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

The outcome of administering ORT (oral rehydration therapy) to 62 infants admitted to a Costa Rican hospital with acute rotavirus or bacterial diarrheas and with 5-10% dehydration was described. 94% of the infants were successfully treated by administering only ORT. There were no significant differences in the success rates for rotavirus diarrhea patients and for various bacterial diarrhea patients. Success rates were 92% for rotavirus patients, 93% for Escherichia coli patients, 96% for idiopathic diarrhea patients, and 100% for salmonella and shigella patients. Upon admission, the average duration of diarrhea was 2.9 days, vomiting was present 88% of the cases, and all patients exhibited some signs of dehydration. The infants were administered the oral formula recommended by the World Health Organization. Patients received 400 ml of oral solution followed by 200 ml of water. The treatment was repeated until skin tuger was normal. 34% of the infants were rehydrated within 6 hours and 76% within 20 hours. Patients were admitted with a variety of electrolyte abnormalies. 24% had hyponatraemia, 27% had hypokalaemia, and 23% had hypernatraemia. Sodium levels were improved within 24 hours for all patients except for 5 hyponataemia patients. Although rotavirus patients had higher stool glucose concentrations than the other patients, they apparently absorbed enough of the solution to rehydrate successfully. Specific data on changes in weight, plasma protins, hematocrit, blood composition, and stool composition and on therapeutic failures was provided. Investigators concluded that ORT was a safe and effective form of therapy for both rotavirus and bacterial diarrhea and for severe cases of dehydration.
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PMID:Oral rehydration and maintenance of children with rotavirus and bacterial diarrhoeas. 22 48

This chapter addresses the role of health professionals in providing abortions and examines the dynamic technology of this field. Once the decision to perform an abortion is made, the proper procedure must be selected. Gestational age is the fundamental determinant but the experience and capability of the practitioner are also crucial. Suction curettage is the safest and most effective procedure available for abortions performed within 10 weeks of conception. Evaluation of the abortion patient should include, at a minimum, tests for hemoglobin, presence of gonococci, and Rh type. One of the most important parts of preparation for an abortion is sensitive and searching counseling. A potentially serious complication of suction curettage is perforation of the uterus. Dilatation and evacuation (D and E), is similar to the suction curettage procedure. This method may be used for gestations of 20 or more weeks after conception and requires greater operator expertise and experience. The complications of D and E are similar to those of suction curettage but are more frequent. Amnioinfusion is currently the most widely used method of pregnancy termination after 14 weeks in the US. The abortifacient agent that has had the greatest use is hypertonic saline. Morbidity associated with saline amnioinfusion includes hemorrhage requiring transfusion, retained tissue requiring manual or surgical removal infection, coagulopathy, and hypernatremia. Prostaglandins are alternative abortifacient agents. A disadvantage of using prostaglandins to induce abortion is that they frequently require repeat doses to be effective. Other disadvantages include nausea, vomiting, diarhea, and bronchospasm. Urea is anther effective abortifacient agent.
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PMID:Abortion. 38 51

A 3 1/2-year-old girl with a huge optic glioma was reported. On February 26, 1978, she was hospitalized for signs of increased intracranial pressure, namely headache, vomiting and consciousness disturbance. Before admission she did not complain of her visual disturbance. A huge mass lesion in the subfrontal-suprasellar region was found by neuroradiological examination. The operation was performed on March 7, 1978, and the tumor arising from the right optic nerve, about 170 grams in weight, was totally removed in piecemeals. Histopathological diagnosis was pilocytic astrocytoma. Immediately after operation diabetes insipidus and hypernatremia developed, but two months later these symptoms disappeared. Post-operative CT scan demonstrated no mass lesion in the subfrontal-suprasellar region. After radiation therapy, she was discharged with slight left hemiparesis on August 31, 1978. Though her right eye was blind, visual acuity remained 0.2 in the left eye. No other neurologic deficits could be found.
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PMID:[Giant optic glioma--case report (author's transl)]. 49 74

