Concentração de sódio e glicose em soro de reidratação oral preparado por Agentes Comunitários de Saúde / Sodium and glucose concentration in therapeutical solution for oral rehydration prepared by Community Health Agents

A diarreia infantil é importante causa de morbimortalidade, sendo indicativo para terapia de reidratação oral (TRO). Este estudo objetivou avaliar o teor de sódio e glicose em soro de reidratação oral preparado por Agentes Comunitários de Saúde (ACS) que atuam em Unidades Básicas de Saúde (UBS), caracterizando o perfil e o conhecimento destes sobre a TRO. Após responderem questionário com informações profissionais e sobre a TRO, os ACS a prepararam por três métodos. O teor de glicose e de sódio das TRO foi determinado e comparado ao proposto pela OMS. Na análise estatística foram utilizados ANOVA, Tukey e odds ratio. Participaram do estudo 52 ACS, majoritariamente mulheres e com ensino médio completo (90,4 por cento). A adequação da TRO foi de 3,9; 9,8 e 28,9 por cento para a colher caseira, colher medida e punhado pitada, respectivamente. O preparo da TRO com a colher caseira resultou em 88,0 por cento das amostras com teor de sódio perigoso à saúde (>101 mmol/L). Entre os ACS, 38,5 por cento tinham menos de 2 anos de trabalho, com risco 4,8 vezes maior de preparar TRO inadequada em sódio. Os ACS referiram indicar a TRO no tratamento da diarreia infantil, desconhecendo efeitos colaterais do preparo inadequado. A composição da TRO produzida pelos ACS foi inadequada em todos os métodos. É recomendável treinamento dos ACS no preparo da TRO.

Infant Diarrhea is a major cause of morbidity and mortality in children and oral rehydration therapy (ORT) is required. This study evaluates the composition of ORT prepared by Community Health Agents (CHAs) working in Basic Health Units, assessing their profile and knowledge about ORT. After the CHAs answer specific questions, they are invited to prepare ORT using three methods. Glucose and sodium levels were then quantified and compared with WHO recommendations. ANOVA, Tukey and odds ratio were used for statistical analysis. 52 CHAs participated, mainly females, and 90.4 percent with full high school education. The adequacy of the ORT was 3.9; 9.8 and 28.9 percent for table spoon, measuring spoon and pinch and scoop, respectively. The ORT preparation by table spoon resulted in 88 percent of samples with dangerous levels of sodium (>101mmol/L). 38.5 percent of the CHAs had less than 2 years experience, leading to a 4.8 times greater risk of preparing ORT with high sodium. The CHAs indicated ORT as a treatment for diarrhea, though they were unaware of the side effects of inadequate preparation. The composition of the ORT produced by the CHAs was inadequate in all methods tested. The CHAs revealed a lack of knowledge of the side effects iof ORT with inadequate salt levels. The recommendation is to train the CHAs in ORT preparation.

Composición de las soluciones caseras usadas en ninos con diarrea sin deshidratación: Mérida-Venezuela: [revisión] / Composition of home made solutions used in children with diarrhea without dehydration: [review]

La diarrea es una causa principal de morbi-mortalidad en niños y el uso de la terapia de rehidratación oral (uso de suero oral más líquidos caseros) puede prevenir la deshidratación. Identificar las soluciones caseras utilizadas en los niños con diarrea sin deshidratación, analizar su composición bioquímica y proponer las más adecuadas. Se entrevistaron 167 madres, en consultas pediátricas, seleccionadas al azar, durante los años 2004-2006, en Mérida-Venezuela; es un estudio epidemiológico, analítico, prospectivo y concurrente. Se identificaron cinco grupos de soluciones caseras: agua de arroz, sopa de plátano, sopa de cambur (banana), infusiones de hierbas y jugos de frutas. El análisis bioquímico se realizó mediante un pH metro, espectroscopia de absorción atómica (Na y K), argentometría (Cl), osmómetro (osmolaridad), glucosa peroxidasa (glucosa), hidrovolumetría por neutralización (bicarbonato) y bandas de absorción (citrato), procesadas en la Facultad de Ciencias de la Universidad de Los Andes. Todas las soluciones estudiadas tienen un pH ácido, con excepción del suero casero con bicarbonato. las concentraciones de electrolitos fueron mínimas en el agua de arroz, las infusiones de hierbas y los jugos de frutas, mientras que fueron más elevadas en las sopas de plátano y banana. (Na y Cl más elevado). Las osmolaridad fue baja en todas las soluciones y alta en los jugos de frutas. Ninguna de las soluciones reúne las concentraciones planteadas por la OMS, aunque en el niño con diarrea sin deshidratación la sopas de plátano y banana pueden ser utilizadas debido a la buena aceptación y al bajo costo. No se recomiendan los jugos de fruta por su alta osmolaridad.

