Towards a better oral rehydration fluid

Improvements in characteristics of solutions used for oral rehydration therapy, to provide significant reductions in amount and duration of diarrhea, are expected to contribute to wider use of these fluids. Recent studies suggest that these may come about from reducing the osmolality of the solution, and by providing short chain fatty acids for better fluid absorption from the colon. This article briefly reviews the physiology of intestinal and colonic absorption in diarrhea, and indicates the further studies that are needed to translate the above advances into universal practice for the treatment of diarrhea.     

Management of meningitis in children with oral fluid restriction or intravenous fluid at maintenance volumes: a randomised trial

A multi-centre randomised open trial was done to determine whether moderate oral fluid restriction or intravenous fluid at full maintenance volumes would result in a better outcome for children with bacterial meningitis in Papua New Guinea, and what clinical signs could guide fluid management. Children with clinical signs and cerebrospinal fluid suggestive of bacterial meningitis received either breast milk by nasogastric tube at 60% of normal maintenance volumes (n = 172) or intravenous half-normal saline and 5% dextrose at 100% of normal maintenance volumes (n = 174) for the 1st 48 hrs of treatment. An adverse outcome was death or severe neurological sequelae, and a good outcome was defined as intact survival or survival with at worst mild-to-moderate neurological sequelae. The probability of an adverse outcome was 24.7% in the intravenous group and 33.1% in the oral-restricted group, but the difference was not statistically significant (RR 0.75, 0.53-1.04, p = 0.08). Sunken eyes or reduced skin turgor at presentation were risk factors for an adverse outcome (OR 5.70, 95% CI 2.87-11.29) and were most strongly associated with adverse outcome in the fluid-restricted group. Eyelid oedema during treatment was also a risk factor for an adverse outcome (OR 2.54, 95% CI 1.36-4.75) and eyelid oedema was much more common in the intravenous group (26%) than in the restricted group (5%). For many children with bacterial meningitis in less developed countries, moderate fluid restriction is unnecessary and will be harmful; a normal state of hydration should be achieved but over-hydration should be avoided. Giving 100% of normal maintenance fluids, especially with intravenous hypotonic fluid, will lead to oedema in up to one quarter of children with bacterial meningitis. If additional intravenous fluids are required for children with meningitis, an isotonic solution should be used.     

Single dose tetanus toxoid—a review of trials in India with special reference to control of tetanus neonatorum

The article reviews trials done in India during last 20 years on the antibody response to a single dose of tetanus toxoid in adults. It appears from the review that a single dose of tetanus toxoid seems to produce antibody response. The response is more related to the dose of antigen. The most interesting observation is in relation to the existence of natural antibodies in our population.     

Generalized tetanus in a teenager]

Tetanus has become an exceptional disease in industrialized countries since vaccination. CASE REPORT: We report a case of generalized tetanus in a young teenager, with a healthy outcome, but requiring long intensive care support. CONCLUSION: Tetanus mortality has decreased, but its morbidity is still severe. The only way to prevent it is vaccination. Almost all pediatric cases concern patients living in families refusing vaccination, because of philosophic or religious beliefs.     

Neonatal tetanus in a military hospital

Summary A clinical analysis of ten cases of neonatal tetanus treated at the Command Hospital, Central Command, Lucknow (U.P.), during a period of three years is presented. All the cases except one were delivered at home. All the neonates were full term and weighed over 2,500 G. at the time of admission. The onset of symptoms varied from the fourth to thirteenth day of birth. The diagnosis was based on clinical data. Umbilical sepsis was found in eight cases; the cord swab grew pyogenic organisms butCl. tetani were not grown. The management of all the cases was uniform throughout the period of study. Antitetanus serum (ATS) was given in one single dose on admission. Appropriate doses of sedatives and muscle relaxants were used in all the cases. Their use was judicious and adjusted as required. The survival rate of the series is 70%. From the Departments of Pediatrics and Medicine Command Hospital (CC), Lucknow.     

Intrathecal serotherapy in neonatal tetanus: a controlled trial.

60 infants with neonatal tetanus were treated at random either by 40 000 units of equine tetanus antitoxin (TAT), intravenously and intramuscularly, or by 40 000 units TAT, IV and IM, plus 150 units of human tetanus immune globulin TIG) intrathecally. There were 30 infants in each treatment group. Babies were similar in age, sex, weight, incubation period, temperature, and signs and symptoms on arrival at the hospital. The mortality rate, days in hospital and days of sedation were not significantly different in the two groups.     

Intrathecal tetanus immunoglobulins in the management of tetanus

Objective To study the clinical profile, treatment and outcome of tetanus in children treated with intrathecal tetanus immunoglobulin. (TIG) Methods Retrospective analysis of hospital records of tetaus cases admitted to the pediatric ICU during the five year period between 1999 to 2004 was done. Results There were 66 cases of tetanus treated with intrathecal TIG. Children below 5 years formed 53% of cases and 47% were above 5 years. Totally unimmunized children constituted 82% of cases and 18% partially immunized children. The portal of entry was otogenic in 58% of cases and injury in 30% of cases. The common complications observed included thrombophlebitis, aspiration pneumonia, laryngospasm and autonomic system involvement. There were no complications specific to intrathecal administration of TIG. The mortality due to tetanus was 9%. Discussion Mortality and morbidity due to tetanus was less in the present study compared to other centers where TIG is given intramuscularly. Conclusion Intrathecal TIG is effective in the treatment of mild and moderate tetanus. Randomized controlled clinical trials are needed to evaluate the efficacy of intrathecal TIG in the management of severe tetanus.