The development of intestinal infection in the body is accompanied by a complex of unpleasant symptoms - frequent urination, cutting sharp abdominal pains, vomiting, fever. During an illness, a person loses a large amount of fluid, which must be replaced as soon as possible. There are two main ways to rehydrate the body — oral (ORT) and intravenous (HIT), but the first technique is preferred in most cases. In our article, we consider the main points related to the concept of ORT. We will try to answer the questions: “What is ORT?”, “In which cases is it appropriate to conduct it?”, What are the rules for oral rehydration? ” and etc.
Intestinal infections, gastrointestinal symptoms
Acute intestinal infections (ACI) include a whole group of infectious diseases caused by microorganisms - viruses or bacteria. The indicated category of pathological conditions is characterized by similar symptoms and affects mainly the gastrointestinal tract, causing its dysfunction.
In this case, carriers of the pathogen (sick people or animals) become the source of infection.
Symptoms of diseases are very diverse. Disorders in the digestive tract 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 (spilled pain in the abdomen), loose stools without an admixture of mucus or blood;
- colitis is characterized by a false urge to defecate, a sharp pain in the left iliac region, frequent loose stools with interspersed mucus or blood;
- there are cases when the manifestations of the disease combine the symptoms of gastritis, colitis and enteritis.
Other signs of OCI
In addition to disruptions in the work of the gastrointestinal tract, other disorders in the activity of the body occur during acute intestinal infections:
- severe intoxication against a background of increased body temperature, vomiting, headaches;
- enlarged spleen and liver;
- disorders associated with a lack of minerals and trace elements (anemia, hypovitaminosis);
- the appearance on the body of a rash of various etiologies;
- infectious toxic shock;
- in infants, a large fontanel is sinking.
In addition, one of the most dangerous manifestations of OCI is dehydration - a process that results in a deficiency of fluid in the structures and tissues of the body. This can be expressed by dry mucous membranes or skin, the patient is very thirsty, he has a hemodynamic disorder. In severe forms of dehydration, anhydremic shock develops. In addition, fever, lack of normal salivation, hoarseness of the voice is possible. A person loses body weight, while soft tissue turgor occurs - a condition in which cell membranes are strained. The dehydration syndrome is called exicosis. To replenish the lost fluid in the body, in most cases, oral rehydration is performed.
The danger of exsicosis for babies
Acute intestinal infections are insidious in that they develop very quickly. In addition, this group of pathologies is characterized by frequent complications and a severe course of the disease.
The clinical manifestations of salmonellosis, viral diarrhea, shigellosis, and 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 features of the system of water-salt metabolism of infants and children of the first years of life. Compared to adults, a child’s body is characterized by:
- functional immaturity of the organs of the genitourinary sphere (kidneys);
- a large volume of extracellular fluid;
- in children, water is released through the lungs and skin to a greater extent, and this is due to the fact that the ratio of the surface of the body 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 degree of exsicosis and implies the use of glucose-salt solutions. An alternative to this measure is intravenous rehydration, as well as concomitant 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 actions, glucose-salt solutions are used that 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 in pathological conditions through the intestinal mucosa, due to which the water-salt 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, before the arrival of medical specialists.
Depending on whether the loss of what prevails in the body - water or electrolytes, there are:
- salt deficiency dehydration - predominant loss of electrolytes;
- water deficiency dehydration - water loss predominates;
- isotonic dehydration - loss of water and electrolytes occurs to the same extent.
In accordance with this classification, various formulations are used to eliminate dehydration.
Preparations
With dehydration (exsicosis), it is urgent to replenish the volume of lost fluid. Solutions for oral rehydration can be prepared independently by mixing powder previously purchased in a pharmacy with water, or using a ready-made drug. The range of medicines presented in pharmacies is quite diverse.
For stopping the process of dehydration, for example, the drug "Rehydron" is often used. One dose of powder contains sodium chloride, sodium citrate, potassium chloride and glucose. An analogue of this tool 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 in a diluted form, the drug is stored for no more than a day, so it should be prepared immediately before administration.
When oral rehydration can be used biorisovye or carrot-rice decoctions, as well as funds "Oralit", "Hydrovit", "Hydrovit Forte" and others.
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 a strawberry flavor. There are also no-supplement preparations. The contents of the Hydrovita or Hydrovita Forte packet 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 arbitrary indicator. Depending on the degree of exicosis (i.e., on the condition of the patient), on the timeliness of the start of recovery procedures, on the type of drug, the dose of the medicine can vary in each case. Excess doses, for example, may be effective at the start of treatment.
The following volumes of drugs are advisory in nature (per one kilogram of body weight):
- infants - 100-150 ml of the drug;
- young children - 80-120 ml;
- schoolchildren - 50-80 ml;
- older children, adults - 20-60 ml.
