PMID: 25568559 PMCID: PMC4269529 DOI: 10.5455/medarh.2014.68.304-307] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 09/20/2014] [Indexed: 11/21/2022] Open
Abstract
Background: An accurate assessment of the degree of dehydration in infants and children is important for proper decision-making and treatment. This emphasizes the need for laboratory tests to improve the accuracy of clinical assessment of dehydration. The aim of this study was to assess the relationship between clinical and laboratory parameters in the assessment of dehydration. Methods: We evaluated prospectively 200 children aged 1 month to 5 years who presented with diarrhea, vomiting or both. Dehydration assessment was done following a known clinical scheme. Results: We enrolled in the study 200 children (57.5% were male). The mean age was 15.62±9.03 months, with more than half those studied being under 24 months old. Overall, 46.5% (93) had mild dehydration, 34% (68) had moderate dehydration, 5.5% (11) had severe dehydration whereas, 14% (28) had no dehydration. Patients historical clinical variables in all dehydration groups did not differ significantly regarding age, sex, fever, frequency of vomiting, duration of diarrhea and vomiting, while there was a trend toward severe dehydration in children with more frequent diarrhea (p=0.004). Serum urea and creatinine cannot discriminate between mild and moderate dehydration but they showed a good specificity for severe dehydration of 99% and 100% respectively. Serum bicarbonates and base excess decreased significantly with a degree of dehydration and can discriminate between all dehydration groups (P<0.001). Conclusion: Blood gases were useful to diagnose the degree of dehydration status among children presenting with acute gastroenteritis. Serum urea and creatinine were the most specific tests for severe dehydration diagnosis. Historical clinical patterns apart from frequency of diarrhea did not correlate with dehydration status. Further studies are needed to validate our results.
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Affiliation(s)
- Teuta Faik Hoxha
- Pediatric Clinic, University Clinical Center of Kosova, Prishtina, Kosovo ; Department of Statistics, Faculty of Medicine, University of Tirana, Tirana, Albania
| | - Mehmedali Azemi
- Pediatric Clinic, University Clinical Center of Kosova, Prishtina, Kosovo ; Department of Statistics, Faculty of Medicine, University of Tirana, Tirana, Albania
| | - Muharrem Avdiu
- Pediatric Clinic, University Clinical Center of Kosova, Prishtina, Kosovo ; Department of Statistics, Faculty of Medicine, University of Tirana, Tirana, Albania
| | - Vlora Ismaili-Jaha
- Pediatric Clinic, University Clinical Center of Kosova, Prishtina, Kosovo ; Department of Statistics, Faculty of Medicine, University of Tirana, Tirana, Albania
| | - Violeta Grajqevci
- Pediatric Clinic, University Clinical Center of Kosova, Prishtina, Kosovo ; Department of Statistics, Faculty of Medicine, University of Tirana, Tirana, Albania
| | - Ela Petrela
- Pediatric Clinic, University Clinical Center of Kosova, Prishtina, Kosovo ; Department of Statistics, Faculty of Medicine, University of Tirana, Tirana, Albania
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Yalda Lucero A. Etiología y manejo de la gastroenteritis aguda infecciosa en niños y adultos. REVISTA MÉDICA CLÍNICA LAS CONDES 2014. [DOI: 10.1016/s0716-8640(14)70063-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Ely BR, Cheuvront SN, Kenefick RW, Spitz MG, Heavens KR, Walsh NP, Sawka MN. Assessment of extracellular dehydration using saliva osmolality. Eur J Appl Physiol 2013; 114:85-92. [PMID: 24150781 DOI: 10.1007/s00421-013-2747-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Accepted: 10/08/2013] [Indexed: 01/04/2023]
Abstract
INTRODUCTION When substantial solute losses accompany body water an isotonic hypovolemia (extracellular dehydration) results. The potential for using blood or urine to assess extracellular dehydration is generally poor, but saliva is not a simple ultra-filtrate of plasma and the autonomic regulation of salivary gland function suggests the possibility that saliva osmolality (Sosm) may afford detection of extracellular dehydration via the influence of volume-mediated factors. PURPOSE This study aimed to evaluate the assessment of extracellular dehydration using Sosm. In addition, two common saliva collection methods and their effects on Sosm were compared. METHODS Blood, urine, and saliva samples were collected in 24 healthy volunteers during paired euhydration and dehydration trials. Furosemide administration and 12 h fluid restriction were used to produce extracellular dehydration. Expectoration and salivette collection methods were compared in a separate group of eight euhydrated volunteers. All comparisons were made using paired t-tests. The diagnostic potential of body fluids was additionally evaluated. RESULTS Dehydration (3.1 ± 0.5% loss of body mass) decreased PV (-0.49 ± 0.12 L; -15.12 ± 3.94% change), but Sosm changes were marginal (<10 mmol/kg) and weakly correlated with changes in absolute or relative PV losses. Overall diagnostic accuracy was poor (AUC = 0.77-0.78) for all body fluids evaluated. Strong agreement was observed between Sosm methods (Expectoration: 61 ± 10 mmol/kg, Salivette: 61 ± 8 mmol/kg, p > 0.05). CONCLUSIONS Extracelluar dehydration was not detectable using plasma, urine, or saliva measures. Salivette and expectoration sampling methods produced similar, consistent results for Sosm, suggesting no methodological influence on Sosm.
