These tools will no longer be maintained as of December 31, 2024. Archived website can be found here. PubMed4Hh GitHub repository can be found here. Contact NLM Customer Service if you have questions.


Pubmed for Handhelds

PUBMED FOR HANDHELDS

Search MEDLINE/PubMed

  • Title: [Rapid intravenous rehydration in acute diarrhea].
    Author: Sperotto G.
    Journal: Bol Med Hosp Infant Mex; 1992 Aug; 49(8):506-13. PubMed ID: 1449637.
    Abstract:
    With the use of oral rehydration, the need for the use of endovenous rehydration has decreased considerably. Albeit, the use is still necessary in severely dehydrated patients or when oral rehydration fails. Textbooks produced in developed countries recommend slow administration of fluids to correct dehydration in 12 to 24 hours. In developing countries, due to the great number of severely dehydrated patients, this approach is not useful. We developed, during the last 20 years, an approach to intravenous rehydration that permits rehydration of the severely ill patient in a much shorter time (2 to 3 hours) and permits an early refeeding. It can be used in all patients, even newborns or malnourished. No laboratory tests are necessary. Only a small number of simple and readily available solutions are used to prepare the electrolyte mixtures. This work argues that rapid intravenous rehydration is desirable in cases of acute diarrhea. It provides detailed instructions for preparing and administering the correct solutions and for recognizing patients who are hyponatremia or suffering from acute acidosis. With widespread use of oral rehydration therapy, i.v. rehydration is limited to patients with acute dehydration or contraindications to oral rehydration. For purposes of prognosis, dehydration is usually classified according to the concentration of serum sodium or the degree of fluid loss. The objectives of i.v., rehydration are to eliminate the deficits of water and electrolytes, replace losses so that the patient will not become dehydrated again, and permit early feeding. The water deficit is variable and may amount to 100-150 ml/kg in the severely dehydrated. The sodium deficit is 9-17 mmol/kg and the potassium deficit is 3-15 mmol/kg. Early feeding after no more than 8 hours of fasting is currently considered more effective in preventing malnutrition in children with diarrhea and dehydration. Since the presence of deficits prevents feeding, the initial period of dehydration should not be prolonged beyond 4 hours. In developed countries, i.v. rehydration takes place over 12-24 hours with periods of fasting of 24-48 hours, but the mortality associated with this method of treatment in dehydrated children with diarrhea is higher. To meet its objectives, i.v., rehydration should take place in 3 phases, a rapid initial phase followed by simultaneously occurring phases of maintenance and of replacement in which normal and abnormal losses are replaced. The initial rapid phase should restore the normal perfusion of vital organs by eliminating deficits of sodium and water in no more than 2 hours. All sings of dehydration should disappear. The weight of the child before dehydration and thus the weight loss is seldom known, but experience with the method allows adequate approximations to be made. The solution used in almost all patients is a mixture of physiological solution of NaCl .9% and 5% dextrose solution (PS:DS5% 1:1). The only exceptions are patients with very low sodium levels or severe acidosis, who can be recognized by the experienced practitioner based on their characteristic clinical symptoms. The final concentration of sodium in the solution is .45% of NaCl and that of dextrose 2.5%. The patient is always reevaluated after 1 hour of treatment to detect possible complications. Treatment of hyponatremia and acidosis requires adjusting levels in the 1st hour of treatment with special formulas so that the standard formula may be administered. Instructions are provided for calculating the quantity and content of fluids for the maintenance and replacement stages, which are customarily administered in segments of 6-8 hours.
    [Abstract] [Full Text] [Related] [New Search]