Treatment of mild to moderate dehydration in children with oral rehydration therapy

Purpose: To review current literature on the effectiveness of oral rehydration therapy (ORT) in the treatment of mild to moderate dehydration in children.
Data sources: Recommendations from American Academy of Pediatrics (AAP), World Health Organization (WHO), selected research articles (2000–2006), and Internet sources.
Conclusions: Dehydration is a common diagnosis in pediatric primary care. The literature indicates that dehydration is more often treated with intravenous (IV) therapy when ORT would be equally effective. ORT is an effective treatment for children with mild to moderate dehydration. ORT could be used more frequently rather than IV rehydration therapy. The use of ORT versus traditional methods of IV hydration matches the nursing philosophy of holistic care by enhancing client comfort and autonomy.
Implications for practice: Current practice in the treatment of mild to moderate dehydration in children does not match both AAP and WHO guidelines, which are based on evidence supporting ORT effectiveness. Treatment with ORT allows children more flexibility to be treated at home and thus decreases hospital stay. Evidence shows that the time required to initiate ORT is actually quicker than IV therapy and allows for a less stressful therapy that can be performed in the home.     

Infusion treatment in severe dehydration (infantile toxicosis)]

Severe dehydration in infants is a common life threatening condition. The therapy of different forms of dehydration has been described. Many practical suggestions for diagnostic procedures have been added. Clinical and pathophysiological peculiarities typical of the treatment of severe infantile dehydration have been stressed.     

Disseminated intravascular coagulation and acute renal failure in an infant. Treated with streptokinase and peritoneal dialysis (author's transl)]

An infant, aged seven months, developed toxic shock with acute renal failure as a sequel to the development of hypertonic dehydration. The anuric phase persisted despite treatment of the dehydration and diuretic infusions. The coagulation tests showed signs of disseminated intravascular coagulation and so the child was given fibrinolytic therapy for 36 hours following initial heparinization. Excretion of urine recommenced 8 hours after the initiation of fibrinolytic therapy. Peritoneal dialysis was carried out in parallel with the fibrinolytic treatment without haemorrhagic complications. It was possible to terminate dialysis on the fourth day already and renal function subsequently recovered completely.     

Dehydration therapy and hypotension in postresuscitation cerebral oedema,and application of intra-ocular pressure measurement — A review of resuscitation work,part I

The following issues in post-resuscitative cerebral oedema and hypotension were discussed: (1) the concept and importance of secondary cerebral oedema; (2) ‘hypovolaemic’ hypotension and cerebral oedema, aetiology, contradiction and treatment; (3) fluid intake control and dehydration effect; and (4) diuresis and inannitol-nephrosis. Although there is still no evidence to show that dehydration therapy directly plays a distinct role on the restoration of injured cerebral cells, we believe that prompt and effective dehydration treatment would be beneficial to the recovery of cerebral damage.In addition, the application of intra-ocular pressure (IOP) measurement as an indirect criterion of cerebral oedema and hypovolaemia was introduced.     

Dehydration syndromes. Oral rehydration and fluid replacement

Dehydration caused by diarrhea remains a major source of morbidity and mortality worldwide. Dehydration is a common clinical presentation seen by most physicians. Clinical diagnosis depends on the recognition of signs and symptoms as well as change in weight. Laboratory studies are helpful in categorizing the dehydration as isotonic, hyponatremic, or hypernatremic, which is necessary to plan appropriate therapy. In many situations, oral rehydration therapy is possible and desirable. Intravenous rehydration remains the standard of care for children with severe dehydration and shock.     

Treatment-related diarrhea in patients with cancer

Diarrhea caused by chemotherapy or radiation in patients with cancer can cause dehydration, electrolyte imbalance, malnutrition, fluid depletion, and hospitalization. In severe cases, uncontrolled diarrhea can lead to therapy dose reductions or even death. Oncology professionals may simply assess for the absence or presence of diarrhea, rather than using a standard assessment tool; they also may lack awareness regarding availability of established assessment and treatment guidelines. However, use of treatment guidelines can lead to optimal prevention and management of treatment-induced diarrhea in patients with cancer. Oncology nurses play a key role in the identification and treatment of chemotherapy- and radiation therapy-induced diarrhea.     