Diarrhoea continues to be one the main causes of morbidity-mortality in latin american countries due to dehydration. this is why the most important strategy to avoid deaths due to dehydration is oral rehydration therapy (oral rehydration solution plus homemade solutions) which may vary according to each region of the country. To identify the most frequently used homemade solutions for preventing dehydration in children with acute diarrhoea within the community in Mérida, Venezuela; to analyze the biochemical composition of these solutions; to propose the use of the most adequate ones. By means o an epidemiological, analytical, prospective and concurrent study 167 inquiries were performed to mothers who sought medical help in the main assistance centers of the city. these mothers were selected randomly during 2004-2006. five groups of homemade solutions were identified: rice water (golden rice in esther grain or flour), plantain soup with or without chicken, banana soup, herbal infusions and fruit juices. Biochemical analysis was performed by means of: ohmmeters (pH), spectroscopy of atomic absorption (Na and K), argentometry (Cl), osmometer (osmolarity), glucose peroxidase (glucose), hidrovolumetry by neutralization (bicarbonate) and absorption bands (citrate) processed at the Science Faculty of the Universidad de Los Andes. All the homemade liquids have an acidic pH, except solutions with added bicarbonate. electrolytes concentrations were minimum except for the plantain and banana soups, which have a higher sodium and chloride concentration. The osmolarity of most solutions was low, with exception of fruit juices (orange and guava). Conclusions: none of the homemade solutions meet the requirements established by the World Health Organization as an ideal rehydration solution. However, plantain and banana soup may be used in children with diarrhea without dehydration due to their high availability.

Does an L-glutamine-containing, glucose-free, oral rehydration solution reduce stool output and time to rehydrate in children with acute diarrhoea? A double-blind randomized clinical trial.

This study assessed whether an oral rehydration solution (ORS) in which glucose is replaced by L-glutamine (L-glutamine ORS) is more effective than the standard glucose-based rehydration solution recommended by the World Health Organization (WHO-ORS) in reducing the stool volume and time to rehydrate in acute diarrhoea. In a double-blind, randomized controlled trial in a Mexican hospital, 147 dehydrated children, aged 1-60 month(s), were assigned either to the WHO-ORS (74 children), or to the L-glutamine ORS (73 children) and followed until successful rehydration. There were no significant differences between the groups in stool output during the first four hours, time to successful rehydration, volume of ORS required for rehydration, urinary output, and vomiting. This was independent of rotavirus-associated infection. An L-glutamine-containing glucose-free ORS seems not to offer greater clinical benefit than the standard WHO-ORS in mildly-to-moderately-dehydrated children with acute non-cholera diarrhoea.

Low osmolar oral rehydration salts solution in the treatment of acute watery diarrhoea in neonates and young infants: a randomized, controlled clinical trial.

To compare the efficacy and safety of low osmolar oral rehydration salts solution (ORS-75) (mmol/L: Na+ 75, osmolarity 245) with that of World Health Organization-recommended ORS (ORS-90) (mmol/L: Na+ 90, osmolarity 311 ) in the treatment of acute watery diarrhoea in neonates and very young infants, a randomized double-blind, controlled clinical trial was carried out at the Clinical Research and Service Centre of ICDDR,B: Centre for Health and Population Research, Dhaka, Bangladesh, during January 1998-December 1999. Infants, aged < or = 2 months, presenting with a history of watery diarrhoea of < or = 72 hours, with no or some dehydration and without any systemic illness, were randomly assigned to receive either ORS-75 or ORS-90 for the correction and subsequent prevention of dehydration. Infants were studied for a maximum of five days. Total stool output, stool frequency, and requirement for ORS were outcome measures. Serum electrolytes were measured at 24 hours after admission to monitor serum sodium imbalance. Seventy-three infants received ORS-75, and 71 received ORS-90. Both the groups were comparable in their baseline characteristics. Diarrhoea resolved within five days in 53% and 66% of infants receiving ORS-75 and ORS-90 respectively (p = 0.3). Total stool volume [median (inter-quartile range) 132 (65-280) vs 139 (70-259) g/kg, p = 0.9], during the study period, was not significantly different between the two groups. Total stool frequency [31 (16-51) vs 35 (16-53), p = 0.9] and total ORS intake [192 (96-374) vs 209 (134-317) mL/kg, p = 0.7] were similar between the groups. No infants developed late evidence of hypernatraemia, irrespective of treatment. The results of the study indicate that ORS-75 is as safe as standard ORS-90 in the treatment of acute watery diarrhoea in neonates and very young infants and is effective in correcting and preventing dehydration.

Towards a better oral rehydration fluid.

Improvements in characteristics of solutions used for oral rehydration therapy, to provide significant reductions in amount and duration of diarrhea, are expected to contribute to wider use of these fluids. Recent studies suggest that these may come about from reducing the osmolality of the solution, and by providing short chain fatty acids for better fluid absorption from the colon. This article briefly reviews the physiology of intestinal and colonic absorption in diarrhea, and indicates the further studies that are needed to translate the above advances into universal practice for the treatment of diarrhea.

Trastornos hidroelectrolíticos e hidratación oral en diarreas / Hydro-electrolytic disorders and oral hydration solution in diarrheas

La deshidratación por diarrea es el trastorno más frecuente del metabolismo hidroelectrolítico en los niños. Se analizan los mecanismos de regulación del agua, los electrolitos y el equilibrio ácido base y los trastornos observados en la deshidratación por diarrea: acidosis metabólica con hipokalemia y tendencia a hipernatremia por la pérdida proporcional mayor de agua que de soluto. El medicamento de elección para prevenir y tratar estos trastornos es el suero oral con la fórmula recomendada por la Organización Mundial de la Salud y el Fondo de las Naciones Unidad para la Infancia (UNICEF). En los últimos años se han analizado nuevas fórmulas que además de hidratar, pueden reducir el gasto fecal y la duración de la diarrea, siendo las soluciones a base de arroz las únicas que han mostrado esta propiedad en pacientes con cólera. De acuerdo a la evaluación del estado de hidratación, se clasifica a los pacientes en: a) hidratados, b)deshidratados y c) con choque hipovolémico, y se aplica el plan de tratamiento correspondiente (A, B o C). Se analizan estos nuevos esquemas de tratamiento y sus resultados