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Affiliation(s)
- Brett R Ely
- Thermal and Mountain Medicine Division, U.S. Army Research Institute of Environmental Medicine, Kansas St, Building 42, Natick, MA, 01760, USA
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Abstract
PURPOSE OF REVIEW To review the advances in the assessment, treatment, and evaluation of care for pediatric dehydration. RECENT FINDINGS Recent studies have added new information across the spectrum of care for dehydration. Advances in the assessment of dehydration allow more accurate clinical evaluation, but do not help predict the treatment outcomes. Antiemetics as an adjunct to oral rehydration therapy have been proven well tolerated, efficacious, and cost-effective. Rapid, large-volume intravenous rehydration for outpatients with dehydration did not show any benefit over more standard regimens. Clinical guidelines incorporate all these aspects of care; however, physicians show poor adherence to the guidelines despite the evidence that guidelines improve outcomes and reduce cost. SUMMARY Dehydration burdens the healthcare system worldwide. Through advances in its assessment, treatment with antiemetics and intravenous fluids, and standardization of practice with clinical guidelines, this burden could be reduced.
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Cheuvront SN, Kenefick RW, Charkoudian N, Sawka MN. Physiologic basis for understanding quantitative dehydration assessment. Am J Clin Nutr 2013; 97:455-62. [PMID: 23343973 DOI: 10.3945/ajcn.112.044172] [Citation(s) in RCA: 103] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Dehydration (body water deficit) is a physiologic state that can have profound implications for human health and performance. Unfortunately, dehydration can be difficult to assess, and there is no single, universal gold standard for decision making. In this article, we review the physiologic basis for understanding quantitative dehydration assessment. We highlight how phenomenologic interpretations of dehydration depend critically on the type (dehydration compared with volume depletion) and magnitude (moderate compared with severe) of dehydration, which in turn influence the osmotic (plasma osmolality) and blood volume-dependent compensatory thresholds for antidiuretic and thirst responses. In particular, we review new findings regarding the biological variation in osmotic responses to dehydration and discuss how this variation can help provide a quantitative and clinically relevant link between the physiology and phenomenology of dehydration. Practical measures with empirical thresholds are provided as a starting point for improving the practice of dehydration assessment.
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Cheuvront SN, Fraser CG, Kenefick RW, Ely BR, Sawka MN. Reference change values for monitoring dehydration. Clin Chem Lab Med 2011; 49:1033-7. [DOI: 10.1515/cclm.2011.170] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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O'Ryan M, Lucero Y, O'Ryan-Soriano MA, Ashkenazi S. An update on management of severe acute infectious gastroenteritis in children. Expert Rev Anti Infect Ther 2010; 8:671-82. [PMID: 20521895 DOI: 10.1586/eri.10.40] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
This article focuses on clinical and diagnostic aspects relevant to severe acute infectious gastroenteritis in children and will update treatment strategies focused on, although not limited to, anti-infective therapy. For the purposes of this article we will consider severe acute infectious gastroenteritis as follows: watery diarrhea accompanied by, or at high risk for, moderate to severe dehydration due to abrupt onset of vomiting that reduces oral intake, and/or frequent emission of liquid stools, or moderate to severe dysenteric/bloody diarrhea with moderate to high-grade fever. The article will not include food poisoning associated with bacterial toxins and will only briefly discuss oral rehydration strategies and intravenous solutions. The article will also briefly discuss current preventive measures against rotavirus gastroenteritis through vaccination, a topic that has been extensively discussed elsewhere.
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Affiliation(s)
- Miguel O'Ryan
- Institute of Biomedical Sciences, Faculty of Medicine, University of Chile, Santiago, Chile.
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