Use of a Single Solution for Oral Rehydration and Maintenance Therapy of Infants With Diarrhea and Mild to Moderate Dehydration

PEDIATRICS ◽  
1995 ◽  
Vol 95 (5) ◽  
pp. 639-645
Author(s):  
Mitchell B. Cohen ◽  
Adam G. Mezoff ◽  
D. Wayne Laney ◽  
Jorge A. Bezerra ◽  
Bernadette M. Beane ◽  
...  
Keyword(s):  
United States ◽  
Acute Diarrhea ◽  
Medical Center ◽  
Randomized Study ◽  
Maintenance Phase ◽  
The United States ◽  
Sodium Absorption ◽  
Oral Rehydration ◽  
Rehydration Solutions ◽  
Single Solution

Objective. To compare the efficacy of two commonly used solutions in the rehydration of infants with mild to moderate dehydration caused by acute diarrhea in the United States. Design and setting. Double-blind, parallel-group, randomized study performed at Children's Hospital Medical Center. Patients. Sixty infant boys (≤2 years old), with mild (≤5%) or moderate (6 to 9%) dehydration caused by acute diarrhea of less than 1 week's duration were included in the study. Interventions. Infants were randomly assigned to receive treatment with either a glucose-based oral rehydration solution (ORS) (Pedialyte, Ross Laboratories, Columbus, OH) or a rice syrup solids-based ORS (Infalyte, Mead Johnson Nutritional Group, Evansville, IN). After rehydration was achieved, patients entered a maintenance phase during which, in addition to a maintenance ORS, breast milk or a soy-based formula was offered infants older than 1 year were also given a lactose-free diet. Outcome measures. Rehydration was judged clinically. Infants remained on a metabolic bed during the study in to separate and quantitate urine and stool output. Therefore, in addition to clinical outcome, we compared intake, output and apparent absorption and retention of fluid, sodium, and potassium between groups. Results. All patients were successfully rehydrated using an ORS without the use of intravenous fluids. No differences were detected between treatment groups in time to rehydration, percentage of weight gain after rehydration, consumption of ORS to achieve rehydration, or stool output. However, the apparent sodium absorption (net intake less fecal output) was greater in the Infalyte group than the Pedialyte group during the first 24 hours. Conclusion. The two maintenance oral electrolyte solutions (Pedialyte and Infalyte) most commonly used in the United States are effective as rehydration solutions for infants with mild to moderate dehydration. We speculate that a strategy for oral rehydration therapy in the United States, based on the use of a single solution during the rehydration and maintenance phase, might gain additional acceptance by practicing pediatricians and family physicians.

Oral Rehydration Therapy for Acute Diarrhea in Ambulatory Children in the United States: A Double-Blind Comparison of Four Different Solutions

PEDIATRICS ◽  
1985 ◽  
Vol 76 (2) ◽  
pp. 159-166 ◽  
Author(s):  
Mathuram Santosham ◽  
Barbara Burns ◽  
Vinay Nadkarni ◽  
Stephan Foster ◽  
Steven Garrett ◽  
...  
Keyword(s):  
United States ◽  
Acute Diarrhea ◽  
Oral Rehydration Therapy ◽  
The United States ◽  
Double Blind Study ◽  
Double Blind ◽  
Oral Rehydration ◽  
Rehydration Solutions ◽  
Few Data ◽  
Us Children

Oral rehydration solutions containing 50 to 90 mmol/L of sodium have recently been recommended for the treatment of diarrhea in both hospitalized and ambulatory children in the United States. Few data are available, however, from ambulatory US children. Therefore, we conducted a randomized double-blind study comparing the use of four different oral rehydration solutions with differing concentrations of sodium, glucose, and base. Ambulatory children less than 2 years of age with acute diarrhea (N = 140) were randomly chosen to receive solutions containing sodium at 90 (solution A), 50 (solution B), and 30 mmol/L (solutions C and D). All oral rehydration solutions contained 20 g/L of glucose except solution D which contained 50 g/L of glucose. Solution A contained bicarbonate as its base source whereas the other three contained citrate. All but three (98%) children were treated uneventfully according to the study protocol, and there were no differences among groups in measurements of clinical outcome. It was concluded that in ambulatory US children, oral rehydration solutions containing 90, 50, or 30 mmol/L of sodium can be used safely for the treatment of mild acute diarrhea and that citrate is as efficacious as bicarbonate in the correction of acidosis.

