Acute gastroenteritis Acute diarrhea

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Acute gastroenteritis, Acute diarrhea

Acute gastroenteritis remains one of the most common illnesses affecting infants and children in Canada and the world. Although most children have mild symptoms with little or no dehydration, a substantial number are affected more seriously. Almost 10% of hospitalizations of children younger than 5 years of age are because of diarrhea and it is estimated that almost ¼ of a million children are hospitalized each year with gastroenteritis. The average child under age 5 experiences 2.2 diarrheal episodes per year; children attending Day Care Centers have an even higher incidence. There are surveys to show that many health care providers do not follow recommended procedures for the optimal management of children with diarrhea

Replacement of fluid and electrolyte losses is the critical central element of effective treatment of acute diarrhea. Oral rehydration therapy (ORT) is the preferred treatment of fluid and electrolyte losses caused by diarrhea in children with mild (3-5%) and moderate (6-9%) dehydration. While intravenous therapy was the first successful routine method of correcting fluid and electrolyte losses following diarrhea, it became clear in the late 1960’s that the use of oral glucose-electrolyte solutions were equally successful in treating patients with cholera in Bangladesh and India. Over the last decade, a series of studies from developed countries have proven the effectiveness of ORT compared with intravenous therapy in children with diarrhea from causes other than cholera

Oral rehydration takes advantage of the glucose-coupled sodium transport system. This is a process for sodium absorption which remains intact in infective diarrheas due to viruses or enteropathogenic bacteria. It has been shown that glucose enhances sodium and secondarily water transport across the mucosa of the upper intestine. The amount of fluid absorbed depends on three factors which makes the composition of rehydration solutions critical. Maximal water uptake occurs with a sodium concentration from 40 to 90 mmol/L, a glucose concentration from 110 to 140 mmol/L and in a solution with an osmolality of about 290 mOsm/L. Here you have some examples:

1. Cola has approximately 700 mmol/L of fructose and glucose and has an osmolality of 750mOsm/L.
2. Undiluted apple juice has approximately 690 mmol/L of fructose, glucose and sucrose and has an osmolality of 730mOsm/L
3. Sports beverages have approximately 255 mmol/L of sucrose and glucose with an osmolality of 330mOsm/L.

There are four classes of anti-diarrheal pharmacological agents, and as a general rule none should be used to treat acute diarrhea in children. These medications include the following, and are effective by altering:

1. Intestinal motility, e.g. Loperamide (Imodium)
2. Secretions e.g. Bismuth subsalicyclate (Pepto-Bismol)
3. Adsorption of toxins and water e.g. Donnagel or Kaopectate
4. Intestinal microflora e.g. lactobacillus.

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