in actue diarrhea University of Cape Town急性腹泻的补液开普顿大学课件.pptVIP

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in actue diarrhea University of Cape Town急性腹泻的补液开普顿大学课件.ppt

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in actue diarrhea University of Cape Town急性腹泻的补液开普顿大学课件

H2O Na+ Instruct caregivers for: Ongoing vomiting despite small fluid sips, especially if associated with abdominal distension or pain Persisting fever after 24 hours of ORT Increasing lethargy and failure to feed Deteriorating hydration and failure to pass urine Presence of blood in the stools Diarrhoea persisting for more than 1 week. Oral rehydration May not reduce stool volume or duration of diarrhoea BUT saves lifes by preventing dehydration! Pro’s and Con’s of additional medication Cost Limited benefit Draw parents’ attention from the main intervention – Rehydration! Dehydration is the main clinical feature of acute diarrhoea and generally reflects disease severity. Weight loss, prolonged capillary refill time, skin turgor, and abnormal respiratory pattern are the best individual clinical signs of dehydration. Microbiological investigations generally are not needed. Rehydration is the key treatment and should be applied as soon as possible. Reduced or low osmolality oral rehydration solution should be used, and it should be offered ad libitum. Regular feeding should not be interrupted and should be carried on after initial rehydration. Regular milk (lactose-containing) formulas are appropriate in the vast majority of cases. * Rehydration in acute diarrhea Jorge Amil Dias Porto, Portugal jamildias@zonmail.pt Water and electrolyte movement across the intestinal mucosa K Hodges and R Gill, Gut Microbes, 2010 K Hodges and R Gill, Gut Microbes, 2010 K Hodges and R Gill, Gut Microbes, 2010 Stool electrolyte losses Infection Stool sodium Cholera 88.9 mMol/L ETEC 53.7 mMol/L Rotavirus 37.2 mMol/L AM Molla et al. J Pediatr 1981 History of Oral Rehydration 1910 Intestinal absorption in patients with cholera Sellards, Phillip J Sci 1953 186 patients with cholera treated without iv lfuids Chatterjee, Lancet 1960’s Identification of glucose-solute co-transport 1971 WHO recommended the use of ORS intestinal sodium co-transport “Oral rehydration is potentially the most