In Reply: Use and Misuse of Oral Therapy for Diarrhea

PEDIATRICS ◽  
1991 ◽  
Vol 88 (5) ◽  
pp. 1073-1074
Author(s):  
JOHN D. SNYDER
Keyword(s):  
United States ◽  
American Academy ◽  
Oral Therapy ◽  
The United States ◽  
Oral Rehydration ◽  
American Academy Of Pediatrics ◽  
Rehydration Solutions ◽  
The Us ◽  
The World ◽  
Oral Rehydration Salts

As Dr O'Banion points out, most of the oral therapy solutions available in the United States are classified as maintenance solutions by the American Academy of Pediatrics (AAP). However, as mentioned in the paper, these solutions have proven to be very effective treatment for children with dehydration in this country. Solutions conforming to the AAP recommendations as rehydration solutions are not as widely available in this country. The WHO/UNICEF oral rehydration salts formulation, which is supplied as inexpensive packets throughout the world, is not found easily in the US.

Letters to the Editor

PEDIATRICS ◽  
1995 ◽  
Vol 96 (2) ◽  
pp. 377-378
Author(s):  
Mitchell B. Cohen
Keyword(s):  
United States ◽  
Electrolyte Solutions ◽  
The United States ◽  
Letters To The Editor ◽  
Oral Rehydration ◽  
Rehydration Solutions

Dr Lallier writes that the taste of oral rehydration solutions (ORS) is an impediment to their use. I concur that ORS commonly in use in the United States are not tasty to my palate either. Exceptions are the CeraLyte rice-based oral electrolyte solutions (Cera Products, Columbia, MD), which are not readily available and have not yet been adequately studied in children. Some advocate the addition of powders or flavored sugarless solutions to enhance the palatability of ORS.

Rehydration

PEDIATRICS ◽  
1986 ◽  
Vol 77 (4) ◽  
pp. 618-618
Author(s):  
WILLIAM C. MACLEAN
Keyword(s):  
United States ◽  
Fluid Therapy ◽  
Acute Diarrhea ◽  
Oral Rehydration Therapy ◽  
The United States ◽  
Average Gain ◽  
Oral Rehydration

To the Editor.— The recent well-done study by Santosham et al1 seems to be mistitled, "Oral Rehydration Therapy for Acute Diarrhea in Ambulatory Children in the United States. . ." Rehydration was not studied. The average gain in weight in the first 24 hours of fluid therapy was 1% or less and indicated that dehydration was generally absent. The investigators studied the situation as it exists in the United States, ie, well-nourished, generally well-hydrated children with diarrhea.

Safety and Efficacy of High-dose Rhesus-Human Reassortant Rotavirus Vaccines-Report of the National Multicenter Trial

PEDIATRICS ◽  
1996 ◽  
Vol 98 (1) ◽  
pp. A38-A38 ◽  
Author(s):  
Margaret B. Rennels ◽  
Roger I. Glass ◽  
Penelope H. Dennehy ◽  
David I. Bernstein ◽  
Michael E. Pichichero ◽  
...  
Keyword(s):  
United States ◽  
Medical Center ◽  
The United States ◽  
Multicenter Trial ◽  
High Dose ◽  
Rotavirus Vaccine ◽  
Kaiser Permanente ◽  
Safety And Efficacy ◽  
Rotavirus Vaccines ◽  
Medical Office

In the January 1996 article titled "Safety and Efficacy of High-dose Rhesus Human Reassortant Rotavirus Vaccines—Report of the National Multicenter Trial" (Rennels et al. Pediatrics, 1996:97:7-13), the Acknowledgments section on page 12 included an incorrect location for one member of the United States Rotavirus Vaccine Efficacy Group, and another member was inadvertently omitted. The correct list should include: Stephen Fries, MD, Boulder Medical Center, Boulder, CO; and Hervey Froehlich, MD, Kaiser Permanente Medical Office, Fresno, CA.

