sodium-bicarbonate and Diarrhea--Infantile

In a double-blind, randomized trial, we compared the efficacy of bicarbonate-containing oral rehydration solution vs citrate-containing solution in the treatment of infantile diarrheal dehydration and acidosis. Ninety-seven infants 3 to 24 months of age were entered in the study; 49 received bicarbonate-containing solution and 48 citrate-containing solution. The two groups were similar in all respects at the beginning of the study. Oral rehydration was successful (i.e., no intravenously administered fluids were required) in 85% of study patients; the success rate was similar in both treatment groups. Serum total CO2 concentration increased in a similar fashion in both groups, reaching near normal values at 48 hours after admission. We conclude that sodium citrate can be substituted for sodium bicarbonate in the formulation of the orally administered rehydration solution recommended by the World Health Organization for treatment of diarrheal dehydration in infants.

Topics: Bicarbonates; Carbon Dioxide; Child, Preschool; Citrates; Citric Acid; Clinical Trials as Topic; Diarrhea, Infantile; Double-Blind Method; Female; Fluid Therapy; Hematocrit; Humans; Infant; Male; Sodium; Sodium Bicarbonate

This study investigated the therapeutic effectiveness of oral rehydration salt (ORS) solutions containing trisodium citrate (ORS-citrate) in place of sodium bicarbonate (ORS-bicarbonate). 74 children with cholera and 34 infants and children under 2 years of age with infantile diarrhea, all of whom had moderate to severe dehydration, were randomly assigned to 1 of the 2 treatment solution groups. Children with severe dehydration were 1st rehydrated with intravenous fluid followed by maintenance therapy with ORS solution (bicarbonate or citrate), while those with moderate dehydration received either ORS-bicarbonate or ORS-citrate during both the initial and the maintenance phases of therapy. Treatment effectiveness was assessed by comparing the success rates, stool output, ORS intake, gain in body weight, changes in erythrocyte volume fraction and plasma specific gravity, correction of acidosis, and maintenance of electrolyte balance. Of the children with cholera, 92% of those who received ORS-citrate and 86% of those who received ORS-bicarbonate were successfully treated. Of the children under 2 years of age with infantile diarrhea, 100% of those who received ORS-citrate and 94% of those who received ORS-bicarbonate were treated successfully. The results indicated that treatment with ORS-citrate is as successful as that with ORS-bicarbonate in terms of its ability to rehydrate, correct the acidosis, and maintain electrolyte concentrations. Thus, trisodium citrate dihydrate, which has the a advantage of a longer shelf-life in hot and humid climates, can effectively replace sodium bicarbonate in the standard ORS solution if used as an adjunct to standard hydration and antibiotic therapy in children with severe cholera or as the only treatment in children with infantile diarrhea assocated with less severe dehydration.

Topics: Bicarbonates; Child; Child, Preschool; Cholera; Citrates; Citric Acid; Diarrhea, Infantile; Electrolytes; Fluid Therapy; Humans; Infant; Sodium; Sodium Bicarbonate; Solutions

Sugar-based Oral Rehydration Therapy (ORT) is still the conventional treatment for diarrhoeal diseases. The WHO/UNICEF, and other groups endorse and actively promote its use for all cases of diarrhoea. Despite the deleterious effects of sugars promotion on dental health, and the incontrovertible role of sugars as the major factor responsible for the present upsurge in dental caries prevalence in the developing countries, the search for an ideal Oral Rehydration Solution (ORS) has so far completely ignored any dental considerations. Of the presently available rehydration solutions, the cereal or food-based solutions offer greater advantages over the sugar based solutions. Further research efforts must be directed at non-sugar based ORT, and funding organisations should give support to researchers and research institutions working to replace sugars with cereal flours, improve food-based ORS, or develop novel approaches to ORT that are based on non-cariogenic ingredients. Policy makers, researchers and health care workers generally must always consider, in addition to other factors, the dental implications of their recommendations on ORT.

Topics: Child, Preschool; Dental Caries; Developing Countries; Diarrhea, Infantile; Edible Grain; Fluid Therapy; Humans; Infant; Potassium Chloride; Rehydration Solutions; Sodium Bicarbonate; Sodium Chloride; Sucrose; World Health Organization

Topics: Acidosis; Bacterial Infections; Bicarbonates; Breast Feeding; Catheters, Indwelling; Diarrhea, Infantile; Follow-Up Studies; Humans; Infant, Newborn; Intestinal Obstruction; Male; Metronidazole; Milk, Human; Neomycin; Parenteral Nutrition; Ranitidine; Short Bowel Syndrome; Sodium; Sodium Bicarbonate; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Vomiting

A epidemic of enteric pathogens bacteria occurred in december 1989 and caused two deaths in a nursery. There were many investigations between december 1989 and september 1990 trying to clarify this epidemic context. A new serovar of Salmonella had for the first time been isolated from babies' feces in Algeria. Salmonella m'bandaka has been identified in more than 50% of analysis. During an hygienic investigation in this nursery the above Salmonella m'bandaka was isolated in a open physiologic solution flask.

Topics: Algeria; Bicarbonates; Campylobacter Infections; Comorbidity; Cross Infection; Diarrhea, Infantile; Disease Outbreaks; Drug Contamination; Drug Resistance, Microbial; Escherichia coli Infections; Feces; Humans; Infant; Rotavirus Infections; Salmonella; Salmonella Infections; Sodium; Sodium Bicarbonate; Solutions

Topics: Citrates; Citric Acid; Copper Sulfate; Diagnosis, Differential; Diarrhea, Infantile; Drug Combinations; Feces; Humans; Infant, Newborn; Intensive Care Units, Neonatal; Sodium Bicarbonate

Topics: Bicarbonates; Child; Child, Preschool; Diarrhea; Diarrhea, Infantile; Fluid Therapy; Glucose; Humans; Infant; Isotonic Solutions; Potassium Chloride; Sodium Bicarbonate; Sodium Chloride