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Zieg J, Narla D, Gonsorcikova L, Raina R. Fluid management in children with volume depletion. Pediatr Nephrol 2024; 39:423-434. [PMID: 37452205 DOI: 10.1007/s00467-023-06080-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 06/06/2023] [Accepted: 06/26/2023] [Indexed: 07/18/2023]
Abstract
Volume depletion is a common condition and a frequent cause of hospitalization in children. Proper assessment of the patient includes a detailed history and a thorough physical examination. Biochemical tests may be useful in selected cases. Understanding the pathophysiology of fluid balance is necessary for appropriate management. A clinical dehydration scale assessing more physical findings may help to determine dehydration severity. Most dehydrated children can be treated orally; however, intravenous therapy may be indicated in patients with severe volume depletion, in those who have failed oral therapy, or in children with altered consciousness or significant metabolic abnormalities. Proper management consists of restoring circulatory volume and electrolyte balance. In this paper, we review clinical aspects, diagnosis, and management of children with volume depletion.
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Affiliation(s)
- Jakub Zieg
- Department of Pediatrics, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Deepti Narla
- Department of Pediatric Nephrology, Akron Children's Hospital, Cleveland, OH, USA
| | - Lucie Gonsorcikova
- Department of Pediatrics, First Faculty of Medicine, Charles University in Prague and Thomayer University Hospital, Prague, Czech Republic
| | - Rupesh Raina
- Department of Pediatric Nephrology, Akron Children's Hospital, Cleveland, OH, USA.
- Cleveland Clinic Akron General Medical Center, Akron, OH, USA.
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Ijiri E, Mori C, Sasakawa T. Effect of preoperative oral rehydration before cesarean section on ultrasound assessment of gastric volume and intraoperative hemodynamic changes: a randomized controlled trial. BMC Anesthesiol 2023; 23:293. [PMID: 37648966 PMCID: PMC10466736 DOI: 10.1186/s12871-023-02250-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 08/18/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Cesarean section often requires an urgent transfusion load due to decreased blood pressure after spinal anesthesia. This prospective randomized study aimed to investigate whether a preoperative oral rehydration solution (ORS) stabilized perioperative circulatory dynamics. METHODS Sixty-three parturients scheduled for cesarean section under combined spinal epidural anesthesia (CSEA) were randomly allocated to one of three groups: Group O received 500 mL ORS before bedtime and 500 mL 2 h before CSEA; Group M received mineral water instead of ORS; and Group C had no fluid intake (controls). After entering the operating room, stomach size was measured using ultrasound. Blood samples were obtained, and CSEA was induced. Vasopressors were administered when systolic blood pressure was < 90 mmHg or decreased by > 20%. As a vasopressor, phenylephrine (0.1 mg) was administered at ≥ 60 beats/min heart rate or ephedrine (5 mg) at < 60 beats/min heart rate. The primary outcome was the total number of vasopressor boluses administered. Secondary outcomes were the cross-sectional area of the stomach antrum, maternal plasma glucose levels, serum sodium levels, total intravenous fluid, bleeding volume, urine volume, operative time, and cord blood gas values after delivery. RESULTS The total number of vasopressor boluses was lower in Group O than in Group C (P < 0.05). Group O had lower total dose of phenylephrine than Group C (P < 0.05). There were no significant differences between Group M and other groups. No differences were detected regarding secondary outcomes. CONCLUSIONS In women scheduled for cesarean section, preoperative ORS stabilized perioperative circulatory dynamics. Neither ORS nor mineral water consumption increased the stomach content volume. TRIAL REGISTRATION This trial is registered in the University Hospital Medical Information Network Clinical Trials Registry (UMIN000019825: Date of registration 17/11/2015).
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Affiliation(s)
- Eriko Ijiri
- Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Chie Mori
- Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Tomoki Sasakawa
- Department of Anesthesiology, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjyuku-ku, Tokyo, 162-8666, Japan.
