The development of an intestinal infection in the body is accompanied by a complex of unpleasant symptoms - frequent urge to go to the toilet, cutting sharp pains in the abdomen, vomiting, fever. During an illness, a person loses a large amount of fluid, which must be replenished as soon as possible. There are two main methods of rehydration of the body - oral (ORT) and intravenous (VIT), however, the first method is preferred in most cases. In our article, we will consider the main points related to the concept of ORT. We will try to give answers to the questions: “What is ORT?”, “In what cases is it appropriate to conduct it?”, What are the rules of oral rehydration?” etc.
Intestinal infections, gastrointestinal symptoms
Acute intestinal infections (AII) include a whole group of infectious diseases caused by microorganisms - viruses or bacteria. This category of pathological conditions is characterized by similar symptoms and affects mainly the gastrointestinal tract,causing his dysfunction.
The carriers of the pathogen (sick people or animals) become the source of infection.
The symptoms of diseases are very diverse. Gastrointestinal disorders are associated with the occurrence of gastritis, enteritis or colitis:
- gastritis is accompanied by nausea, vomiting, heartburn, belching, pain in the epigastric region;
- enteritis leads to bloating, rumbling of the intestines, painful sensations with unclear localization (diffuse abdominal pain), loose stools without mucus or blood;
- colitis is characterized by false urge to defecate, sharp pain in the left iliac region, frequent loose stools interspersed with mucus or blood;
- there are cases when the manifestations of the disease combine signs of gastritis, colitis and enteritis.
Other signs of OKI
In addition to malfunctions in the gastrointestinal tract, other disturbances in the body's activity occur with AII:
- severe intoxication against the background of fever, vomiting, headaches;
- enlarged spleen and liver;
- disorders associated with a lack of minerals and trace elements (anemia, hypovitaminosis);
- appearance of a rash of various etiologies on the body;
- toxic shock;
- in babies there is a retraction of a large fontanel.
In addition, one of the most dangerous manifestations of AII is dehydration -the process, as a result of which there is a lack of fluid in the structures and tissues of the body. This can be expressed by dryness of the mucous membranes or skin, the patient is very thirsty, he has a hemodynamic disorder. In severe forms of dehydration, anhydrous shock develops. In addition, fever, lack of normal salivation, hoarseness of voice are possible. A person loses body weight, while soft tissue turgor occurs - a condition in which the cell membranes are tense. The dehydration syndrome is called exsicosis. To replace the lost fluid in the body, in most cases, oral rehydration is performed.
Danger of exsicosis for babies
Acute intestinal infections are insidious because they develop very quickly. In addition, this group of pathologies is characterized by frequent complications and a severe course of the disease.
Clinical manifestations of salmonellosis, viral diarrhea, shigellosis, escherichiosis in children can, unfortunately, end in death due to the development of dehydration syndrome - exicosis.
Sensitivity to pathological fluid loss is primarily due to the peculiarities of the system of water-s alt metabolism in infants and children of the first years of life. Compared to an adult, a child's body is characterized by:
- functional immaturity of the genitourinary organs (kidneys);
- large volume of extracellular fluid;
- in children, the excretion of water through the lungs and skin occurs to a greater extent, and this is due to the fact thatthe ratio of the body surface to a unit of mass is a large value when compared with the body of an adult.
The main method of recovering babies after acute intestinal infections is to replenish the lost fluid. Oral rehydration in children, as well as in the adult population, is indicated in case of mild or moderate exsicosis and involves the use of glucose-s alt solutions. An alternative to this measure is intravenous rehydration, as well as related manipulations - etiotropic therapy, diet therapy, enterosorption.
What is ORT?
ORT is the process of replenishing fluid lost by the body due to vomiting and/or frequent bowel movements, as well as fever. To perform the above action, glucose-s alt solutions are used, which enter the patient's body in the traditional way.
The method of oral rehydration is based on the properties of glucose, which promotes the transfer of sodium and potassium ions lost during pathological conditions through the intestinal mucosa, due to which the water-s alt balance is restored.
