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Query: UMLS:C0740441 (acute diarrhea)
 2,275 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The appropriate approach to the diagnosis and management of acute infectious diarrhea is determined by the frequency and setting of the illness, the recognizable causes or syndromes, the cost and yield of available diagnostic tests, and the treatability of the disease. Acute diarrhea affects everyone throughout the world from one to more than six times each year, depending on age, location, and living conditions. The range of identifiable viral, bacterial, and parasitic etiologies is great, and the cost of indiscriminate use of etiologic studies for diagnosis is prohibitive. Because of its insensitivity for many organisms and poor selection of cases for testing, routine stool culture has been one of the most costly and ineffective microbiologic tests; the cost per positive result has traditionally exceeded $900 to $1,000. The appropriate treatment for the vast majority of cases (independent of their cause) is simple and effective: oral glucose- and electrolyte-containing rehydration solution. On the basis of an appropriate history and understanding of pathogenesis, fecal specimens can be selectively obtained and promptly examined for leukocytes and parasites, and the common noninflammatory diarrheas can be separated from the inflammatory infections in order to focus further studies on the latter group. The bacteria for which specific antimicrobial therapy should be considered usually cause inflammatory diarrhea in the United States. Therefore, only when the history or fecal leukocyte findings indicates an inflammatory process is it appropriate to culture for the routine invasive bacterial pathogens. In sporadic inflammatory diarrhea, culture methods should include those for Campylobacter jejuni as well as Salmonella and Shigella. Several special circumstances may prompt a consideration of parasites (including Giardia, Entamoeba, Strongyloides, Cryptosporidium), Vibrio, Yersinia, Clostridium difficile, enterotoxigenic Escherichia coli, food-borne agents, or sexually transmitted pathogens. The practical value of specific identification of rotaviruses (by enzyme-linked immunosorbent assay, Rotazyme, or electron microscopy) is primarily epidemiologic, particularly in hospitalized infants or young children. Using such a selective approach to fecal culture will greatly increase its yield and can reduce the cost per positive result from $1,000 to less than $150.
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PMID:Evaluation and diagnosis of acute infectious diarrhea. 401 91

Different combinations of fluid therapy, feeding regimen, and cholestyramine were compared in search for optimal treatment of infants hospitalized for acute diarrhea. The infants (n = 81) received either rapid oral rehydration using the oral rehydration solution-World Health Organization formula (sodium 90 mmol/L, ORS-WHO) or traditional oral fluid replacement using a commercial glucose-electrolyte solution (sodium 35 mmol/L). One-half of the infants in both groups received full feedings at 24 h of hospitalization; in the remaining infants, feedings were gradually introduced over a period of 5 days. In addition, all the children were randomized to receive either cholestyramine 2 g four times daily or an equivalent amount of placebo. Rehydration with ORS-WHO, but not traditional fluid replacement therapy, led to correction of initial metabolic acidosis after 6-10 h; no cases of hypernatremia were observed with the use of ORS-WHO. Rapid return to full feedings appropriate for age, including milk products, was associated with better weight gain and significantly shorter duration of diarrhea compared with gradual introduction of feedings. Cholestyramine treatment further shortened the duration of diarrhea without adverse effects in those children who had received ORS-WHO and thus were properly rehydrated. In contrast, in children with poor initial hydration, cholestyramine treatment was associated with prolonged metabolic acidosis. We conclude that treatment of acute diarrhea by rehydration with ORS-WHO and rapid introduction of full feedings is effective and safe, and this combination forms a therapy of choice for typical hospitalized cases of acute infantile diarrhea in Finland. Cholestyramine may be of value as an adjunct therapy after adequate rehydration.
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PMID:Oral rehydration, rapid feeding, and cholestyramine for treatment of acute diarrhea. 402 May 69

Oral rehydration solutions containing 50 to 90 mmol/L of sodium have recently been recommended for the treatment of diarrhea in both hospitalized and ambulatory children in the United States. Few data are available, however, from ambulatory US children. Therefore, we conducted a randomized double-blind study comparing the use of four different oral rehydration solutions with differing concentrations of sodium, glucose, and base. Ambulatory children less than 2 years of age with acute diarrhea (N = 140) were randomly chosen to receive solutions containing sodium at 90 (solution A), 50 (solution B), and 30 mmol/L (solutions C and D). All oral rehydration solutions contained 20 g/L of glucose except solution D which contained 50 g/L of glucose. Solution A contained bicarbonate as its base source whereas the other three contained citrate. All but three (98%) children were treated uneventfully according to the study protocol, and there were no differences among groups in measurements of clinical outcome. It was concluded that in ambulatory US children, oral rehydration solutions containing 90, 50, or 30 mmol/L of sodium can be used safely for the treatment of mild acute diarrhea and that citrate is as efficacious as bicarbonate in the correction of acidosis.
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PMID:Oral rehydration therapy for acute diarrhea in ambulatory children in the United States: a double-blind comparison of four different solutions. 402 87