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Besnard O, Maillard O, Franco JM, Lebreton N, Reix G, Legrand F, Bertolotti A, Leruste S. Hydration and clinical warning signs of Dengue fever in primary care: an observational prospective study. Infect Dis Now 2023; 53:104708. [PMID: 37054972 DOI: 10.1016/j.idnow.2023.104708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 03/16/2023] [Accepted: 04/01/2023] [Indexed: 04/15/2023]
Abstract
OBJECTIVES Dengue fever is an arbovirosis expanding worldwide, for which hydration has been reported to reduce the risk of hospitalization. Our objective was to estimate the volume of hydration in Reunionese patients with dengue. METHODS A prospective observational study included patients presenting with a 'dengue-like' syndrome in ambulatory care. General practitioners recruited patients during consultation, and beverage consumption over the previous 24 hours was reported at two different times. Warning signs were defined according to the 2009 WHO guidelines. RESULTS GPs included 174 patients from April to July 2019. Average oral hydration volume was 1863 mL and 1944 mL, at the 1st and 2nd medical consultations, respectively. Water was the most wide consumed liquid. Drinking at least 5 glasses of liquid was significantly associated with fewer clinical warning signs at the 1st medical consultation (p = 0.044). CONCLUSIONS Sufficient hydration volume could prevent dengue warning signs. Further studies with standardized measurement of hydration would be needed.
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Affiliation(s)
- O Besnard
- Université de La Réunion - UFR Santé - Département universitaire de médecine générale, Site de l'IES, CHU de La Réunion, Saint-Pierre, France
| | - O Maillard
- INSERM, CIC1410, CHU de La Réunion, Saint-Pierre, Frances.
| | - J-M Franco
- Université de La Réunion - UFR Santé - Département universitaire de médecine générale, Site de l'IES, CHU de La Réunion, Saint-Pierre, France; INSERM, CIC1410, CHU de La Réunion, Saint-Pierre, Frances
| | - N Lebreton
- Université de La Réunion - UFR Santé - Département universitaire de médecine générale, Site de l'IES, CHU de La Réunion, Saint-Pierre, France
| | - G Reix
- Université de La Réunion - UFR Santé - Département universitaire de médecine générale, Site de l'IES, CHU de La Réunion, Saint-Pierre, France
| | - F Legrand
- Université de La Réunion - UFR Santé - Département universitaire de médecine générale, Site de l'IES, CHU de La Réunion, Saint-Pierre, France; Institut de Recherche pour le Développement - Ceped - UMR 196, Université de Paris, 45, rue des Saint-Pères, 75006 Paris, France
| | - A Bertolotti
- INSERM, CIC1410, CHU de La Réunion, Saint-Pierre, Frances; CHU de La Réunion, Service de maladies infectieuses-médecine interne-dermatologie, Saint Pierre, France
| | - S Leruste
- Université de La Réunion - UFR Santé - Département universitaire de médecine générale, Site de l'IES, CHU de La Réunion, Saint-Pierre, France; INSERM, CIC1410, CHU de La Réunion, Saint-Pierre, Frances
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Moretti ME, Ungar WJ, Freedman SB, Schuh S. Cost-effectiveness of preferred fluids versus electrolytes in pediatric gastroenteritis. CAN J EMERG MED 2021; 23:646-654. [PMID: 33745119 DOI: 10.1007/s43678-021-00108-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 02/11/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND While electrolyte maintenance solution is recommended and commonly used in pediatric gastroenteritis, it can be more costly and less palatable than preferred fluids such as apple juice. OBJECTIVE To assess the incremental cost-effectiveness of apple juice/preferred fluids versus electrolyte maintenance solution in reducing treatment failures in children in an emergency department from societal and health care perspectives. METHODS A probabilistic cost-effectiveness analysis was performed using clinical trial and chart data. All intervention, and direct and indirect costs were included, with a 14-day time horizon. Cost-effectiveness was examined by calculating the difference in mean number of treatment failures and mean cost/patient between treatment groups. The probabilistic point estimate and 95% confidence intervals for incremental costs and incremental effectiveness were determined. RESULTS The apple juice strategy was less costly than electrolytes with average per child savings of CAD $171 (95% CI $22 to $1097) from a societal perspective, and $147 (95% CI $23 to $1056) from a health care perspective. There were 0.08 fewer treatment failures per child (95% CI - 0.15 to - 0.02). The higher electrolyte maintenance solution cost was due to more frequent hospitalizations, ongoing care, and greater lost parental productivity due to additional medical visits. CONCLUSION Apple juice/preferred fluids strategy was dominant over electrolytes in the treatment of children with minimal dehydration secondary to acute gastroenteritis as this option yielded fewer treatment failures and a lower societal cost. Given the high prevalence of acute gastroenteritis, this approach may result in significant cost savings while leading to improved clinical outcomes.