The effectiveness of oral rehydration directly depends on the timeliness of the manipulation. The procedure should be started already in the first hours of the onset of symptoms of the disease, at home, even before the arrival of medical specialists.
Depending on whether the loss of what prevails in the body - water or electrolytes, they distinguish:
- s alt deficiency dehydration - predominant loss of electrolytes;
- water scarcedehydration - water loss predominates;
- isotonic dehydration - the loss of water and electrolytes occurs to the same extent.
In accordance with this classification, drugs of various composition are used to eliminate dehydration.
Drugs
When the body is dehydrated (exicosis), it is urgent to replenish the volume of lost fluid. Solutions for oral rehydration can be prepared independently by mixing the powder previously purchased at the pharmacy with water, or using a ready-made preparation. The range of medicines presented in pharmacies is quite diverse.
To stop the process of dehydration of the body, for example, the drug "Regidron" is often used. One dose of the powder contains sodium chloride, sodium citrate, potassium chloride and glucose. An analogue of this remedy is Glucosolan, which contains sodium chloride, sodium bicarbonate, potassium chloride and glucose. These powders are diluted with one liter of water (boiled). It should be remembered that the diluted drug is stored for no more than a day, so it should be prepared immediately before taking.
For oral rehydration, biorice or carrot-rice broths, as well as Oralit, Hydrovit, Hydrovit Forte, etc. can be used.
The composition of the polyionic preparation "Hydrovit" includes a sorbent - colloidal silicon dioxide. "Hydrovit" and "Hydrovit Forte" are prescribed for young children. The specific taste of the solution is masked by the strawberry aroma. There isalso preparations without additives. The contents of the Hydrovita or Hydrovita Forte package are diluted with a glass (200 ml) of water or chilled tea. The solution is given to the patient in small portions (often soldered with a spoon).
Dosage
The daily volume of a polyionic solution is a rather conditional indicator. Depending on the degree of exicosis (i.e., on the patient's condition), on the timeliness of the start of restorative procedures, on the type of drug, the dose of the drug may vary in each case. Overdosing, for example, can be effective early in treatment.
The following volumes of drugs are advisory (per kilogram of body weight):
- babies - 100-150 ml of the drug;
- younger children - 80-120ml;
- schoolchildren - 50-80 ml;
- older children, adults - 20-60 ml.
Often in the treatment of young children, glucose-s alt solutions are combined with s alt-free solutions - rice water, water, tea, rosehip broth in the following proportions:
- 1:1 - for watery diarrhea;
- 1:2 - for fever and mild diarrhea;
- 2:1 - with severe vomiting.
S alt and non-s alt solutions cannot be mixed, so their introduction is alternated. When performing oral rehydration in infants, they do not stop feeding, but reduce the amount of food to 50-75%.
Oral Rehydration Algorithm
An oral rehydration procedure is usually done in two sets. First eliminate the water-s alt deficiency -manipulation is performed within the first six hours. At the second stage, maintenance therapy is started. This is done during the entire subsequent period of treatment.
During rehydration, the patient's daily need for fluids and s alts is taken into account. It is also important not to forget that even during therapy, some losses are still present. During the second stage of the procedure, a person needs to replenish with a medical solution the volume of fluid that he lost with the stool during the previous six hours.
The effectiveness of oral rehydration is due in most cases only to how correctly the procedure was carried out. It should be remembered that when soldering a large volume of solution, the patient may vomit, so the liquid must be administered gradually: 1-2 teaspoons every 5-10 minutes. If nausea is present, wait a bit and continue fluid administration.
The use of rehydration drugs usually lasts until the diarrhea stops.
The effectiveness of the procedure is evaluated according to several criteria:
- weight gain;
- improvement of general condition;
- reducing the volume of fluid lost with stool and vomiting.