Gastroenteritis in Children: Part II. Prevention and Management

The treatment of gastroenteritis in children focuses on preventing dehydration. A child with minimal or no dehydration should be encouraged to continue his or her usual diet plus drink adequate fluids. Many studies have shown that a child's regular diet reduces the duration of diarrhea. Oral rehydration therapy with a rehydration solution can be used to treat diarrhea in children with mild to moderate dehydration. Ondansetron can decrease vomiting or help avoid the need for intravenous fluid, but it increases episodes of diarrhea. Probiotics can be used to shorten the course of diarrhea. Good handwashing reduces the incidence of acute gastroenteritis, but not rotavirus. The introduction of two rotavirus vaccines in the United States in 2006 significantly reduced the incidence of rotavirus gastroenteritis. The oral, live vaccines have strong safety records, despite a minimal incidence of intussusception.     

Pathophysiology and therapy of diabetic ketoacidosis and of non-ketoacidotic hyperosmolar diabetic coma

Metabolic derangements in diabetic coma are the sequelae of insulin deficiency. These defects are aggravated by the actions of insulin counteracting ("diabetogenic") hormones and hypertonic dehydration, which both impair insulin action. Conversely, it has been shown that hypo-osmolar rehydration of a hyperosmolar, severely hyperglycaemic diabetic patient reduces insulin resistance and restores biological responsiveness of previously dehydrated insulin-dependent tissues towards insulin. Thus treatment of diabetic coma requires appropriate fluid and electrolyte replacement as a life-saving emergency action alongside insulin replacement. The use of proper rehydration during the past decade might also explain the reported fall in the insulin requirement for the treatment of diabetic coma from approximately 1,000 units per coma to low-dose insulin therapy. In order to guarantee proper treatment of severe hyperglycaemia and normalization of the hyperosmolar state, we feel that hypo-osmolar rehydration has to be initiated in parallel with low-dose insulin therapy (5 to 6 U/h) to restore the physiological response of the respective target tissues to insulin action and to ameliorate glucose utilization. This approach probably avoids a too rapid fall in plasma osmolarity, minimizes the risk of cerebral oedema and hypokalaemia, and improves survival. The development of severe diabetic ketoacidosis or of hyperosmolar non-ketotic diabetic coma should be prevented by advice to patients on the importance of metabolic monitoring, which can be done by proper self-monitoring of blood glucose. In addition, information should be provided on the detrimental metabolic effects of both dehydration and stress.     

Oral rehydration therapy in diarrhea. Not just for Third World children

Oral rehydration therapy is an effective, practical, and economical means of treatment for dehydration secondary to diarrhea. The regimen can be used on an outpatient basis with a substantial reduction in both cost and hospital-induced anxiety. It is not necessary to discontinue breast-feeding infants with diarrhea, and early feeding does not prolong the diarrheal illness.     

Humidification for oxygen therapy in non-ventilated patients

Oxygen therapy is a necessary treatment for some patients in hospital; however, as with any treatment there are side effects. These include drying and cooling of the respiratory tract. This can lead to unpleasant side effects discouraging patients from continuing with their treatment. To overcome this there are a variety of humidification devices, both heated and cold, which can help people tolerate their treatment. This article will discuss the AQUAPAK system which humidifies dry oxygen making it more comfortable for the patient to breathe and preventing dehydration of the respiratory system.     

高渗盐水在缺血性脑梗死治疗中的作用

目的:对比高渗盐水和甘露醇在缺血性脑梗死治疗中的作用.方法:将46例病人随机分为三组,在常规治疗的基础上,A组静注7.5%高渗盐水,B组静注10%高渗盐水,C组静注20%甘露醇,连续6d.在治疗过程中,观察患者的血电解质、肾功能及神经功能缺损程度的变化.结果:三种治疗方案均能有效减轻患者的神经功能缺损.但在治疗过程中,C组的大部分患者出现了血尿素氮和肌酐浓度升高等肾功能受损表现,而A、B两组则无此现象.结论:与甘露醇相比,高渗盐水无明显的肾毒性,可能更适合于缺血性脑梗死的治疗.     