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Affiliation(s)
- Myla E Moretti
- Clinical Trials Unit, Ontario Child Health Support Unit, The Hospital for Sick Children, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Wendy J Ungar
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. .,Program of Child Health Evaluative Sciences, The Hospital for Sick Children Peter Gilgan Centre for Research and Learning, Toronto, ON, Canada.
| | - Stephen B Freedman
- Sections of Pediatric Emergency Medicine and Gastroenterology, Departments of Pediatrics and Emergency Medicine, Cumming School of Medicine, Alberta Children's Hospital, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Suzanne Schuh
- Program of Child Health Evaluative Sciences, The Hospital for Sick Children Peter Gilgan Centre for Research and Learning, Toronto, ON, Canada.,Division of Pediatric Emergency Medicine, Faculty of Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Cheuvront SN, Kenefick RW, Luque L, Mitchell KM, Vidyasagar S. Are oral rehydration solutions optimized for treating diarrhea? Nutr Health 2021; 27:461-465. [PMID: 33583247 DOI: 10.1177/0260106021991641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND A historical turning point occurred in the treatment of diarrhea when it was discovered that glucose could enhance intestinal sodium and water absorption. Adding glucose to salt water (oral rehydration solution, ORS) more efficiently replaced intestinal water and salt losses. AIM Provide a novel hypothesis to explain why mainstream use of ORS has been strongly recommended, but weakly adopted. METHODS Traditional (absorptive) and novel (secretory) physiological functions of glucose in an ORS were reviewed. RESULTS Small amounts of glucose can stimulate both intestinal absorption and secretion. Glucose can exacerbate a net secretory state and may aggravate pathogen-induced diarrhea, particularly for pathogens that affect glucose transport. CONCLUSION A hypothesis is made to explain why glucose-based ORS does not appreciably reduce diarrheal stool volume and why modern food science initiatives should focus on ORS formulations that replace water and electrolytes while also reducing stool volume and duration of diarrhea.
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Wiens KE, Schaeffer LE, Sow SO, Ndoye B, Cain CJ, Baumann MM, Johnson KB, Lindstedt PA, Blacker BF, Bhutta ZA, Cormier NM, Daoud F, Earl L, Farag T, Khalil IA, Kinyoki DK, Larson HJ, LeGrand KE, Cook AJ, Malta DC, Månsson JC, Mayala BK, Mokdad AH, Ogbuanu IU, Sankoh O, Sartorius B, Topor-Madry R, Troeger CE, Welgan CA, Werdecker A, Hay SI, Reiner RC. Oral rehydration therapies in Senegal, Mali, and Sierra Leone: a spatial analysis of changes over time and implications for policy. BMC Med 2020; 18:405. [PMID: 33342436 PMCID: PMC7750121 DOI: 10.1186/s12916-020-01857-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 11/18/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Oral rehydration solution (ORS) is a simple intervention that can prevent childhood deaths from severe diarrhea and dehydration. In a previous study, we mapped the use of ORS treatment subnationally and found that ORS coverage increased over time, while the use of home-made alternatives or recommended home fluids (RHF) decreased, in many countries. These patterns were particularly striking within Senegal, Mali, and Sierra Leone. It was unclear, however, whether ORS replaced RHF in these locations or if children were left untreated, and if these patterns were associated with health policy changes. METHODS We used a Bayesian geostatistical model and data from household surveys to map the percentage of children with diarrhea that received (1) any ORS, (2) only RHF, or (3) no oral rehydration treatment between 2000 and 2018. This approach allowed examination of whether RHF was replaced with ORS before and after interventions, policies, and external events that may have impacted healthcare access. RESULTS We found that RHF was replaced with ORS in most Sierra Leone districts, except those most impacted by the Ebola outbreak. In addition, RHF was replaced in northern but not in southern Mali, and RHF was not replaced anywhere in Senegal. In Senegal, there was no statistical evidence that a national policy promoting ORS use was associated with increases in coverage. In Sierra Leone, ORS coverage increased following a national policy change that abolished health costs for children. CONCLUSIONS Children in parts of Mali and Senegal have been left behind during ORS scale-up. Improved messaging on effective diarrhea treatment and/or increased ORS access such as through reducing treatment costs may be needed to prevent child deaths in these areas.
