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Query: UMLS:C0017160 (gastroenteritis)
 11,398 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Of 1045 children admitted with gastroenteritis over a 12-month period and studied retrospectively, serum sodium level was tested in 802. Sixty patients (7.5%) had hypernatremic dehydration (HD). The peak incidence of HD, the highest serum sodium levels, and the worst outcome were all encountered in infants under the age of 3 months. An association with pre-admission high solute feeding was less obvious. Pre-admission volume intake could not be evaluated. There was no association of HD with the etiological pathogen or climatic conditions. The weight-for-age was below the fifth percentile in 21 patients (35%). One patient (1.7%) died, another (1.7%) developed peripheral gangrene, and four (6.7%) were left with significant neurologic complications. All of these patients were under the age of 4 months. In this subtropical country, the most important risk factor for the development of hypernatremia in the course of gastroenteritis is the young age. Environmental risk factors do not seem to play a significant role.
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PMID:Hypernatremic dehydration in infants with gastroenteritis. 670 30

During the 5-year period 1973--77 there was a considerable change in infant feeding practice (the use of low solute cows' milk formulae instead of high solute formulae and the later introduction of solid foods into the diet) which should have led to a reduced incidence of hypernatraemia among infants admitted to hospital with gastroenteritis. We have compared the incidence of hypernatraemia in such infants admitted during three 12-month periods between January 1973 and December 1977. Our results show there was such a reduction; they also show that hypernatraemia did not occur in infants fed a low solute milk formula alone.
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PMID:Decline of hypernatraemia as a problem in gastroenteritis. 718 56

Electrolyte disturbances and response to oral electrolyte therapy were studied in 88 children with mild to moderate dehydration due to acute gastroenteritis. A solution with a sodium concentration of 50 mmol/litre was tested in a group of 60 children and results obtained with those in a group of 28 children taking a standard oral solution with a concentration of 90 mmol/litre. Adequate hydration was accomplished in both groups and none of them received intravenous fluids. Neither group received additional water or other fluid in the first 24 hours. There was a significant rise in sodium concentration with both solutions and none of the children developed hypernatraemia. A significant rise in potassium is observed in children with clinical kwashiorkor when hydrated with the low sodium solution.
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PMID:Oral rehydration for diarrhoeal diseases in children. 732 31

The major disorder of water and electrolyte metabolism in children is dehydrating diarrhea. The major advance in the treatment of this condition has been the development of oral rehydration therapy, ie, the enteral administration of a balanced glucose-electrolyte solution. This therapy is effective in patients of all ages, dehydration of all degrees short of hypovolemic shock, with gastroenteritis of all causes, and electrolyte disturbances including hypo- and hypernatremia. This review highlights current experimental and clinical studies that have focused on oral rehydration solutions that have the additional benefit of reducing the severity and duration of diarrheal disease. Recent results have been conflicting, however, and the search for the optimal solution continues.
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PMID:Fluid and electrolyte therapy for children. 806 39

Non-typhoid salmonellosis remains a common infective illness. We studied 77 consecutively admitted children aged 1 month to 15 years in order to determine frequency of antecedents, the strain of the isolated organisms, clinical findings, frequency of complications and the adequacy of management. The presentation and severity of the illness were compared between younger than two and older children. Salmonella typhimurium was isolated in 65% of the cases. Two thirds of the tested strains were multiresistant to antibiotics. Non-typhoid salmonellosis usually occurred in the form of acute gastroenteritis: in only 4% of the cases it presented as pyrexia of unknown origin without gastrointestinal symptoms. 30% of the cases had been exposed to one or more antimicrobial agents within four weeks before the date of their stool culture. Only 30% had been breast fed. Previously diagnosed cow's milk protein intolerance resulted to be present in 14% of the less than two years old children (p < 0.02). Abdominal pain and headache were found more frequently in older children (p < 0.02). Protein C reactive values were significantly higher in this age group (p < 0.05). 25% of the children were mildly or moderately dehydrated. Hypernatremia was uncommon. 31% of the cases were treated with antibiotics: the antimicrobial treated children presented diarrhoea for longer period (p < 0.05) and they remained admitted for longer time (p < 0.00).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Clinico-epidemiological observations of 77 pediatric cases of infection with non-typhi salmonellae]. 807 87