小儿感染性休克的3项治疗问题

目的：观察超量扩容、快速脱水、早期强心３项措施在小儿感染性休克治疗中的疗效。方法：将９８例小儿感染性休克患儿按２∶１随机分为甲组６５例,乙组３３例,甲组以２∶１液（用０．９％盐水２份与１．４％碳酸氢钠１份组成）加５％碳酸氢钠及６％低分子右旋糖酐等大量快速扩容;以２０％甘露醇、速尿快速脱水,以西地兰、川芎嗪注射液早期强心治疗。乙组按感染性休克常规治疗,以２∶１液或６％低分子右旋糖酐１０～２０ｍｌ／ｋｇ快速扩容,仅在发现脑水肿指征时给脱水剂,在出现心力衰竭指征时给强心剂;２组抗生素、血管活性药、地塞米松及能量合剂等综合治疗措施完全相同。结果：甲组治愈率８７．６９％,乙组为６０．６１％（Ｐ＜０．０１）;甲组有尿时间（１．８７±１．０２）小时,血压恢复正常时间（１．８４±０．７９）小时,脉搏及心跳有力时间（１．９０±０．８１）小时,四肢转温时间（２．５１±０．３６）小时,均较乙组为快（Ｐ均＜０．０１）。结论：对小儿感染性休克采取的３项改进措施疗效明显。     

Dangers of a wrong diet in patients with renal insufficiency in the predialytic state or during chronic hemodialysis

Patients with chronic renal failure and on chronic intermittent hemodialysis have several metabolic risks such as retention of urea and other products of nitrogen metabolism, catabolism, acidosis, edema, dehydration, hyper- and hypotension, hyperkalemia, renal osteopathy, and renal anemia. Uremic coma is usually avoided by balanced nutritional therapy and treatment with hemodialysis. A dietary regimen containing protein with high amounts of essential amino acids is an important part of treatment. In patients on chronic hemodialysis disorders of protein and amino acid metabolism are caused by either deficiency of essential ingredients of the food or by the metabolic defects due to chronic uremia.     

Dehydration and fluid therapy

In the clinical setting, dehydration implies loss of both water and electrolytes. This is indeed what occurs in diarrhea, which is the most common cause of dehydration in children. The treatment of diarrhea is detailed first, followed by consideration of several less common conditions leading to dehydration in early infancy, including acute adrenal insufficiency and pyloric stenosis.     

Use of enterodes in the treatment of patients with food poisoning

The authors applied enterodes (a low-molecular colloid solution for enteral administration) in the treatment of 35 patients with food toxoinfections. In 25 patients, the use of enterodes had to be rejected owing to the progress of dehydration. Only 10 patients received enterodes in full. The clinical effect was attained only in one female patient with mild intoxication and with the lack of dehydration. In 9 patients, the effect turned out incomplete or was absent. The authors believe that enterodes cannot be used in the treatment of patients with food toxoinfections.     

小儿轮状病毒肠炎176例临床特点分析

目的提高对小儿轮状病毒肠炎的临床认识，为防治轮状病毒肠炎提供依据。方法对本院儿科2005年10月至2007年9月收治的急性轮状病毒肠炎176例进行回顾性分析。结果婴儿轮状病毒肠炎不同喂养方式的脱水程度比较，人工喂养组与母乳喂养组差异有极显著性（P〈0．01），与混合喂养组差异有统计学意义（P〈0．05）。0—12月组和13～24月组患儿脱水程度、代谢性酸中毒比较差异均有显著性（P〈0．05）。本文患儿等渗性脱水127例，低渗性脱水38例，高渗性脱水11例，轻度与中～重度脱水组发生低血钠的分别为14例（15．1％）、24例（28．9％），两组比较差异有统计学意义（P〈0．05）。结论母乳喂养可减轻婴幼儿轮状病毒肠炎的病情。婴儿脱水程度重，代谢性酸中毒的发病率高。轮状病毒肠炎以等渗性脱水为主，但是随着脱水程度的加重，低渗性脱水的发患者数明显增高。     

A Randomized Clinical Trial of Recombinant Human Hyaluronidase-Facilitated Subcutaneous Versus Intravenous Rehydration in Mild to Moderately Dehydrated Children in the Emergency Department