Oral rehydration treatment for children
There are times when the elimination of the symptoms of exsicosis in young children must be started immediately, at home, before the arrival of doctors. Therefore, the mother must clearly understand the purpose and course of the upcoming procedure. You should do something like this:
- treat hands with antiseptic;
- put on gloves;
- put the baby on a horizontal surface, while turning the head to one side;
- use a ready-made solution or, using powder and liquid, prepare the drug yourself (it is important to strictly follow the indicated instructions, consult a specialist if possible);
- for six hours every 5-10 minutes to solder the child one teaspoon of the solution (in especially severe cases, the liquid can be administered through a probe - through the nose); the rehydration procedure is carried out until the symptoms of vomiting and diarrhea stop;
- if there is no urination for more than 6-8 hours, infusion therapy is started - the introduction of solutions into the bloodstream, the dosage should be strictly calculated;
- process the spoon and container that contained the solution;
- remove gloves, sanitize hands.
Oral versus intravenous rehydration
Elimination of the symptoms of exsicosis and replenishment of the fluid lost by the body is possible not only by oral, but also by intravenous rehydration. These two methods are constantly compared, research is being conducted on their effectiveness. To date, the results are as follows: both methods help to achieve the goals at about the same level, but each of them has its own characteristics.
It has been established that oral rehydration shows the best results in the treatment of children. The drugs are administered in the traditional way,once again without injuring the child. Medicines are combined with decoctions of natural products. This technique is recommended as the primary treatment for mild to moderate dehydration in babies.
These conclusions came after two years of research, which involved children aged two months to three years with symptoms of mild dehydration. Seventy-three little patients were divided into two groups - one category of children was prescribed ORT, the other - HIT.
As a result, patients who received oral rehydration therapy took less time. After oral rehydration, the need for further hospitalization was reduced.
However, despite research findings, the vast majority of pediatricians continue to use intravenous fluid therapy (IVT) to address the effects of moderate exsicosis in children.
Advantages of the ORT method
The ORT method restores the concentration of potassium and sodium in the body much faster. At the same time, stool normalization can be observed 1-2 days later compared to HIT.
The use of oral rehydration therapy automatically reduces the number of intravenous infusions in hospitals, contributing, on the one hand, to reducing the cost of patient treatment, and on the other hand, it provides anti-epidemic protection by preventing viral hepatitis, which can enter the body through the blood or mucous membranes.
In addition, the simplicity of the method, as well as its availabilityprovide the possibility of using ORT in the clinic or at home. Early use of oral rehydration therapy virtually eliminates the need for hospitalization.
Proper application of the method causes almost no complications, while infusion therapy causes side effects in more than 15% of patients.
If ORT is performed incorrectly, the following negative reactions may occur:
- vomiting - due to the rapid desoldering of the patient with a large volume of solution;
- edema - occurs when the proportion of water and saline is incorrect.
Degrees of exicosis
As noted earlier, the oral rehydration technique is indicated for mild to moderate dehydration. To understand whether it is possible to carry out ORT at home or if other methods of restoring the body should be resorted to, it is necessary to know the classification of exsicosis and the signs that accompany each of the degrees of pathology. This is especially true in the case of illness in infants and toddlers in the first years of life.
There are three degrees of exsicosis:
- First - characterized by a slight loss of fluid (up to 5% of body weight). This condition is accompanied by moderate thirst, normal skin elasticity, the presence of lacrimal fluid, and normal breathing. In children, a large fontanel does not sink.
- In the second degree of pathology, failures in the work of the cardiovascular system are observed. In this case, the body loses more fluid (up to 10% of body weight). The patient has lethargy or, conversely, anxiety;sunken eyes; lack of tear fluid; weak and rapid pulse. A large fontanel sinks in children.
- The third degree of exsicosis results in fluid loss of more than 10% of body weight. The patient is in serious condition, he has hemodynamic disturbances, hypovolemic shock. The condition is characterized by signs such as drowsiness, lack of desire to take fluids, cold extremities, very dry oral mucosa, and no urination for six hours or more.
If fluid loss exceeds 20% of body weight, in most cases the disease ends in death.
