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Query: UMLS:C0011991 (diarrhea)
 57,543 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A discussion of causes, diagnosis, and treatment of childhood diarrhea is presented. If the pH of the stomach is not acidic enough, harmful bacteria may not be killed. If peristaltic action is not regular, defense against intestinal diseases is hindered. The proper bacteria and immunologlobulin (with secretory piece and J-chain) must be present in the intestine to prevent infection. Loss of large volumes of fluid is one clinical symptom of diarrhea. The changes in water volume can cause changes in the osmolarity of other body fluids, which can lead to fluid loss in other organs or increase in brain pressure. Acidosis can also accompany diarrhea, as can intracellular losses of potassium and other ions. Laboratory tests of the blood for hemoglobulin, hematocrit, and electrolyte levels can aid in the diagnosis of the cause of infantile diarrhea. The feces can be tested for leukocytes, erythrocytes, and pH value. Absence of leukocytes can indicate an enterotoxic or viral diarrhea; antibiotics are contraindicated. Determinations of E. coli and enterotoxins as well as immunoglobulin tests do not provide relevant information. Treatment can be effected by oral glucose-electrolyte therapy. In more severe cases, i.v. infusions of salt, plasma, salt-free albumin, or whole blood may be indicated. Medications such as ampicillin and clindamycin have been used to treat diarrhea, but any medication which inhibits peristaltic action is contraindicated in children.
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PMID:[Past and present aspects of diarrheal disease in childhood. Clinical study and treatment (author's transl)]. 0 46

The study of the equilibrium of the main electrolytes (Na+, K+, Cl-), in plasma and intestinal content and the evolution of the partial plasma (Na+, K+, Cl-) in the young rabbit suffering from diarrhoea revealed disturbances of the mineral metabolism. Mineral losses were lower in sick animals than in controls. When the reduction of ingested matter was taken into account, the ion balance showed a deficit. The apparent coefficient of digestive utlization (aCDU) of the electrolytes Na+ and K+ dropped, although the reabsorption of these ions in the last segments of the digestive tract was generally good. The pH remained normal and the proteinaemia fell, suggesting a haemodilution. This was backed up by the presence of a hyponatraemia and a hypochloraemia, but did not account for the large drop in kaliemia. On the other hand, the plasma osmotic pressure increased, very probably in association with a high uraemia. It would therefore seem that the pathogenesis of diarrhoea in the young rabbit differed from that of other known examples, such as diarrhoea in the calf and in the infant. In the young rabbit, the pathogenesis of diarrhoea resulting from coccidiosis would seem to be, as much a result of a nutritional deficiency in particular of potassium, as of a malfunctioning of the digestive tract.
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PMID:Changes in hydromineral metabolism in diarrhoeic rabbits. 2. Study of the modifications of electrolyte metabolism. 3 84

The faecal output of chloride, sodium and potassium was studied in 14 patients with active idiopathic proctocolitis, in an attempt to establish a relationship between faecal electrolyte output and acid-base balance data. 7 patients with ileostomy and 8 healthy volunteers were used as controls. The daily faecal excretion of chloride and sodium in proctocolitis was significantly in excess of normal, whereas that of potassium was within the normal range. From the comparison with the results in patients with ileostomy it is concluded that colitic colon has an impaired capacity to absorb chloride and sodium but retains the ability to secrete potassium. The intestinal loss of chloride in addition to that of sodium and water may be regarded as a salt-losing diarrhoea and may account for the metabolic alkalosis commonly found in proctocolitis.
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PMID:Salt-losing diarrhoea in idiopathic proctocolitis. 3 30

The use of sucrose in oral rehydration therapy solutions in place of glucose was tested in 18 patients, 17 males and 1 female, admitted for treatment of severe dehydration due to diarrhea and vomiting. 13 of these patients were positive for cholera (1 with untyped vibrio), whereas 4 others cultured no recognizable pathogen. Patients received an average 1100 ml of intravenous fluids to keep the intravenous drip open during the oral therapy period, and the intravenous therapy was stopped or slowed during oral (or nasogastric) therapy. Average patient age was 32 years. Oral solutions contained either 48 or 38 gm of sucrose per liter plus (in all solutions) sodium chloride (4.2 gm/liter), sodium bicarbonate (2 gm/liter), and potassium citrate (2.7 gm/liter). Of the 18 patients, 15 could be maintained using this solution, but 3 developed massive increases in net fluid losses with increases in plasma specific gravity, which necessitated terminating the therapy. In these failure cases, plasma specific gravity increased over 1.031. Stool samples of 12 patients tested were found to contain reducing sugar: prehydrolysis 436 mg/100 ml, posthydrolysis 957 mg/100 ml. The breakdown of sucrose by intestinal enzymes or by bacteria accounts for the presence of reducing sugar in the stool. These data contrast with the rarity of treatment failures of oral glucose therapy; therefore, glucose is the preferable component in oral rehydration electrolyte solution therapy.
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PMID:Sucrose in oral therapy for cholera and related diarrhoeas. 4 61

