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Severe Dehydration (severe + dehydration)
Selected AbstractsExternal Validation of the Clinical Dehydration Scale for Children With Acute GastroenteritisACADEMIC EMERGENCY MEDICINE, Issue 6 2010Benoit Bailey MD Abstract Objectives:, The objective was to validate the clinical dehydration scale (CDS) for children with gastroenteritis in a different pediatric emergency department (ED) from where it was initially derived and validated. Methods:, A prospective cohort study was performed in a tertiary care pediatric ED over a 1-year period. A sample of triage nurses were trained in applying the CDS. The CDS consists of four clinical characteristics (general appearance, eyes, mucous membranes, and tears), each of which are scored 0, 1, or 2 for a total score of 0 to 8, with 0 representing no dehydration; 1 to 4, some dehydration; and 5 to 8, moderate/severe dehydration. Children 1 month to 5 years of age with vomiting and/or diarrhea who had the CDS documented at triage and a final diagnosis of gastroenteritis, gastritis, or enteritis were enrolled. Exclusion criteria included a chronic disease, treatment with intravenous (IV) rehydration within the previous 24 hours, visit to the ED for the same illness in the 7 days prior to arrival, and diarrhea of more than 10 days' duration. The primary outcome was the length of stay (LOS) in the ED from the time of seeing a physician to discharge, analyzed with a Kruskal-Wallis test. Results:, From April 2008 to March 2009, 150 patients with a mean (±SD) age of 22 (±14) months (range = 4 months to 4 years) were enrolled. Fifty-six patients had no dehydration, 74 had some dehydration, and 20 had moderate/severe dehydration. The median LOS in the ED after being seen by a physician was significantly longer as children appeared more dehydrated according to the CDS: 54 minutes (interquartile range [IQR] = 26,175 minutes), 128 minutes (IQR = 25,334 minutes), and 425 minutes (IQR = 218,673 minutes) for the no, some, and moderate/severe dehydration groups, respectively (p < 0.001). Conclusions:, The CDS has been further validated in children with gastroenteritis in a different pediatric center than the original one where it was developed. It is a good predictor of LOS in the ED after being seen by a physician. ACADEMIC EMERGENCY MEDICINE 2010; 17:583,588 © 2010 by the Society for Academic Emergency Medicine [source] Another cause of bloody diarrhoea in infancy: Cytomegalovirus colitis in an immunocompetent childJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 9-10 2004R Hinds Abstract: Although a ubiquitous pathogen, cytomegalovirus (CMV) is very rarely thought to be the cause of significant gastrointestinal infection in the immunocompetent child. We report the case of a 2-month-old infant who presented with bloody diarrhoea and severe dehydration, which was subsequently diagnosed as CMV enterocolitis and resolved spontaneously without antiviral treatment. [source] Review article: the clinical management of congenital chloride diarrhoeaALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 4 2010S. WEDENOJA Aliment Pharmacol Ther,31, 477,485 Summary Background, Congenital chloride diarrhoea in a newborn is a medical emergency, requiring early diagnostics and treatment to prevent severe dehydration and infant mortality. While most of the 250 cases reported arise from Finland, Poland and Arab countries, single cases with this autosomal recessive disorder appear worldwide. Such congenital chloride diarrhoea rarity makes diagnosis difficult. Life-long salt substitution with NaCl and KCl stabilizes fluid, electrolyte and acid-base balance diagnosis. When properly treated, the long-term outcome is favourable. Aim To summarize data on congenital chloride diarrhoea diagnosis, pathophysiology and treatment, and to provide guidelines for both acute and long-term management of congenital chloride diarrhoea. Methods, Data are based on MEDLINE search for ,chloride diarrhoea', in addition to clinical experience in the treatment of the largest known series of patients. Results, Treatment of congenital chloride diarrhoea involves (i) life-long salt substitution; (ii) management of acute dehydration and hypokalaemia during gastroenteritis or other infections; and (iii) recognition and treatment of other manifestations of the disease, such as intestinal inflammation, renal impairment and male subfertility. Conclusions, This review summarizes data on congenital chloride diarrhoea and provides guidelines for treatment. After being a mostly paediatric problem, adult patients constitute a rare challenge for gastroenterologists worldwide. [source] In vitro