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Affiliation(s)
- Kirsten E Wiens
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave. NE, Seattle, WA, 98195, USA
| | - Lauren E Schaeffer
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave. NE, Seattle, WA, 98195, USA
| | - Samba O Sow
- Centre for Vaccine Development, Mali (CVD-Mali), Bamako, Mali
| | - Babacar Ndoye
- African Field Epidemiology Training Programme - Senegal, Ministry of Health, Dakar, Senegal
| | - Carrie Jo Cain
- World Hope International, Makeni, Sierra Leone
- Health Care Ministries, Wesleyan Church of Sierra Leone, Makeni, Sierra Leone
| | - Mathew M Baumann
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave. NE, Seattle, WA, 98195, USA
| | - Kimberly B Johnson
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave. NE, Seattle, WA, 98195, USA
| | - Paulina A Lindstedt
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave. NE, Seattle, WA, 98195, USA
| | - Brigette F Blacker
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave. NE, Seattle, WA, 98195, USA
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, University of Toronto, Toronto, ON, Canada
- Centre of Excellence in Women & Child Health, Aga Khan University, Karachi, Pakistan
| | - Natalie M Cormier
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave. NE, Seattle, WA, 98195, USA
| | - Farah Daoud
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave. NE, Seattle, WA, 98195, USA
| | - Lucas Earl
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave. NE, Seattle, WA, 98195, USA
| | - Tamer Farag
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave. NE, Seattle, WA, 98195, USA
| | - Ibrahim A Khalil
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Damaris K Kinyoki
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave. NE, Seattle, WA, 98195, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Heidi J Larson
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave. NE, Seattle, WA, 98195, USA
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Kate E LeGrand
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave. NE, Seattle, WA, 98195, USA
| | - Aubrey J Cook
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave. NE, Seattle, WA, 98195, USA
| | - Deborah C Malta
- Department of Maternal and Child Nursing and Public Health, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Johan C Månsson
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave. NE, Seattle, WA, 98195, USA
| | - Benjamin K Mayala
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave. NE, Seattle, WA, 98195, USA
- ICF International, DHS Program, Rockville, MD, USA
| | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave. NE, Seattle, WA, 98195, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Ikechukwu U Ogbuanu
- Expanded Programme on Immunization, World Health Organization, Geneva, Switzerland
| | - Osman Sankoh
- Statistics Sierra Leone, Tower Hill, Freetown, Sierra Leone
- Njala University, Njala, Bo, Freetown, Sierra Leone
| | - Benn Sartorius
- Department of Global Health, University of Washington, Seattle, WA, USA
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Roman Topor-Madry
- Institute of Public Health, Jagiellonian University Medical College, Kraków, Poland
- Agency for Health Technology Assessment and Tariff System, Warsaw, Poland
| | - Christopher E Troeger
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave. NE, Seattle, WA, 98195, USA
| | - Catherine A Welgan
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave. NE, Seattle, WA, 98195, USA
| | - Andrea Werdecker
- Demographic Change and Aging Research Area, Federal Institute for Population Research, Wiesbaden, Germany
| | - Simon I Hay
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave. NE, Seattle, WA, 98195, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Robert C Reiner
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave. NE, Seattle, WA, 98195, USA.
- Department of Global Health, University of Washington, Seattle, WA, USA.
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Abstract
PURPOSE OF REVIEW An understanding of fluid and electrolyte losses from diarrhea and mechanisms of solute cotransport led to development of oral rehydration solution (ORS), representing a watershed in efforts to reduce diarrheal disease morbidity and mortality. This report reviews the scientific rationale and modifications of ORS and barriers to universal application. RECENT FINDINGS Solutions with osmolality and electrolyte composition different from original ORS for routine and unique pathophysiology such as in malnutrition have met with varying success. Following the conceptual rationale of sodium-glucose cotransportation to facilitate water absorption, other cotransporters and formulations have been explored with the aim to improve ORS efficacy and acceptance. ORS remains the anchor of acute watery diarrhea and dehydration management worldwide. Despite development of different formulations, the current standard solution is the mainstay of treatment for nearly all situations. Efforts to improve oral hydration solution and to increase acceptance and usage are ongoing.
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Affiliation(s)
- Sylvia Y Ofei
- Department of Pediatrics, University of Kentucky College of Medicine/Kentucky Children's Hospital, Lexington, USA.,Pediatric Gastroenterology, Hepatology, and Nutrition, University of Kentucky College of Medicine, 138 Leader Ave, Lexington, KY, 40506-9983, USA
| | - George J Fuchs
- Department of Pediatrics, University of Kentucky College of Medicine/Kentucky Children's Hospital, Lexington, USA. .,Pediatric Gastroenterology, Hepatology, and Nutrition, University of Kentucky College of Medicine, 138 Leader Ave, Lexington, KY, 40506-9983, USA.