The decrease of morbidity-mortality caused by gastroenteritis is in relation to the factors largely responsible for the fall in infant mortality and mortality from communicable diseases in developing countries. Nevertheless, diarrhea is still a considerable public health problem in these countries, especially among children under 5 years old. 98% of all deaths in children younger than 15 years are in the developing world. Five of the ten leading killers are communicable, perinatal, and nutritional disorders largely affecting children. The knowledge of the etiology and epidemiology of childhood diarrhea in a given area is needed to plan any measure designed to prevent or ameliorate diarrheal illness and to develop practical guidelines for the most appropriate examination procedures. In Romania, although the real data of morbidity by acute diarrhea are not known, the reports show a significant decrease in the past 10 years. In 1993, 420.2 cases at 100,000 inhabitants were reported, the most commonly affected being the children age 0-4 years. The incidence decreased to 338.5 cases at 100,000 inhabitants in 1997 (and a quite similar incidence for the first 11 month of 1998). Between 1993-1998, 527,977 cases were reported (58.1% in urban area), with a higher frequency in spring-autumn season. Antibiotics are not required in case of acute diarrhea with little or no fever. Antibiotics could be discussed for cholera-like diarrhea and are required in case of invasive bacterial diarrhea, shigellosis, cholera, and Clostridium difficile as well as diarrhea with fever and sanguinolent stools in infants or salmonella-induced diarrhea with signs of extradigestive complications. Importance of oral rehydration solution in the treatment of diarrhoeal diseases is well known. It can be applied to all types of diarrhoea, practically, without any side effects, complications, such aas hypernatraemia is avoidable. It has proved to be effective for dehydration caused by diarrhoea and for diarrhoea, too. There is a need for effective infection control policies, which include appropriate training of staff; simple surveillance systems and readily available expert advice to ensure that outbreaks are rapidly controlled. Approaches to prevention include education about risk factors, which often fails to lead to modification of risky behavior. Further regional epidemiological studies are necessary to develop more appropriate management guidelines.
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PMID:[Acute infectious diarrheal disease in Romania: 1993-1998]. 1042 19

In a clinical prospective 3-year study of 158 children aged 2 weeks to 14 years with hypernatraemic dehydration (serum sodium 150 mmol/l or more), infants predominated (61.4%). The 158 children with hypernatraemia accounted for 13.7% of all children admitted with gastroenteritis over the same period, and significant aetiological factors included the use of artificial feeds, differences between the children with hypernatraemia and those with normo- or hyponatraemia, P < 0.001, P < 0.001, respectively; the use of breast milk, P < 0.001, P < 0.001, respectively; nutritional status, P < 0.001, P < 0.001, respectively; and clinical state of mild to moderate dehydration P < 0.001; P < 0.001, respectively; but not with patients considered severely dehydrated. There was also a significant difference between the presence of neurological features in hyper- and normonatraemic patients P < 0.001; in hyper- and hyponatraemic patients P < 0.05, and in mortality rate between hyper- and normonatraemic patients, P < 0.05 but not between hyper- and hyponatraemic patients. A history of refusal to feed or vomiting was obtained in 41 children (25.9%). The mean serum sodium was 155.5 mmol/l (range 150-189 mmol/l); mean serum urea 7.7 mmol/l (range 1-18.9 mmol/l). Hypernatraemic dehydration remains an important and serious complication of childhood gastroenteritis in our area of study. The use of artificial milk feeds is contributory, and well-nourished babies appear more at risk. We recommend more liberal water intake during gastroenteritis and the public should also be educated on and made more aware of this condition.
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PMID:A prospective clinical study of patients with hypernatraemic dehydration. 1045 91

