Initial fluid of choice for diarrhea in an infant is:
Ans. c. ORS (Ref: Ghai 8/e p293 294)The cornerstone of acute diarrhea management is rehydration by using oral rehydrarion solutions (ORS). Initial fluid of choice for diarrhea in an infant is ORS.Acute Diarrhea ManagementThe cornerstone of acute diarrhea management is rehydration by using oral rehydration solutions (ORS).Principles of Acute Diarrhea Management1. Correction of dehydration, electrolytes and hypoglycemia2. Evaluation for infections using appropriate investigations and their management3. Nutritional therapyPhysiological Basis for Oral Rehydration TherapyIn most cases of acute diarrhea, sodium and chloride are actively secreted from the gut mucosa due to pathogen-induced dysfunction of several actively functioning absorption pumps.However, glucose dependent sodium pump remains intact and functional transporting one molecule of glucose and dragging along a molecule of sodium and one of water across intestinal mucosa resulting in repletion of sodium and water losses.The glucose dependent sodium and water absorption is the principle behind replacing glucose and sodium in 1:1 molar ratio in the WHO oral rehydration solution (ORS).Use of low osmolality ORS causes reduction of stool output, decrease in vomiting and decrease in the use of unscheduled IV fluids without increasing the risk of hyponatremia.For this reason, the recommendation for use of standard WHO ORS (having osmolarity of 311 mmol/l) was changed to low osmolarity WHO ORS (having osmolality of 245 mmol/l)QHome available fluids for Acute DiarrheaFluids that contain salt (preferable)* Oral rehydration solution* Salted drinks (e.g. Salted rice water or salted yoghurt drink)* Vegetable or chicken soup with saltFluids that do not contain salt (acceptabte)* Plain water, water in which a cereal has been cooked (e.g. unsalted rice water), unsalted soup, yoghurt drinks without salt, green coconut water, weak unsweetened tea, unsweetened fresh fruit juiceUnsuitable home available fluids* Commercial carbonated beverages, commercial fruit juices, sweetened teaZinc SupplementationIt is helpful in decreasing severity and duration of diarrhea and also risk of persistent diarrhea.Zinc is recommended to be supplemented as sulphate, acetate or gluconate formulation, at a dose of 20 mg of elemental zinc per day for children >6 months for a period of 14 days.Composition of WHO Recommended ORSConstituentg/lOsmole or ionmmol/lSodium chloride2.6Sodium75QGlucoser anhydrous13.5Chloride65Potassium chloride1.5Glucose, anhydrous75Trisodium citrate, dihydrate2.9Potassium20Q Citrate10Total osmolarity 245Q
Salt water
Sugar water
ORS
Dextrose
Fluid and Electrolyte Treatment of Specific Disorders