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Misgna HG, Ebessa B, Kassa M. Prevalence of oral rehydration therapy use and associated factors among under-five children with diarrhea in Dangure, Benishangul Gumuz Region, Ethiopia/2018. BMC Res Notes 2019; 12:67. [PMID: 30700333 PMCID: PMC6354353 DOI: 10.1186/s13104-019-4078-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Accepted: 01/11/2019] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES This study aims to assess the prevalence of oral rehydration therapy use and associated factors among under-five children with diarrhoea in Dangure district, Benishangul Gumuz Region, Ethiopia/2018. RESULT A total of 615 under-five children who suffered from diarrhoea 2 weeks before the study were included and the response rate was 610 (99%). Among the total children participated in this study 189 (31%) were between 12 and 23 months with mean 23.5 and SD ± 6.9. Five hundred seventeen (84.8%) of mothers had access to oral rehydration therapy and 85% of mother's home had taken less than 1 h distance from the health facility. The prevalence of oral rehydration therapy is 51%. Two hundred sixty-seven (43.8%) mothers mentioned correctly about the importance of oral rehydration therapy which is to replace fluid while other 243 (39.8%) mothers stated that oral rehydration therapy uses to decrease diarrhoea. Mother's educational status, monthly income, knowledge of oral rehydration therapy, previous experience and seeking advice for treatment from health facilities were factors associated with oral rehydration therapy use.
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Affiliation(s)
- Haftom Gebrehiwot Misgna
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Health Sciences, Mekelle University, Mekelle, Ethiopia.
| | | | - Mekuria Kassa
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
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Oshima S, Aoki Y, Kawasaki Y, Yokoyama J. The effect of oral hydration on the risk or aspiration and hemodynamic stability before the induction of anesthesia: A systematic review and meta-analysis. J Clin Anesth 2018; 49:7-11. [PMID: 29803011 DOI: 10.1016/j.jclinane.2018.05.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 05/10/2018] [Accepted: 05/18/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Preoperative oral rehydration solutions (ORS) are frequently used in clinical practice in Japan, although their effect remains to be explained. The purpose of this study was to investigate the clinical outcomes associated with ORS usage. DESIGN Systematic review and meta-analysis. SETTING Surgical departments at each hospital. PARTICIPANTS A total of 546 patients with American Society of Anesthesiologists physical status classification I or II (non-pregnant adults only) reported in six articles. INTERVENTIONS Patients in the included studies had originally been randomly allocated to the ORS or control group. MEASUREMENTS Incidence of aspiration and vomiting during induction of anesthesia, gastric fluid volume (absolute volume), gastric pH, stroke volume variation (SVV) during induction of anesthesia. Risk difference (RD) or mean difference (MD) with 95% confidence interval (CI) were calculated using a random effects model. MAIN RESULTS There was no aspiration or vomiting in either group [3 studies, 428 patients, RD 0 (95% CI -0.01 to 0.01), I2 = 0%]. ORS administration caused no significant difference in gastric volume [4 studies, 486 participants, MD -1.12 ml (95% CI -5.61 to 3.36), I2 = 62%] or gastric pH [4 studies, 486 participants, MD -0.03. (95% CI -0.37 to 0.31), I2 = 0%] compared with the control group. In contrast, ORS resulted in a significant reduction in SVV during the anesthesia induction period [3 studies, 118 participants, MD -3.02 (95% CI -5.44 to -0.59), I2 = 65%]. CONCLUSIONS Our systematic review indicates that oral rehydration therapy does not increase the risk of aspiration or vomiting. In contrast, it may help stabilize circulatory dynamics during anesthesia induction.