femtosecond laser subsurface micro-disruption inside human cornea and pre-cleared scleraLASER PHYSICS LETTERS, Issue 6 2010A.A. Alekhin Abstract Micro-incisions were fabricated inside human cornea and sclera in vitro using single femtosecond laser pulses. In these experiments sclera was for the first time pre-cleared by means of a biocompatible and clinically safe (non-toxic) natural agent (refractive-index matching 40%-glucose solution in water), partially replacing water in the tissue comparing to its severe dehydration by previously used agents. Basic operational parameters of the corresponding microsurgical procedures are reported. (© 2010 by Astro Ltd., Published exclusively by WILEY-VCH Verlag GmbH & Co. KGaA) [source] A nationwide study on hospital admissions due to dehydration in exclusively breastfed infants in the Netherlands: its incidence, clinical characteristics, treatment and outcomeACTA PAEDIATRICA, Issue 5 2009Rolf AA Pelleboer Abstract Aims: To estimate the incidence and clinical characteristics in hospital admissions due to dehydration or undernutrition and their laboratory evaluation and treatment outcome in exclusively breastfed infants. Methods: All hospital admissions during the first 3 months of life assessed by the Dutch Paediatric Surveillance Unit (DPSU) between mid 2003 and mid 2005. Results: Nationwide 158 cases reported, correspond to an incidence of 58/y/100 000 breastfed infants; it is lower for severe dehydration at risk for hypernatraemia; 20/y/100 000. Sixty-five per cent of cases were <2 weeks old, their median weight loss was 9.3% and median age at admission 5 days; Serum sodium value was measured in only 12% of all cases. Insufficient volume intake and inadequate growth were most frequently reported (61% and 41%). Lethargy, jaundice or clinical dehydration was scored in 11,25%, seizures or shock in 3%. A breast pump at home was used in only 31%. In the hospital breast pumps were available (82%) as lactation consultants (73%). For treatment 65% was offered formula, in 30% by nasogastric drip. Most admissions lasted up to 3 days, all recovered fully and 33% were breastfed exclusively at discharge. Conclusion: The incidence of severe dehydration in the Netherlands is relatively low. With extended use of breast pumps at home it could be lower. To prevent complications, we recommend applying a reference weight chart, a full clinical examination and more extensive screening of serum sodium and glucose. [source] Young children non-immunized against measles: Characteristics and programmatic implicationsACTA PAEDIATRICA, Issue 1 2006F Chowdhury Abstract Aim: To examine the presenting characteristics, including nutritional status, of young children without measles immunization and to suggest appropriate public health measures to improve immunization status. Methods: In this retrospective case-control analysis, we studied 4075 children aged 12,23 mo of either sex, who attended ICDDR, B's Dhaka hospital during 1994,2003. Cases included children who reported to this facility without receiving measles vaccine, and the control children were those who received the vaccine. Results: 3181 of 4075 (78%) children, including 1227 (39%) girls and 1954 (61%) boys, received measles immunization. The proportion of vaccinated children increased from 74% in 1997 to 82% in 2001. Some non-specific effects of measles immunization were observed. Fifty-one per cent of the children without measles immunization were stunted, 76% were underweight, and 48% were wasted. The non-immunized children were twice as likely to be stunted, underweight, and wasted than the immunized children; they were more often dehydrated (some or severe dehydration) (28% vs 22%, p<0.001), required longer duration (>72 h) of hospitalization (15% vs 10%, p<0.001), did not receive vitamin A capsule in the previous 6 mo (56% vs 36%, p<0.001), and had more frequent abnormal lung auscultation indicative of acute lower respiratory tract infections (8% vs 5%, p<0.001). Female children, illiterate mother, lack of vitamin A supplementation, and history of measles were significantly associated with non-immunization against measles after controlling for co-variables. Results were similar when different nutritional indicators (underweight, stunting, or wasting) were added separately to logistic regression models. Conclusion: Intervention strategies to enhance immunization coverage in infants should target illiterate mothers and their children, particularly the females and malnourished ones, provide them with measles immunization and vitamin A capsule, and encourage their periodic follow-up visits as part of a preventive nutritional programme. [source] | ||||||||||