Four infants with suspected soy protein intolerance were studied prospectively. All had vomiting, diarrhea, hematochezia, and weight loss of more than 10%. Laboratory abnormalities included anemia (3), acidosis (3), hypoalbuminemia (3), hypernatremia (1), hyponatremia (3), and mild eosinophilia (2). Symptoms developed between three hours and five days after systematic testing with increasing volumes of soy formula. After challenge with soy protein formula, proctosigmoidoscopy and rectal biopsy were performed within 24 hours of developing stools with gross blood. Proctosigmoidoscopy showed both spontaneous and induced friability and loss of vascular pattern in mucosa. Rectal biopsy showed acute colitis with crypt abscesses, depletion of mucus from rectal glands, and polymorphonuclear leukocytes within the lamina propria. Soy protein-induced colitis should be suspected in those infants who present with persistent and bloody diarrhea after being fed soy formula.
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PMID:Colitis, persistent diarrhea, and soy protein intolerance. 56 Nov 79

In a prospective study of rotavirus (RV) diarrhoea in Indian (Asian) infants in South Africa, it was found that in common with findings elsewhere in the world, vomiting and dehydration are prominent features of this disease. The dehydration was usually isotonic, though both hypo- and hypernatraemia did occur. Hypokalaemia was found to be much less common in RV than in non-RV diarrhoea. Unlike findings elsewhere, no definite 'rotavirus syndrome' associated with pyrexia and respiratory symptoms could be identified in RV diarrhoea as these occurred with equal frequency in non-RV patients. The mean total duration of RV diarrhoea (i.e. before admission plus during the hospital stay) was 5 days. The RV patients took significantly longer to recover from their diarrhoea than the non-RV ones, and mixed RV-bacterial infections prolonged the illness even more. Breast-feeding was associated with milder disease. Less than 2% of both RV and non-RV cases developed persistent diarrhoea of longer than 14 days' duration and this was most frequent in patients under 6 months of age with poor nutritional status.
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PMID:Rotavirus studies in Indian (Asian) South African infants with acute gastro-enteritis: II. Clinical aspects and outcome. 170 40

Over 10% of emergency room patients are diagnosed as having alcohol (6.0%) or drug intoxication. In the present study 196 alcohol intoxications treated in a hospital were studied retrospectively; 49.2% of the patients had abnormal acid-base values, alcoholics more often than non-alcoholics (p = 0.04). Mean blood ethanol concentration (BAC) was 310 mg/dl (SD 120); alcoholics had higher concentrations of alcohol. BAC was the higher the lower the serum pH was (p less than 0.002, r = -0.45). The deeper the coma the lower the serum pH (p less than 0.05) and the higher the BAC (p less than 0.0001). Respiratory acidosis (31.7%) was an important finding in those intoxicated. Metabolic acidosis (7.9%) could be explained by the presence metabolites of ethanol in the serum and by decreased extra-cellular fluid volume. Metabolic alkalosis related to vomiting and an extra-cellular fluid volume decrease was found in 7.9% of the patients. Respiratory alkalosis was a rare finding (1.6%). Hypokalemia (22.5%) and hypernatremia (15.3%) were the most important electrolyte changes. Chronic alcoholics had lower serum potassium than had non-alcoholics; 3.6% (n = 7) of the patients had to be intubated. Acid-base disturbances were frequent in adults with alcohol intoxication. Serum pH correlated well with the state of consciousness and the BAC.
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PMID:Acid-base balance in alcohol users seen in an emergency room. 174 42

A total of 186 infants, suffering from acute diarrhea were studied and divided into two groups: 84 children were placed in group A and given the ORS recommended by the World Health Organization which contains sodium and glucose at concentrations of 60 and 90 mmol/L respectively and an osmolality of 311 mOsm/kg (mmol/kg) (ORS-90). Group B included 82 children who received an ORS containing sodium and glucose at concentrations of 60 and 90 mmol/L respectively and with an osmolality of 240 mOsm/kg (mmol/kg) (ORS-60). Seven belonging to group A (8.3%) required intravenous rehydration due to the severity of the diarrhea (three cases), persistent vomiting (three cases) and paralytic ileus (one case), while only two cases belonging to group B (2.5%) required intravenous rehydration due to severe losses through feces (one case) and another due to paralytic ileus (one case). No differences were observed due to the variations in sodium concentrations among either of the groups of patients, whether that be in the natremias when admitted or once rehydrated, with a general tendency towards the correction of the hypernatremia or hyponatremia seen during admittance with both types of ORS. A similar situation was observed with the variations in serum potassium. The results obtained from this study show the different advantages of using an ORS with lesser sodium and glucose concentrations as well as minor osmolality with those from using the solution recommended by the World Health Organization, when a lesser index of failures is observed in the treatment of children with acute diarrhea with oral rehydration therapy. Yet before widely recommending its' use, it should be demonstrated that the new ORS induces lesser losses through feces during the rehydrating period in children dehydrated due to acute diarrhea.
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PMID:[Comparative study of 2 oral rehydration solutions containing 60 or 90 mmol/L of sodium and with different osmolalities]. 227 Nov 25

