Rehydration therapy efficacy of viral gastroenteritis in children
DOI: 10.32364/2618-8430-2024-7-2-14
M.K. Bekhtereva1,2, A.M. Komarova1
1Children's Research and Clinical Center of Infectious Diseases of the Federal
Medical-Biological Agency, St. Petersburg, Russian Federation
2St. Petersburg State Pediatric Medical University, St. Petersburg, Russian Federation
Aim: to compare the efficacy of reduced osmolarity oral rehydration solution (ORS) with zinc and infusion therapy with salt and sugar-salt solutions in children suffering from viral gastroenteritis (VGE) complicated by dehydration syndrome of I-II stage and II stage.Patients and Methods: a prospective open-ended comparative randomized clinical trial was conducted. The children were divided into two groups: the main group (n=45) with therapy used reduced osmolarity ORS (carbohydrates 2.84 g, glucose 2.82 g, chlorides 0.453 g, zink 0.003 g, osmolarity: 245 mOsm/L, per 1 sachet), and the comparison group (n=34), receiving standard infusion therapy with salt-sugar solutions. The severity of acute gastroenteritis was assessed using a modified Vesikari score. Comprehensive clinical and laboratory examination of children was performed before and after treatment.
Results: the mean severity of the patients' condition on the modified Vesikari score was 13.26±0.7 points for VGE, which corresponds to the moderate severity. In 42 (93.3±4.5%) patients of the main group, the condition stabilization and reduction of pathological losses were achieved during the first 6 hours, and therefore oral rehydration was continued. In this case, the active use of ORS was conducted for 24–48 hours with an assessment of the trend in general and topical symptoms, as well as laboratory parameters of the fluid and electrolyte balance and renal excretion of nitrogenous compounds. 3 patients (6.66±3.7%) who required further parenteral fluid administration were excluded from the study due to the lack of proper oral rehydration effect associated with the vomiting and the impossibility of further therapeutic manipulations. During oral rehydration in the main group, the febrile reaction duration was comparable in the lasting with the comparison group. Normalization of general well-being in the form of the fatigue disappearance was noted in the compared groups at the same time, while the vomiting cessation was recorded in a significantly shorter time in the main group. Exicosis and diarrhea were managed to be stopped in the main and comparison groups at almost comparable time.
Conclusion: rehydration with low-osmolar ORS helps to avoid possible complications of parenteral fluid administration and a traumatic situation for a child.
Keywords: exicosis, dehydration syndrome, viral gastroenteritis, acute intestinal infection, oral rehydration, oral rehydration therapy, oral rehydration solution, zinc, low-osmolar oral rehydration solution, children.
For citation: Bekhtereva M.K., Komarova A.M. Rehydration therapy efficacy of viral gastroenteritis in children. Russian Journal of Woman and Child Health. 2024;7(2):177–183 (in Russ.). DOI: 10.32364/2618-8430-2024-7-2-14
ABOUT THE AUTHORS:
Maria K. Bekhtereva — C. Sc. (Med.), Senior Researcher at the Research Department of Intestinal Infections, Children's Scientific Clinical Center of Infectious Diseases of the Federal Medical Bio-logical Agency of Russia; 9A, Professor Popov str., St. Petersburg, 197022, Russian Federation; Associate Professor of the Department of Infectious Diseases in Children, St. Petersburg State Pediatric Medical University; 2, Litovskaya str., St. Petersburg, 194100, Russian Federation; ORCID iD 0000-0003-2923-1630.
Anna M. Komarova — Junior Researcher at the Research Department of Intestinal Infections, Children's Scientific Clinical Center of Infectious Diseases of the Federal Medical Biological Agency of Russia; 9A, Professor Popov str., St. Petersburg, 197022, Russian Federation; ORCID iD 0000-0001-7047-8307.
Contact information: Maria K. Bekhtereva, e-mail: mkbechtereva@mail.ru.
Financial Disclosure: no authors have a financial or property interest in any material or method mentioned.
There is no conflict of interest.
Received 18.02.2024.
Revised 15.03.2024.
Accepted 09.04.2024.
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4. Farthing M., Salam M.A., Lindberg G. et al. Acute diarrhea in adults and children: a global perspective. J Clin Gastroenterol. 2013;47(1):12–20. DOI: 10.1097/MCG.0b013e31826df662.
5. Николаева С.В., Усенко Д.В., Горелов А.В. Сочетанные острые кишечные инфекции у детей: клинические особенности, подходы к терапии. РМЖ. Медицинское обозрение. 2019;5:26–29.Nikolaeva S.V., Usenko D.V., Gorelov A.V. Combined acute enteric infections in children: clinical features and therapy approaches. RMJ. Medical Review. 2019;5:26–29 (in Russ.).