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Sreeramareddy CT, Low YP, Forsberg BC. Slow progress in diarrhea case management in low and middle income countries: evidence from cross-sectional national surveys, 1985-2012. BMC Pediatr 2017; 17:83. [PMID: 28320354 PMCID: PMC5360044 DOI: 10.1186/s12887-017-0836-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 03/08/2017] [Indexed: 02/01/2023] Open
Abstract
Background Diarrhea remains to be a main cause of childhood mortality. Diarrhea case management indicators reflect the effectiveness of child survival interventions. We aimed to assess time trends and country-wise changes in diarrhea case management indicators among under-5 children in low-and-middle-income countries. Methods We analyzed aggregate data from Demographic and Health Surveys and Multiple Indicator Cluster Surveys done from 1986 to 2012 in low-and-middle-income countries. Two-week prevalence rates of diarrhea, caregiver’s care seeking behavior and three case management indicators were analyzed. We assessed overall time trends across the countries using panel data analyses and country-level changes between two sequential surveys. Results Overall, yearly increase in case management indicators ranged from 1 · 3 to 2 · 5%. In the year 2012, <50% of the children were given correct treatment (received oral rehydration and increased fluids) for diarrhea. Annually, an estimated 300 to 350 million children were not given oral rehydration solutions, or recommended home fluids or ‘increased fluids’ and 304 million children not taken to a healthcare provider during an episode of diarrhea. Overall, care seeking for diarrhea, increased from pre-2000 to post-2000, i.e. from 35 to 45%; oral rehydration rates increased by about 7% but the rate of ‘increased fluids’ decreased by 14%. Country-level trends showed that care seeking had decreased in 15 countries but increased in 33 countries. Care seeking from a healthcare provider increased by ≥10% in about 23 countries. Oral rehydration rates had increased by ≥10% in 15 countries and in 30 countries oral rehydration rates increased by <10%. Conclusions Very limited progress has been made in the case management of childhood diarrhea. A better understanding of caregiver’s care seeking behavior and health care provider’s case management practices is needed to improve diarrhea case management in low- and-middle-income countries.
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Affiliation(s)
| | - Yue-Peng Low
- Institute of Biological Sciences, Faculty of Science, University of Malaya, Kuala Lumpur, Malaysia
| | - Birger Carl Forsberg
- Health Systems and Policy Research (HSP), Department of Public Health Sciences, Karolinska Institutet, S-17177, Stockholm, Sweden
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Doan Q, Chan M, Leung V, Lee E, Kissoon N. The impact of an oral rehydration clinical pathway in a paediatric emergency department. Paediatr Child Health 2011; 15:503-7. [PMID: 21966235 DOI: 10.1093/pch/15.8.503] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2009] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To measure the impact of implementing an oral rehydration clinical pathway for children with mild to moderate dehydration from gastroenteritis in the paediatric emergency department (ED) on the indicators of health care utilization. METHODS ED charts of children, six months to 17 years of age, meeting the criteria for the oral rehydration clinical pathway were reviewed. There were three 12-month periods of data collection: pre-implementation, transition and postimplementation. The clinical pathway consisted of a standard nursing assessment form and instructions on oral rehydration to be initiated and maintained by caregivers while waiting to see a physician. The primary outcome measure was ED length of visit (LOV) for children treated using the clinical pathway. This was compared with LOV for all other ED visits during the study periods to highlight the effect of the clinical pathway implementation. Secondary outcome measures included rate of intravenous rehydration, unscheduled return visits to the ED and hospital admission. RESULTS During the three data collection periods, 11,816 children met the eligibility criteria. A decrease in the mean LOV of 24 min (95% CI 17 to 31) was observed, as well as a trivial decrease in the rate of intravenous rehydration therapy (14.6% to 12%) with implementation of the clinical pathway. CONCLUSION The implementation of an oral rehydration clinical pathway in the ED led to a modest reduction in the ED LOV.
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Affiliation(s)
- Quynh Doan
- Pediatric Emergency, BC Children's Hospital, Vancouver, British Columbia
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Abstract
AIM Preoperative fluid and electrolyte management is usually performed by intravenous therapy. We investigated the safety and effectiveness of oral rehydration therapy (ORT) for preoperative fluid and electrolyte management of surgical patients. METHODS The study consisted of two studies, designed as a prospective observational study. In a pilot study, 20 surgical patients consumed 1000 mL of an oral rehydration solution (ORS) until 2 h before induction of general anesthesia. Parameters such as serum electrolyte concentrations, fractional excretion of sodium (FENa) as an index of renal blood flow, volume of esophageal-pharyngeal fluid and gastric fluid (EPGF), and patient satisfaction with ORT were assessed. In a follow-up study to assess the safety of ORT, 1078 surgical patients, who consumed ORS until 2 h before induction of general anesthesia, were assessed. RESULTS In the pilot study, water, electrolytes, and carbohydrate were effectively and safely supplied by ORT. The FENa value was increased at 2 h following ORT. The volume of EPGF collected following the induction of anesthesia was 5.3±5.6 mL. In the follow-up study, a small amount of vomiting occurred in one patient, and no aspiration occurred in the patients. CONCLUSION These results suggest that ORT is a safe and effective therapy for the preoperative fluid and electrolyte management of selected surgical patients.
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Affiliation(s)
- Hideki Taniguchi
- School of Nutrition & Dietetics, Kanagawa University of Human Services, Yokosuka, Kanagawa 238-8522, Japan.
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