A clinical trial was conducted to compare the safety and efficacy of a new oral rehydration solution (ORS) with that of the ORS recommended by the World Health Organization (WHO). One hundred thirty infants with dehydration due to acute diarrhea were randomized into two groups: 68 infants received the WHO ORS containing sodium and glucose in a concentration of 90 and 111 mmol/L, respectively, and an osmolality of 311 mosm/kg (ORS-90); 62 infants received an ORS containing sodium and glucose in a concentration of 60 and 90 mmol/L, respectively, with an osmolality of 240 mosm/kg (ORS-60). Treatment failure was noted in seven infants (10.3%) in the ORS-90 group; the causes of failure were high stool output (three cases), persistent vomiting (three cases), and ileus (one case). Only one patient in the ORS-60 group (1.6%) was considered a failure because of high stool output. No significant differences were noted in the serum sodium levels in either group of patients, both in relation to the natremia seen on admittance or that seen after rehydration. A trend was observed toward correction of hypernatremia or hyponatremia with both types of ORS. A similar situation was observed with respect to the variations seen in serum potassium levels. The results from this study suggest that there may be clinical advantages of using an ORS with concentrations of sodium and glucose and a total osmolality lower than that of ORS-90, because of the lower incidence of treatment failures.
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PMID:Clinical experience in Mexico with a new oral rehydration solution with lower osmolality. 234 May 39

A 3 year old boy who had glutaric aciduria diagnosed at 22 months of age was admitted with a history of lethargy, vomiting, and fever. He had been receiving glucose polymers as part of his dietary management. He was severely hypernatraemic, but after resuscitation and rehydration made a good recovery. The possible aetiology of his hypernatraemia is discussed.
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PMID:Glucose polymer regimens and hypernatraemia. 224 22

Patients with eating disorders often use diuretics to eliminate fluid to achieve lower body weight. Diuretic abuse can lead to severe hyponatremia. Central pontine myelinolysis, a disruption of the myelinated neurons of the pons, has been associated with rapid correction of severe hyponatremia. A case is presented of a 35-year-old woman who was brought to the emergency service by ambulance complaining of vomiting for 7 days and that she could not hear well because she was 'worn out'. Initial laboratory values included serum Na 91 mEq/l, K 1.6, Cl 46, bicarbonate 33, BUN 4 mg/dl, glucose 306 mg/dl. After 32 h of intravenous fluids, the serum Na was 126, K 4.0, Cl 89, bicarbonate 25, glucose 118 mg/dl. On the 3rd hospital day the serum Na was 139. On the 4th hospital day she was alert and appropriate. On the 5th hospital day, however, she was confabulating and chatty. The serum Na was 139. She progressed to develop a spastic quadriparesis, speech and swallowing difficulties. A magnetic resonance imaging scan showed central pontine myelinolysis. She acknowledged taking 400 mg daily of furosemide and drinking much water. She had a past history of anorexia nervosa. She had a residual weight phobia and strove to keep her weight below 106 lb. Her height was 5 feet, 6 inches. As illustrated by this case, diuretic abuse can cause severe hyponatremia and the subsequent risk of central pontine myelinolysis. In patients with severe chronic or subacute hyponatremia, a safe restoration rate for serum Na has been less than 0.55 mEq/l/h. Serum Na should be below 135 within the first 48 h and hypernatremia should be avoided.
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PMID:Diuretic abuse and central pontine myelinolysis. 248 85


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