6. Guarino A., Ashkenazi S., Gendrel D. et al. European Society for Pediatric Gastroenterology, Hepatology, and Nutrition/European Society for Pediatric Infectious Diseases evidence-based guidelines for the management of acute gastroenteritis in children in Europe: update 2014. J Pediatr Gastroenterol Nutr. 2014;59(1):132–152. DOI: 10.1097/MPG.0000000000000375.
7. McDonald L.C., Gerding D.N., Johnson S. et al. Clinical Practice Guidelines for Clostridium difficile Infection in Adults and Children: 2017 Update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). Clin Infect Dis. 2018;66(7):e1–e48. DOI: 10.1093/cid/cix1085.
8. Жданов К.В., Захаренко С.М., Львов Н.И., Козлов К.В. Противодействие инфекциям в эпоху современных угроз. Инфекционные болезни: новости, мнения, обучение. 2017;6:85–91.Zhdanov K.V., Zakharenko S.M., Lvov N.I., Kozlov K.V. Countering infections in the era of modern threats. Infectious diseases: News, Opinions, Training. 2017;6:85–91 (in Russ.).
9. Мазанкова Л.Н., Горбунов С.Г., Павлова Л.А. Совершенствование патогенетической терапии острых кишечных инфекций у детей раннего возраста. Лечение и профилактика. 2013;4(8):54–57.Mazankova L.N., Gorbunov S.G., Pavlova L.A. Improving pathogenetic therapy of acute intestinal infections in young children. Lecheniye i profilaktika. 2013;4(8):54–57 (in Russ.).
10. Glass R.I., Stoll B.J. Oral Rehydration Therapy for Diarrheal Diseases: A 50-Year Perspective. JAMA. 2018;4;320(9):865–866. DOI: 10.1001/jama.2018.10963.
11. Trehan I., Grabowsky M., Schenker I. Oral Rehydration Therapy and Zinc: Looking Back and Looking Ahead. J Trop Pediatr. 2019;65(5):417–420. DOI: 10.1093/tropej/fmz052.
12. Buccigrossi V., Lo Vecchio A., Bruzzese E. et al. Potency of Oral Rehydration Solution in Inducing Fluid Absorption is Related to Glucose Concentration. Sci Rep. 2020;10(1):7803. DOI: 10.1038/s41598-020-64818-3.
13. Lazzerini M. Oral zinc provision in acute diarrhea. Curr Opin Clin Nutr Metab Care. 2016;19(3):239–243. DOI: 10.1097/MCO.0000000000000276.
14. Lazzerini M., Wanzira H. Oral zinc for treating diarrhoea in children. Cochrane Database Syst Rev. 2016;12(12):CD005436. DOI: 10.1002/14651858.CD005436.pub5.
15. Black R.E. Progress in the use of ORS and zinc for the treatment of childhood diarrhea. J Glob Health. 2019;9(1):010101. DOI: 10.7189/jogh.09.010101.
16. Goh N., Pollak K. Progress over a decade of zinc and ORS scale-up: best practices and lessons learned. (Electronic resource.) URL: https://clintonhealthaccess.org/content/uploads/2016/02/Progress-over-a-Decade-of-Zinc-and-ORS-Scale-Up.pdf. (access date: 02.02.2024).
17. Ермоленко К.Д. Значение оральной регидратации в терапии ротавирусной инфекции у детей. Вопросы практической педиатрии. 2022;17(6):55–61. DOI: 10.20953/1817-7646-2022-6-55-60.Ermolenko K.D. The importance of oral rehydration in the treatment of rotavirus infection in children. Clinical practice in pediatrics. 2022;17(6):55–61 (in Russ.). DOI: 10.20953/1817-7646-2022-6-55-60.
18. Ермоленко К.Ю., Александрович Ю.С., Ермоленко К.Д. и др. Оценка тяжести состояния и прогнозирование исходов инфекционных заболеваний у детей. Клиническая инфектология и паразитология. 2022;11(3):192–203. DOI: 10.34883/PI.2022.11.3.026.Ermolenko K.Yu., Aleksandrovich Yu.S., Ermolenko K.D. and others. Assessing the severity of the condition and predicting the outcome of infectious diseases in children. Clinical infectology and parasitology. 2022;11(3):192–203 (in Russ.). DOI: 10.34883/PI.2022.11.3.026.
19. Руководство по амбулаторно-поликлинической педиатрии. Под ред. А.А. Баранова М.: ГЭОТАР-Медиа; 2006.Guide to outpatient pediatrics. Ed. A.A. Baranova. M.: GEOTAR-Media; 2006 (in Russ.).
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