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 31,883 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

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

Based on positive results in laboratory animals, chlorpromazine was given a clinical trial in humans to determine if it could reduce fluid losses during cholera. In animals, the chlorpromazine inhibited cholera toxin-stimulated intestinal adenylate cyclase and fluid secretion. Therefore, 11 cholera patients suffering severe diarrhea (360-1340 ml/hour) and vomiting were given either intramuscular chlorpromazine (1 mg/kg or 4 mg/kg) (n=8) or oral chlorpromazine of the same dose (1 mg/kg) (n=3). Overall reduction in stool output of 66% in the treated patients was evident after 32 hours of treatment. The decrease in treated patients was significantly greater than the reduction in nontreated patients (26%) during the same 32-hour course of illness. Patients' comfort was also enhanced by the decrease in nausea and mild sedative qualities of chlorpromazine, and no hypotension was observed in these well-hydrated patients.
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PMID:Chlorpromazine reduces fluid-loss in cholera. 8 63

The most important part of treatment of watery diarrhea is hydration. An oral glucose electrolyte solution is often used in place of intravenous therapy in diarrheal diseases caused by Vibrio cholerae, enterotoxigenic E. coli, and undiagnosed watery diarrheal diseases. In cholera and enterotoxigenic E. coli diarrhea, sucrose can be used in place of glucose, as sucrose can be hydrolized to fructose and glucose by intestinal dissacharidases, and it is also more readily available and cheaper than glucose. In a randomized double-blind trial of 57 male children (aged 5 months to 2 1/2 years) with rotavirus diarrhea, 28 were rehydrated with sucrose electrolyte solution and 29 were given glucose solution. The children were compared with 44 children, also with rotavirus diarrhea but treated only with intravenous hydration. There were no significant differences in the rate of rehydration or rate of purging between the 2 groups. Vomiting was not a factor in administering oral therapy during hospital admission. Patients with rotavirus infection may have defects of absorption and digestion of carbohydrates but such abnormalities should not prevent the use of sugar-electrolyte oral solution for hydration. Rotavirus infection is one of the most common causes of infantile diarrhea which necessitates hospital treatment. Either glucose or sucrose can be used in the solution, and this fact is especially important in developing countries where medical supplies are limited.
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PMID:Oral hydration rotavirus diarrhoea: a double blind comparison of sucrose with glucose electrolyte solution. 20 63

To determine the role of Escherichia coli heat-stable enterotoxin (ST) as a virulence factor in human diarrhea, a strain that elaborates only ST (E. coli 214-4) was fed to free-living volunteers in doses of 10(6), 10(8), and 10(10) organisms. Short-lived (1 day) mild illness consisting of abdominal cramps with vomiting or diarrhea occurred in three of five individuals fed 10(8). Typical travelers' diarrhea (loose stools, abdominal cramps, and low-grade fever for 2 to 3 days) was seen in four of five volunteers given 10(10); two had brief cholera-like purging of rice-water stools. Despite fever, there was no evidence of mucosal invasion. E. coli 214-4 became the predominant coliform in stools; coproculture isolates were uniformly negative for heat-labile enterotoxin (LT), whereas most produced ST. Ten of 13 individuals developed rises in antibody to somatic E. coli antigen, and none had rises in LT antitoxin. E. coli that elaborate only ST can cause diarrheal disease in adults.
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PMID:Diarrhea caused by Escherichia coli that produce only heat-stable enterotoxin. 32 97

Under the circumstances of limited health resources and immediate need for preventing the dehydration associated with diarrhea in infants, breastfeeding should be encouraged throughout the diarrheal episode. When this is not possible because of cessation or failure of lactation, an oral electrolyte solution should be administered. It should be sterile and provide a quantity of electrolytes not greatly in excess of 30 mEq/liter of sodium and potassium. There should be little possibility of an error in the dilution of the mixture if it is to be supplied in powdered form. Milk should be reintroduced after 24 hours and the electrolyte mix rapidly discontinued so as to minimize nutritional deficits. If no such electrolyte mixture is available, it is reasonable to alternate feedings of commercial soft drinks or bland teas with milk feedings. There should be specific instructions that the infant should be brought to the hydration center if more than 3 sequential feedings are lost by vomiting, if fever is present, or it the stools exceed the volume of 3 feedings. In general, dehydration of less than 5% of body weight can be managed by this program in the house, dehydration greater than 5% but less than 10% requires supervision by health authorities, and dehydration greater than 10% requires intravenous therapy in a hydration center. In those countries with cholera and during epidemics of shigellosis or enterotoxigenic Escherichia coli, solutions containing 90 mEq/liter of sodium should be given under ambulatory supervision. This solution should be discontinued when fecal losses moderate (less than 60 ml/kg/day) and the lower electrolyte solution (30 mEq/liter) substituted.
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PMID:A critique of oral therapy of dehydration due to diarrheal syndromes. 33 34