Elevated levels of sodium that may be detected in the analysis of post-mortem fluid samples may arise from a wide variety of organic illnesses and environmental factors that have caused either water depletion or solute gain. When hypernatraemia is suspected at autopsy a careful history is required with particular emphasis on pre-existing medical conditions such as renal or gastrointestinal disease. In addition, detailed information is required on the circumstances of death, including any clinical symptoms and signs that the deceased may have manifested, or medical procedures such as dialysis, colonoscopy or intravenous fluid replacement. Reduced intake of fluid may be associated with cognitive or physical impairment or may result from environmental depletion (the latter may be a manifestation of inflicted injury). Both central and nephrogenic diabetes insipidus may result in the loss of excessive amounts of hypotonic fluid. This may also occur following diuretic use, or be due to gastroenteritis or burns. Hypernatraemia may be a marker of excessive salt/saline ingestion and/or administration and may occur accidentally or as a manifestation of child abuse. Given the range of possible etiologies, hypernatraemia may be a significant autopsy finding that requires explanation.
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PMID:The potential significance of elevated vitreous sodium levels at autopsy. 1978 11

Rhabdomyolysis is a life-threatening condition that involves muscle cell destruction. Among its etiologies, severe hypernatremia is a less common cause. We report a teenage girl with congenital central hypoventilation syndrome and hypothalamus dysfunction syndrome who presented with extreme hypernatremia (sodium, 211 mmol/L) with rhabdomyolysis (creatine kinase, 32,850 U/L) and acute renal failure (creatinine, 6.1 mg/dL) following gastroenteritis with 7-kg weight loss. Rhabdomyolysis subsequently led to acute renal failure and hyperkalemia. Acute hemodialysis was initiated on hospital day 3 for hyperkalemia. This resulted in a 13 mmol/L fall in serum sodium in 3 hours despite using a 156 mmol/L sodium bath, but without the development of cerebral edema or neurological defect. This report highlights an unusual cause of rhabdomyolysis in children and the experience of managing such a difficult clinical situation.
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PMID:Extreme hypernatremia combined with rhabdomyolysis and acute renal failure. 1983 53

The objective of this study is to review the presentation, outcome and aetiology of central pontine and extrapontine myelinolysis (CPEPM) in a tertiary hospital center. The study method is a case series and included identification of patients from University of Montreal Health Centre archives database (1995-2007). All diagnoses were confirmed by neuroimaging or brain autopsy. Twelve individuals (25-66 years old) presented heterogeneous manifestations. Co-morbidities included diabetes insipidus (n = 2), haemodialysis (n = 1), cirrhosis (n = 3), gastroenteritis (n = 2) and potomania (n = 1). Aetiologies included rapid correction of severe hyponatremia (n = 6)/acute hypernatremia (n = 1); immediate (n = 2) or remote (n = 1 with recurrent cirrhosis) orthotopic liver transplantation (OLT) with tacrolimus-induced immunosuppression (n = 3); and chronic alcoholism (n = 4, two with hyponatremia). Four individuals died acutely. Two were lost to follow-up. Six had good motor or cerebellar recovery. Neuropsychological evaluations (n = 5/6) revealed a subcortical/frontal dysfunction. Cognitive impairment represented the major remaining lasting sequel (n = 4). Three salient clinical syndromes were observed: (1) predominant cerebellar presentation in individuals with alcoholism (n = 4); (2) significant alteration of consciousness at presentation (n = 4), all resulting in death (OLT, n = 3); (3) seizures persisting after natremia correction (n = 2). Clinical presentation of CPEPM is heterogeneous and can even include seizures. Cognitive impairment should be screened as it is a significant factor limiting return to normal life.
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PMID:Central pontine and extrapontine myelinolysis: from epileptic and other manifestations to cognitive prognosis. 2014 34


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