This report describes the authors' experiences among Apache Indians who required rehydration therapy because of acute diarrhea. About 400 children, aged less than 2 years, who were strong enough to drink, were given oral glucose-electrolyte solutions. The solution contained, in millimoles per liter, sodium (81), potassium (18), chloride (71), bicarbonate (28), and glucost (139). The cost of the formula is 2.5 cents per liter. In children with a 2 degree volume depletion, more of the solution was required (statistically significant) than if the child suffered 1 degree volume depletion; however, 9 of 11 children with 2 degree depletion were adequately hydrated 3-6 hours after administration. Moderate electrolyte abnormalities, which included hypo- and hypernatremia and acidosis, were corrected or improved during the administration of the oral rehydration therapy. Plasma potassium concentrations showed little change. The oral therapy failed in 2 children due to malabsorbed glucose, but both were successfully treated with intravenous fluids, a carbohydrate-free formula, and broad-spectrum antibiotics. The ad libitum sue of oral therapy is effective and should help reduce infant mortality and morbidity due to diarrhea.
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PMID:Ad libitum oral glucose-electrolyte therapy for acute diarrhea in Apache children. 458 Oct 15

This study was conducted from January 1977 to June 1978 in Fortaleza, Brazil, to evaluate the oral rehydration treatment recommended by the World Health Organization for children admitted with acute diarrhea; admission peaked in January-March of both years and children treated came from the lowest socioeconomic strata of the popultion. Initial treatment consisted of intravenous administration of normal saline or 5% glucose with saline solution; intravenous therapy was continued until objective signs of improvement were evident. Of the 53 children observed 24 continued with intravenous therapy, and 29 were administered oral rehydration therapy with a glucose-electrolyte solution containing 90 milliequivalent per liter of sodium ion. Mean age in the intravenous and in the oral groups were 10 and 8 months, respectively. The major symptoms were feverishness and vomiting. Stools from 37 patients were examined for disease agents; enterotoxigenic E. coli were identified in stools from 27% of these patients; ST-producing E. coli in 21.6%, and LT-producing E. coli in the remaining 5.4%. During the initial rehydration period there were no significant differences between the 2 groups as to duration of therapy or amount of fluid given. During the subsequent study period members of the oral treatment group required significantly less fluid and less treatment than members of the intravenous group, average amount of fluid required per kg of body weight being 67.3 ml in the intravenous group, and 32.3 ml in the oral group. Progress toward a normal level of consciousness was significantly greater among members of the oral rehydration group; the mothers of the children were able to administer the oral therapy quite effectively, thus saving time for physicians and nurses.
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PMID:Etiology of childhood diarrhea and oral rehydration therapy in northeastern Brazil. 627 33

The literature on oral sugar-electrolyte mixtures for treatment of acute diarrhoea is reviewed. Several trials have shown that the solution proposed by the WHO for developing countries containing inter alia 90 mmol/l of sodium and 111 mmol/l of glucose is safe for short term oral rehydration. When used in this manner there is no risk for development of hypernatraemia. The surplus base of the solution is not essential and, furthermore, other anions e.g. acetate may be substitute for bicarbonate. Other modifications of the WHO formula have also been successfully tried, e.g. sucrose 4% (117 mmol/l) instead of glucose 2% (111 mmol/l). A somewhat lower concentration of sucrose may, however, prove to be better. Most acute childhood diarrhoeas are not mediated by enterotoxin and thus not of the secretory type, but temporary malabsorption is common. Therefore, the amount of carbohydrate in oral sugar-electrolyte mixtures should be limited. Osmotic diarrhoea due to carbohydrate malabsorption is a more likely cause of hypernatraemia in dehydrated children than too much dietary sodium. In developed countries prepacked oral sugar-electrolyte mixtures are mainly designed for moderately sick children treated at home. There is no reason to raise the carbohydrate content of these mixtures above that of the WHO formula, but the sodium content must be lower. For most situations in home treatment 50 mmol/l of sodium will be adequate.
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PMID:High sugar worse than high sodium in oral rehydration solutions. 634 Apr 10

