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The management of the critically ill child with dehydration secondary to diarrhea.

L. Finberg

Published 1970 in Pediatrics

ABSTRACT

Diarrhea and vomiting, which so frequently complicate diarrheal diseases, occur in a variety of disorders affecting infants. Although enteric infections cause these symptoms more often than all other diseases combined, noninfectious causes may occasionally also occur. While each cause may have specific other effects, the discussion here will deliberately be limited to the management of the physiologic disturbances that accompany excessive loss of water and salts from tile gastrointestinal tract. Etiologic considerations, however important they may be, will not be further pursued. This emphasis is appropriate since survival following critical dehydration depends far more upon the correction of the physiologic disturbance than upon the removal of the cause. A critical stage in diarrheal disease may be defined as occurring when a volume of fluid equal in mass to about 10% of the body weight has been lost over a period of a day or two. Clinically, this usually occurs shortly after anorexia or vomiting has precluded oral intake. At this stage of illness, parenteral fluid therapy should be employed. Oral intake should be curtailed during the early hours of therapy. The use of milk or other foods high in calories and solute complicates management by markedly increasing stool water losses. Even if severe undernutrition coexists with tile diarrhea, the first 6 to 8 hours should be a period of brief starvation; the parenteral glucose will provide emergency calories. Although such routes of administration as intragastric drip and subcutaneous infusion have been employed successfully, their usage should be restricted to places where a deficiency of supplies or trained personnel interdicts the preferred parenteral route—continuous intravenous infusion.

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