Inaccurate measurements when damp or crude ingredients are used for oral glucose-electrolyte solutions for diarrhea treatment are described by Melamed and Segall who suggest that the advantages of spoons may have been overestimated. Spoons also require a delivery system which must reach those at risk but only packets deliver an effective "payload" of ingredients. Some spoons are designed for sugar and salt only, but omission of bicarbonate results in prolonged acidosis in patients receiving the sugar-salt alone because of uncorrected loss of stool bicarbonate. Crystallized sugar plus salt also is lacking in potassium and carries the risk of hypokalemia. Crude sugar may contain potassium, but the concentration would vary greatly. Local crude ingredients are also subject to adulteration, deliquescence, and unwanted natural contaminants. Although other spoons allow for bicarbonate and potassium, the "recipes" ignore the need for a standard-volume container for water, in which the ingredients can be mixed in the required exact volume. A cheap soft plastic bag, with the 1 litre level indicated by a black line, could be distributed with oralyte-type packets of ingredients sufficient to make 1 litre of oral solution (or with spoons), together with instructions to fill with water to the litre mark before adding and mixing the ingredients. Bags can be locally made. Such bags add little to the cost of packets or spoons alone and would help to ensure that water volume is accurately measured.
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PMID:A spoonful of sugar... 7 56

83 in-patients, age 3 months to 12 years, with tonsillitis, otitis, bronchitis and pneumonia were treated with a new galenic preparation of phenoxymethylpenicillin V potassium (Star-Pen Trockensirus SANABO). The drug was very well tolerated, no skin-rash was observed, no problems occurred with the oral administration. Diarrhea, not infrequent in oral penicillin therapy, was -- with one exception -- not noticed in patients above one year of age.
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PMID:[Therapy of bacterial infections in infancy and childhood (author's transl)]. 11 4

Verner and Morrison, in 1958, reported non-insulin-secreting tumours of the pancreas that were associated with a syndrome of refractory diarrhea, achlorhydria and hypokalemia. Surgical resection of such tumours results in rebound acid hypersecretion and cessation of the watery diarrhea. The authors report the case of an 84-year-old man who had three of the four major criteria for diagnosis of the Verner Morrison syndrome. Hypokalemia was absent, but this was possibly due to the large doses of potassium chloride that he was taking in conjunction with diuretics. After resection of the tumour severe obstipation with resultant bowel obstruction developed in addition to rebound hypersecretion and relief of watery diarrhea. Treatment, consisting of bulk laxatives in appropriate amounts, alleviated the obstipation.
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PMID:Recurrent obstipation as a complication of partial pancreatectomy for non-beta cell adenoma of the pancreas. 22 19

In nine critically ill newborns, five of them with intractable diarrhea and four surgical patients, we administered a 5% crystalline aminoacids solution (AA) and glucose in sufficient amount to provide 120 cal times kg. in 24 hours. Six of them recovered after receiving parenteral alimentation for 3 to 15 days, gained weight during or after treatment and were discharged from the hospital in good conditions. Three died, one of them presented septicemia and two pneumonia and pulmonary infarcts. The solution used generated few metabolic alterations, the acid-base status remained within normal range and there were not important changes in the sodium and potassium serum concentrations. On the contrary, children with hyponatremia and hypokalemia at the beginning of the treatment, normalized these constants within the first hours, as diarrhea ceased. The most frequent complications were infiltrations and reaction of the surrounding tissue of the catheterized vein and local skin infection. Only one patient died of septicemia, possibly caused by this proceeding. In summary, parenteral alimentation though not free from risk, seems to be a useful proceeding when oral feeding is impossible or inadvisable. The utmost danger is septicemia. Metabolic changes are minimal and they do not mean a risk for child's life; nevertheless, there is a need for long term studies to bring up definite conclusions. The solutions in actual use are probably not the most physiological for the newborn. It is necessary to adequate them according to the new advances made on child nourishment during his first days of life.
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PMID:[Parenteral nutrition in critically ill newborns]. 23 14

Children repeatedly admitted to a Jamaican clinic with gastroenteritis associated with protein-energy-malnutrition (PEM) were treated by oral glucose-electrolyte rehydration. Children were fed other food from the outset if they so requested. The solution was administer by cup and spoon, i.e., small amounts vs. bottle administration, frequently throughout the day and night. A simple solution, very inexpensive, is outlined and includes a 3-finger pinch of salt, a 3-finger pinch of sodium bicarbonate, and 2 teaspoons of potassium chloride dissolved in 100 cu. cm of water. In all, 16 children suffering from sporadic, unspecific diarrhea over a period of 9 months showed marked improvement of the condition within 1-2 days of cup and spoon rehydration.
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PMID:Cup and spoon rehydration of children with acute diarrhoea. 24 5

In order to minimize interaction of sorbents with food and digestive secretions, an intestinal bypass was created for sorbent administration in normal and uremic rats (N = 18) and goats (N = 5). Two separate limbs of small intestine were fashioned, one for food absorption and one for sorbent function, which joined at a Roux-Y anastomosis before the cecum. Particulate sorbent suspensions were injected into the intestine via a cutaneous stoma, and were excreted with food wastes in the feces. In animals with normal kidneys, sorbent function was calculated from changes in fecal and urinary excretion. Nitrogen clearance by the intestinal bypass was 20 to 40% of normal renal clearance in rats and goats. Potassium clearance was 40% of normal renal clearance in rats, and over 100% in goats. Sorbent treatment in anephric animals caused serum urea nitrogen concentrations to stabilize at 210 mg/dl in rats, and 110 mg/dl in goats. Serum potassium concentrations stabilized at 4.5 mEq/liter in rats, and fell to 2 mEq/liter in goats. Water balance was maintained by producing a mild osmotic diarrhea. At least three substances which accumulate in renal failure--urea, potassium, and water--were removed in therapeutically significant amounts.
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PMID:Roux-Y intestinal bypass for administration of sorbents in uremia. 27 84


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