Treatment of Infants with Acute Diarrhea: What's Recommended and What's Practiced

PEDIATRICS ◽  
1992 ◽  
Vol 90 (1) ◽  
pp. 1-4 ◽  
Author(s):  
Jorge A. Bezerra ◽  
Theodore H. Stathos ◽  
Burris Duncan ◽  
John A. Gaines ◽  
John N. Udall
Keyword(s):  
United States ◽  
Acute Diarrhea ◽  
Treatment Guidelines ◽  
The United States ◽  
Policy Statement ◽  
Family Practitioner ◽  
Family Practitioners ◽  
American Academy Of Pediatrics ◽  
Number Of Patients ◽  
Strength Formula

In 1985, the American Academy of Pediatrics (AAP) published a policy statement on the treatment of infants with acute diarrhea complicated by mild to moderate d ehydration. To determine how closely physicians in the United States follow the AAP's treatment guidelines, a questionnaire was sent to 457 pediatricians and 360 family practitioners. The questionnaire presented a hypothetical infant with acute diarrhea complicated by mild to moderate dehydration and included questions regarding the number of such patients seen yearly, length of time used to rehydrate the infant, and how formula or solids are introduced following rehydration. Complete responses were received from 53% of pediatricians and 40% of family practitioners. The number of patients with acute diarrhea seen per year did not affect physician's treatment. Pediatricians and family practitioners responded similarly to most questions. Contrary to the AAP's guidelines to rehydrate in 4 to 6 hours, 62% of responding physicians extend the rehydration period to 12 to 24 hours. Also contrary to the AAP's recommendations, 62% of pediatricians and family practitioners use a lactose-free formula. The majority of responding physicians do follow the AAP's treatment guidelines to initiate feedings with diluted formula. Significantly more pediatricians than family practitioner advance to a full-strength formula within 1 day (P = .011). Fewer than 50% of physicians polled started solids within 24 hours as suggested by the AAP. Overall, the findings suggest that very few pediatricians and family practitioners follow all aspects of the AAP's treatment guidelines for infants with acute diarrhea complicated by mild to moderate dehydration.

Operationalizing the Science

2011 ◽  
pp. 1600-1622
Author(s):  
Joseph L. Kannry
Keyword(s):  
United States ◽  
Medical Informatics ◽  
21St Century ◽  
Medical Center ◽  
The United States ◽  
Clinical Informatics ◽  
Evidence Based ◽  
Medical Practices ◽  
Healthcare It ◽  
Compare And Contrast

Healthcare IT (HIT) has failed to live up to its promise in the United States. HIT solutions and decisions need to be evidence based and standardized. Interventional informatics is ideally positioned to provide evidence based and standardized solutions in the enterprise (aka, the medical center) which includes all or some combination of hospital(s), hospital based-practices, enterprise owned offsite medical practices, faculty practice and a medical school. For purposes of this chapter, interventional informatics is defined as applied medical or clinical informatics with an emphasis on an active interventional role in the enterprise. A department of interventional informatics, which integrates the science of informatics into daily operations, should become a standard part of any 21st century medical center in the United States. The objectives of this chapter are to: review and summarize the promise and challenge of IT in healthcare; define healthcare IT; review the legacy of IT in healthcare; compare and contrast IT in healthcare with that of other industries; become familiar with evidence based IT: Medical informatics; differentiate medical informatics from IT in healthcare; distinguish medical, clinical, and interventional informatics; justify the need for operational departments of interventional informatics.

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