Often in the treatment of young children, glucose-salt solutions are combined with salt-free - rice broth, water, tea, rosehip broth in the following proportions:
- 1: 1 - with watery diarrhea;
- 1: 2 - with fever and moderate diarrhea;
- 2: 1 - with severe vomiting.
Salt and salt-free solutions must not be mixed, so their administration is alternated. When carrying out oral rehydration in infants, their feeding does not stop, but they reduce the amount of food to 50-75%.
Oral rehydration: algorithm
The oral rehydration procedure is usually carried out in two approaches. First, water-salt deficiency is eliminated - the 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.
When rehydration takes into account the patient's daily need for fluids and salts. It is also important not to forget that even with therapy, some losses are still present. During the second stage of the procedure, a person needs to replenish with the help of a drug solution the volume of fluid that he lost with stool during the previous six hours.
The effectiveness of oral rehydration in most cases is determined only by how well the procedure was carried out. It should be remembered that when desoldering a large volume of the solution, the patient may experience vomiting, therefore, the liquid must be administered gradually: 1-2 teaspoons every 5-10 minutes. If nausea is present, wait a little and continue to administer the fluid.
The use of rehydration medications usually lasts until the diarrhea stops.
The effectiveness of the procedure is evaluated on several grounds:
- weight gain;
- general condition improvement;
- decrease in the amount of fluid lost with stool and vomiting.
Oral rehydration in children
There are cases when the elimination of the symptoms of exicosis in young children must begin immediately, at home, before the arrival of doctors. Therefore, mom should clearly understand the purpose and course of the upcoming procedure. You should do something like the following:
- treat your hands with an antiseptic;
- wear gloves;
- put the child on a horizontal surface, while turning the head to the side;
- apply the ready-made solution or, using powder and liquid, prepare the drug yourself (it is important to strictly follow the specified instructions, if possible consult a specialist);
- for six hours, every 5-10 minutes, solder the child one teaspoon of the solution (in especially severe cases, the liquid can be introduced by means of a probe through the nose); the rehydration procedure is carried out until the symptoms of vomiting and diarrhea stop;
- if urination is absent for more than 6-8 hours, start infusion therapy - the introduction of solutions into the bloodstream, the dosage should be strictly calculated;
- process the spoon and the container in which the solution was contained;
- remove gloves, treat hands with an antiseptic.
Comparison of oral and intravenous rehydration
The elimination of the symptoms of exicosis and the replenishment of fluid lost by the body is possible not only through oral, but also through intravenous rehydration. These two methods are constantly being compared, studies are being conducted on the subject of their effectiveness. To date, the results are as follows: both methods help achieve your goals at approximately the same level, but each of them has its own characteristics.
It has been established that in the treatment of children, oral rehydration shows the best results. Drugs are administered in the traditional way, without again injuring the child. Medicines are combined with decoctions of natural products. This technique is recommended as the main therapy for mild to moderate dehydration in babies.
These conclusions were reached after two-year studies in which children aged two months to three years with symptoms of moderate dehydration participated. Seventy-three small patients were divided into two groups - one category of children was prescribed ORT, the other - HIT.
As a result, patients who were prescribed oral rehydration took less time. After oral rehydration, the need for further hospitalization was reduced.
However, the vast majority of pediatricians, despite the results of studies, continue to use intravenous infusion therapy (HIT) to eliminate the effects of mild exicosis in children.
Advantages of the ORT Method
The ORT technique 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 automatically reduces the number of intravenous infusions in hospitals, contributing, on the one hand, to lowering the cost of treating a patient, and on the other, providing anti-epidemic protection by preventing viral hepatitis that can enter the body through the blood or mucous membranes.
In addition, the simplicity of the method, as well as its availability, makes it possible to use ORT in the clinic or at home. Early use of oral rehydration virtually eliminates the need for hospitalization.
Proper use of the method practically does not cause complications, while with infusion therapy, side effects occur in more than 15% of patients.
If ORT is performed incorrectly, the following negative reactions can occur:
- vomiting - due to rapid desoldering of the patient with a large volume of solution;
- edema - occur with the wrong proportion of water and saline.
Degrees of exsicosis
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 to resort to other methods of restoring the body, you need to know the classification of exicosis and the signs that accompany each of the degrees of pathology. This is especially true in the case of illness of infants and toddlers of the first years of life.
There are three degrees of exicosis:
- The first is 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 tear fluid, normal breathing. In children, a large fontanel does not sink.
- With the second degree of pathology, malfunctions in the cardiovascular system are observed. In this case, the body loses a large amount of fluid (up to 10% of body weight). The patient has lethargy or, conversely, anxiety; sunken eyes; lack of tear fluid; weak and frequent pulse. In children, a large fontanel sinks.
- The third degree of exsicosis leads to a loss of fluid 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 limbs, very dry mucous membranes of the oral cavity, lack of urination for six hours or more.
If fluid loss exceeds 20% of body weight, in most cases the disease ends in death.