The gut hormone response to a breakfast meal was studied in 12 subjects hospitalised for an episode of acute diarrhoea (presumed infective) who were otherwise well and in 13 healthy control subjects. Fasting blood glucose concentrations were low but basal insulin concentrations were raised. Basal concentrations of pancreatic polypeptide and both basal and postprandial responses of motilin, enteroglucagon, and vasoactive intestinal polypeptide (VIP) were also significantly greater than controls. No abnormalities in plasma concentrations of gastrin, gastric inhibitory polypeptide (GIP) or pancreatic glucagon were found. The suggested physiological actions of the raised hormones may be relevant to the pathophysiology of diarrhoea.
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PMID:Gut hormones in acute diarrhoea. 634 84

We evaluated the in vitro and in vivo digestibility and clinical tolerance of three corn syrup sugars (DE10, 15, 24) and one infant formula containing corn syrup sugar as the sole carbohydrate source (DE24). In vitro studies were conducted using human duodenal fluid and jejunal mucosa with normal enzyme activities. In vivo studies included intragastric perfusion studies and tolerance tests using the corn syrup sugars and a clinical formula trial in 32 infants with acute diarrhea. Results of the in vitro studies showed that each of the corn syrup sugars was well hydrolyzed by duodenal fluid and by mixtures of duodenal fluids and mucosal homogenates. Similarly, in vivo studies revealed significant hydrolysis in the proximal intestine, as measured during the perfusion studies, and adequate absorption, as indicated by a rise in serum glucose concentration during tolerance tests. Only patients who had a marginal serum glucose rise after a glucose meal had a blunted rise after a corn syrup feeding. More than 85% of the infants beginning the clinical trial tolerated the formula well and gained weight at or above the expected rate for age during the study interval. These data indicate that, except with severe mucosal injury and secondary monosaccharide intolerance, glucose polymers of the dextrose equivalents tested are suitable carbohydrate sources for infants recovering from acute diarrhea.
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PMID:Corn syrup sugars: in vitro and in vivo digestibility and clinical tolerance in acute diarrhea of infancy. 634 42

Stool specimen from 994 patients with Acute Diarrhoeal Diseases were processed for bacterial agents known to be responsible for acute diarrhoea. These were from patients seen at the Lagos University Teaching Hospital over a 9 month period. The pattern that emerged showed Shigella isolates made up by 36 flexneri; 29 boydii, 21 dysenteriae and 4 sonnei; Salmonella isolates were typhi 3, typhimurium 12, enteritidis 3, Oranienburg 9, others 8; Yersinia enterocolitica 14; Campylobacter species 20; Enterotoxinogenic E. coli 12, Vibrio cholerae 5; Enteropathogenic E. coli 35; Enterotoxinogenic E. coli 12; Enteroinvasive E. coli 5. Shigella was by far the most common with 43.6% of the isolates EPEC with 17% Salmonella 12% Campylobacter species 9.7%. Yersinia enterocolitica 6.7% ETEC 6%, Vibrio cholera 2.5% and EIEC 2.5%. The isolates are discussed in relation to age groups and seasons of the year. Oral glucose-electrolyte therapy was evaluated in 48 infants with acute diarrhoea. Pcv, electrolyte, Blood Urea, gain in body weight and fluid intake were monitored. Acceptability and effectiveness of the ORT in our Community were confirmed. There was no excess gain in body weights or puffiness of face and eyelids in the study subjects.
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PMID:Local pattern of acute enteric bacterial infections in man--Lagos, Nigeria. 634 63

Acute secretory diarrheas constitute a major source of mortality and morbidity world-wide. Our current understanding of the underlying mechanisms involved is reviewed with particular reference to cholera and enterotoxigenic E. coli infections. From the physiological principles involved, a unified concept for the treatment of acute secretory diarrheas is presented. The importance of rehydration is highlighted and practical instructions for the use of oral glucose-electrolyte solutions in the treatment of acute secretory diarrhoeas are given, along with some discussion of the rationale behind their use and optimum composition. The important role of nutritional factors during acute diarrhoea is underlined and the place of various drugs, some established, some experimental, are briefly discussed.
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PMID:Acute secretory diarrheas. Current concepts in pathogenesis and treatment. 634 65


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