"Travelers' diarrhea" is an acute diarrhea sometimes associated with vomiting and afflicting travelers recently arrived in tropical or subtropical countries. Its incidence ranges from 20 to 50 p. 100. It may cause severe deshydratation which is dangerous for third age tourists with humoral or visceral impairments. Recovery must not be expected before 3 to 10 days. Viruses do not seem frequently responsible and, among other causes (salmonellae, shigellae, staphylococci), colibacilli have a main role. They give cholera-like syndromes due to two enterotoxines. Treatment is symptomatic. Prophylaxis is important and chemical drugs as methyl-5-oxine must be prescribed rather than antibiotics which may induce resistances.
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PMID:[Travelers' diarrhea (author's transl)]. 39 5

In an attempt to obviate the need for intravenous fluids by preventing dehydration, 57 adult volunteers who experienced induced clinical cholera during a vaccine development programme were treated from the onset of diarrhoea with oral glucose-electrolytes therapy. 44 individuals with mild to moderately profuse diarrhoea (less than 8 L. total volume) were maintained in normal water and electrolyte balance with oral therapy alone. 13 individuals with severe diarrhoea (greater than 8 L. total volume) could not be maintained in balance with oral therapy alone, due chiefly to emesis during the first day of illness. Emesis occurred in the absence of significant dehydration or acidosis. Since emesis precludes effective early oral therapy in severe cases, domiciliary oral therapy is unlikely to eliminate cholera mortality. Rural diarrhoea treatment centres using oral therapy with limited amounts of intravenous fluids when needed, could reduce case fatality from cholera and related diarrhoeas virtually to zero with least expense.
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PMID:The problem of emesis during oral glucose-electrolytes therapy given from the onset of severe cholera. 44 66

Agglutinating and vibriocidal antibody titers anti-V. cholerae of the serotypes Ogawa and Inaba, were determined in sera from 189 patients with cholera-like diarrheas during the epidemic of cholera occurred in August-September 1973, in Bari. Antibodies were determined in 74,2% of 70 patients, whose in the faeces and vomiting were isolated strains identified as V. cholerae, biotype El Tor, serotype Ogawa. This frequency was higher against the serotype Ogawa. The antibodies could be proved very early, 4-6 days from the beginning of symptomatology, but they disappeared as rapidly; really, at 2.3 months antibodies were determined in 7,7% only of the above mentioned subjects. As regards the other 119 patients with non-vibrio, cholera-like diarrheas, antibodies were determined in 28 subjects only; 27 of these has received cholera-vaccine some weeks before. One single case remained which was bacteriological negative, but showed signifcant agglutinating and vibriocidal antibody titers against the serotypes Ogawa and Inaba.
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PMID:[Research on V. cholerae anti-antibodies (agglutinating and vibriocidal) in patients affected by cholera-like gastroenteritis. Studies performed during the cholera epidemic occurred in Apulia in August-September 1973]. 108 31

Cholera is a diarrheal disease that results from colonization of the small intestine by the Vibrio cholerae organism. The disease is spread primarily by means of fecal contamination of drinking water and may begin with the sudden onset of profuse, watery diarrhea. Vomiting, rapid dehydration, acidosis, muscular cramps and circulatory collapse are other prominent features of severe cholera. Diagnosis is confirmed by identification of the organism in a stool specimen. Treatment requires immediate replacement of the massive fluid loss before diagnostic studies are ordered. Clinicians should suspect cholera in any case of massive, shock-producing diarrhea, especially if the patient has traveled to a cholera-affected country. This article presents epidemiology and public-health measures, pathophysiology, diagnosis, clinical signs and symptoms, and treatment modalities for adults and children infected with the V. cholerae organism.
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PMID:The diagnosis and treatment of cholera. 146 31

Two cases of postoperative enterocolitis due to methicillin-resistant Staphylococcus aureus (MRSA) after gastrectomy were experienced. Case 1: A 59-year-old male underwent subtotal gastrectomy for advanced gastric cancer. Diffuse peritonitis progressed after the first operation, so reoperation for drainage was required. Two days after the second operation, a profuse watery diarrhea developed. Case 2: A 46-year-old male underwent total gastrectomy for early gastric cancer. On the fourth postoperative day, frequent vomiting and cholera-like diarrhea started, followed by profound shock several hours later. Both cases were treated successfully by the administration of vancomycin. Stool cultures of both cases revealed MRSA and it had the same minimal inhibitory concentration, coagulase type and enterotoxin type, so that nosocomial infection was indicated.
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PMID:Enterocolitis due to methicillin-resistant Staphylococcus aureus--report of two cases. 150 67


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