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2. Therapy for Diarrhea
Pages 11-26

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From page 11...
... in industrialized and developing countries has received considerable attention and has been well documented.l0,ll,36~37~43 The oral Dehydration solution formula recommended by the World Health Organization (WHO) contains, in millimols per liter, the following: sodium, 90; chloride, 80; potassium, 20; glucose, 111; and a base, such as citrate tribasic or bicarbonate, 30.
From page 12...
... Suitable intravenous Dehydration solutions, such as Ringer's lactate, have been described elsewhere.52 Maintenance with ORT solution is then begun. Persistent vomiting is often given as a reason for withholding ORT solutions, but vomiting usually stops in the first 4 hours if ORT solutions are used.
From page 13...
... In these studies, nutritional status was measured, and continued feeding was urged for children treated either with or without ORT solutions. Children receiving the oral rehydration solution showed significantly greater gains in weight than children not receiving the solution; the difference persisted over time, even though not all gained weight at normal rates.
From page 14...
... Careful attention will need to be paid to this group. The development of specific protocols for the dietary management of acute diarrhea in different settings goes beyond the scope of this discussion.
From page 15...
... The quality of the mixture of dietary proteins should be considered in selecting foods either to complement breast milk or to provide all a child's nutrient intake. Protein quality should be assessed on the basis of digestibility and the balance of essential amino acids, which are determinants of the efficiency with which the protein is used for maintenance and growth.
From page 16...
... Vegetable fats that include relatively high proportions of unsaturated fat or fats of medium chain length are recommended for the first 6 months of life and are preferred during the early phases of treatment for diarrhea, because they are generally more digestible and absorbable than highly saturated, long-chain fats.l3 Plant-seed oils (e.g., corn and soy) are relatively high in unsaturated fats, including the essential fatty acids.
From page 17...
... Carbohydrates usually account for 35-55% of dietary energy during early infancy.3 The principal types of dietary carbohydrate are starches and the disaccharides sucrose and lactose. Although the feeding of lactose to infants with gastroenteritis might be considered unwise, because of the recognized loss of intestinal lactase activity during intestinal infection, this type of acquired lactase deficiency is seldom total.
From page 18...
... Cameron and Hofvander9 include sample recipes that could be developed and tested for local use. When a child's clinical status does not permit the introduction of complex foods at the beginning of treatment, the addition of starches, cereal powders, proteins, amino acids, or small polypeptides to standard oral Dehydration solutions can be beneficial.
From page 19...
... o :^ l ·- o^ al cat —¢ · · · .~ a c' bo o .,' ~ ~ c.
From page 20...
... ] / ( gas tric capac ity)
From page 21...
... Local food-processing techniques should be used whenever possible, because of their familiarity to the population. For example, the digestibility of legumes can be improved through familiar cooking, fermenting, or germinating techniques that are not ordinarily used for infant feeding; particle size can be reduced by using simple food mills.
From page 22...
... During convalescence, defined as extending from cessation of liquid stools to return to preillness nutritional status, the quantity and frequency of feeding are determined by ad libitum intakes. Keeping track of a child's weight will ensure that ad libitum intakes meet the estimated nutrient needs and that the .
From page 23...
... Easily recognized indicators of the severity of illness should be used in the formulation of these guidelines -- e."., frequency of stools, duration of illness, clinical signs of dehydration, state of alertness, willingness to eat and drink, fever, and blood in the stools. Primary health care workers also need criteria for identifying infants who require more individualized attention.
From page 24...
... Abdominal distention and In adjusting dietary management because of these adverse clinical responses, it is important to stress that it is the child, and not the stool, that is being treated. Feeding should continue even in children whose diarrhea!
From page 25...
... Antibiotics might decrease the duration of diarrhea, the period of discomfort, the potentially lethal complications of gram-negative bacterial infection, and the nutritional deterioration caused by excessive loss of protein in stools in such infection. Antidiarrheal drugs -- such as diphenoxylate, loperamide, tincture of opium, and paregoric -- can reduce symptoms of abdominal cramps, but do not substantially alter diarrhea!


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