BackgroundAlternative treatment of dehydration is needed when intravenous (IV) or oral rehydration therapy fails. Subcutaneous (SC) hydration facilitated by recombinant human hyaluronidase offers an alternative treatment for dehydration. This clinical trial is the first to compare recombinant human hyaluronidase-facilitated SC (rHFSC) rehydration with standard IV rehydration for use in dehydrated children.ObjectiveThis Phase IV noninferiority trial evaluated whether rHFSC fluid administration can be given safely and effectively, with volumes similar to those delivered intravenously, to children who have mild to moderate dehydration.MethodsThe study included mild to moderately dehydrated children (Gorelick dehydration score) aged 1 month to 10 years. They were randomized to receive 20 mL/kg of isotonic fluids using rHFSC or IV therapy over 1 hour and then as needed until clinically rehydrated. The primary outcome was total volume of fluid administered (emergency department [ED] plus inpatient hospitalization). Secondary outcomes included mean volume infused in the ED alone, postinfusion dehydration scores and weight changes, line placement success and time, safety, and provider and parent/guardian questionnaire.Results148 patients (mean age, 2.3 [1.91] years]; white, 53.4%; black, 31.8%) were enrolled in the intention-to-treat population (73 rHFSC; 75 IV). The primary outcome, mean total volume infused, was 365.0 (324.6) mL in the rHFSC group over 3.1 hours versus 455.8 (597.4) mL in the IV group over 6.6 hours (P = 0.51). The secondary outcome of mean volume infused in the ED alone was 334.3 (226.40) mL in the rHFSC group versus 299.6 (252.33) mL in the IV group (P = 0.03). Dehydration scores and weight changes postinfusion were similar. Successful line placement occurred in all 73 rHFSC-treated patients and 59 of 75 (78.7%) IV-treated patients (P < 0.0001). All IV failures occurred in patients aged <3 years; rHFSC rescue was successful in all patients in whom it was attempted. Both treatments were well tolerated. Clinicians rated fluid administration as easy to perform in 94.5% (69 of 73) of the rHFSC group versus 65.3% (49 of 75) of the IV group (P < 0.001). Parents/caregivers were satisfied or very satisfied with fluid administration in 94.5% (69 of 73) of rHFSC-treated patients and 73.3% (55 of 75) of IV-treated patients.ConclusionsIn mild to moderately dehydrated children, rHFSC was inferior to IV hydration for the primary outcome measure. However, rHFSC was noninferior in the ED phase of hydration. Additional benefits of rHFSC included time and success of line placement, ease of use, and satisfaction. SC hydration facilitated with recombinant human hyaluronidase represents a reasonable addition to the treatment options for children who have mild to moderate dehydration, especially those with difficult IV access. ClinicalTrials.gov identifier: NCT00773175.     

额颞对冲性脑损伤并迟发血肿的临床特点及救治措施

目的总结分析额颞部对冲性脑损伤并迟发血肿的临床特点及探讨有效的救治措施。方法对29例额颞颞对冲性脑损伤并迟发血肿患者,采用标准外伤大骨瓣开颅术,术后均入神经外科重症监护,并给予保持呼吸道通畅、脱水、护脑、对症、支持、防治并发症等治疗。结果存活21例,其中良好13例,中残4例,重残4例,死亡8例。结论额颞部对冲性脑损伤并迟发血肿是一种较为危重、复杂的颅脑损伤,及时行标准大骨瓣减压术是救治成功的有效措施。     

桂苓脑路通颗粒联合常规疗法治疗脾虚水停证型继发性脑积水的效果

目的观察桂苓脑路通颗粒联合常规疗法治疗脾虚水停证型继发性脑积水的效果。方法选择2018年1月至2019年11月我院收治的继发性脑积水患者62例,采用查阅随机数字表法将其分为对照组及治疗组,每组31例。两组均给予营养神经、改善循环、静滴甘露醇脱水降颅压、针灸、推拿等常规治疗,在此基础上,对照组给予乙酰唑胺片,治疗组给予桂苓脑路通颗粒。比较两组的治疗效果。结果治疗后,两组患者的NIHSS评分均降低,BI评分均升高,且治疗组优于对照组(P<0.05)。在中医整体临床症状疗效方面,治疗组的总有效率为90.32%,高于对照组的77.42%(P<0.05)。治疗组的治疗总有效率显著高于对照组(P<0.05)。结论桂苓脑路通颗粒联合常规疗法治疗脾虚水停证型继发性脑积水的效果满意。     

Cerebral venous sinus thrombosis.

Cerebral venous sinus thrombosis (CVST) is a rare and potentially deadly condition. Common etiologies include hypercoagulable diseases, low flow states, dehydration, adjacent infectious processes, oral contraceptives, hormonal replacement therapy, pregnancy, and puerperium. Symptoms include nausea, seizures, severe focal neurological deficits, coma, and headache (the most common presenting symptom). Anticoagulation is the mainstay of treatment for CVST. Transvenous clot lysis can be performed using injected thrombolytic agents and specialized catheters for clot retrieval.