Oral rehydration: technique

The development of an intestinal infection in the body is accompanied by a complex of unpleasant symptoms - frequent urge to the toilet, cutting sharp pains in the abdomen, vomiting, fever. During illness, a person loses a large amount of fluid, which must be replenished as soon as possible. There are two main ways of rehydration of the body - oral (ORT) and intravenous (IVT), however, in most cases, the first method is preferable. In this article we will consider the main points related to the concept of ORT. We will try to answer the questions: "What is ORT?", "In what cases is it appropriate?", What are the rules for oral rehydration? ", Etc.

Intestinal infections, symptoms from the digestive tract

To acute intestinal infections (OCI) include a whole group of infectious diseases caused by microorganisms - viruses or bacteria. This category of pathological conditions is characterized by similar symptoms and affects mainly the gastrointestinal tract, causing its dysfunction. The source of infection in this case are carriers of the pathogen (sick people or animals).

Symptomatic diseases are very diverse. Disorders in the work of the gastrointestinal tract are associated with the occurrence of gastritis, enteritis or colitis:

• Gastritis accompanied by nausea, vomiting, heartburn, belching, painful sensations in the epigastric region;
• Enteritis leads to bloating, rumbling of the intestine, painful sensations with unclear localization (diffuse abdominal pain), a loose stool without mucus or blood;
• Colitis is characterized by false urges for defecation, a sharp pain in the left ileal region, a frequent loose stool with splotches of mucus or blood;
• There are cases when manifestations of the disease combine the symptoms of gastritis, colitis and enteritis.

Other signs of OCI

In addition to failures in the work of the gastrointestinal tract, in OCI there are other disorders in the activity of the organism:

• Strong intoxication on the background of fever, vomiting, headaches;
• Increased spleen and liver;
• Disorders associated with a lack of minerals and trace elements (anemia, hypovitaminosis);
• The appearance on the body of rashes of various etiologies;

• Infectious-toxic shock;
• In babies there is a wiggling of a large fontanel.

In addition, one of the most dangerous manifestations of OCI is dehydration of the body - a process that results in a deficiency of fluid in the structures and tissues of the body. It can be expressed by the dryness of the mucous membranes or skin, the patient experiences severe thirst, he has a disorder of hemodynamics. In severe forms of dehydration, an anhydrone shock develops. In addition, fever is possible, lack of normal salivation, hoarseness of voice. The person loses body weight, thus there is a turgor of soft tissues - a condition in which the cell walls are strained. The dehydration syndrome is called exsicosis. To replenish the lost fluid in the body in most cases, oral rehydration is performed.

Danger of excoxicosis in infants

Acute intestinal infections are insidious in that they develop very quickly. In addition, this group of pathologies is characterized by frequent complications and severe course of the disease.

The clinical manifestations of salmonellosis, viral diarrhea, shigellosis, escherichiosis in children can, unfortunately, end with a lethal outcome due to the development of the dehydration syndrome - exsicosis. Sensitivity to pathological fluid loss is primarily due to the peculiarities of the system of water-salt metabolism of infants and children of the first years of life. Compared with an adult, a child's body is characterized by:

• Functional immaturity of the organs of the urino-genital area (kidneys);
• Large volume of extracellular fluid;
• In children, the secretion of water through the lungs and the skin occurs in a greater degree, 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 if compared with the body of an adult.

The main method of restoring children after acute intestinal infections is the replacement of the lost fluid. Oral rehydration in children, as well as in the adult population, is indicated in the case of mild to moderate degree of exsicosis And implies Use of glucose-salt solutions. An alternative to this measure is intravenous rehydration, as well as concomitant manipulations - etiotropic therapy, dietotherapy, enterosorption.

What is ORT?

ORT is the process of replenishment of a fluid lost by the body due to vomiting and / or frequent defecation, as well as fever. To perform the above-described action, glucose-salt solutions are used that enter the patient's body in a traditional way. The method of oral rehydration is based on the properties of glucose, promoting 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 begin already in the first hours of the manifestation of the symptoms of the disease, at home, even before the arrival of medical specialists.

Depending on whether the loss in the body predominates - water or electrolytes, distinguish:

• Salt depletion - the primary loss of electrolytes;
• Water deficit dehydration - water loss prevails;
• Isotonic dehydration - the loss of water and electrolytes occurs to the same extent.

In accordance with this classification, various preparations are used to eliminate dehydration.

Preparations

When dehydrating the body (exsicause), it is necessary to urgently fill the volume of the lost fluid. Solutions for oral rehydration can be prepared independently, mixed with water previously purchased at the pharmacy powder, or use a ready-made drug. The assortment of medicines presented in pharmacies is quite diverse.

To stop the process of dehydration of the body, for example, often use the drug "Regidron". One dose of the powder contains sodium chloride, sodium citrate, potassium chloride and glucose. The analogue of this remedy is "Glucosolan", which contains sodium chloride, sodium bicarbonate, potassium chloride and glucose. These powders are diluted in 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 taking.

With oral rehydration, biris or carrot-rice decoctions, as well as Oralit, Hydrovit, Hydrovit Forte, and others can be used.

The sorbent-silicon colloidal dioxide is included in the composition of the polyionic preparation "Hydrovit". "Hydrovit" and "Gidrovit Forte" are assigned to small children. Specific taste of the solution is masked by strawberry aroma. There are also drugs without additives. The contents of the package "Hydrovita" or "Hydrovita Forte" are diluted with a glass (200 ml) of water or chilled tea. The solution is given to the patient in small portions (often with a spoon).

Dosage

The daily volume of a polyionic solution is a rather conventional indicator. Depending on the degree of exsicosis (i.e., on the patient's condition), on the timeliness of the onset of recovery procedures, on the type of drug, the dose of the drug may vary in each specific case. Excess dose, for example, can be effective at the beginning of treatment.

The following amounts of drugs are recommendatory in nature (per kilogram of body weight):

• Infants - 100-150 ml of the drug;
• Children of younger age - 80-120 ml;
• Schoolchildren - 50-80 ml;
• Children of older age, adults - 20-60 ml.

Often in the treatment of young children, glucose-salt solutions are combined with salt-free solutions - rice broth, water, tea, rosehip broth in the following proportions:

• 1: 1 - with watery diarrhea;
• 1: 2 - with fever and mild diarrhea;
• 2: 1 - with severe vomiting.

Salt and salt-free solutions can not be mixed, so their introduction alternates. When oral rehydration is performed in infants, their feeding does not stop, but they reduce food volumes to 50-75%.

Oral rehydration: algorithm

The procedure for oral rehydration is usually carried out in two approaches. First, water-salt deficiency is eliminated-manipulation is performed within the first six hours. At the second stage, supportive therapy is started. This is done during the entire subsequent period of treatment.

Rehydration takes into account the patient's daily need for fluid 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 fill up with the medication solution the volume of fluid that he lost with the stool during the six previous hours.

The effectiveness of oral rehydration is due in most cases only to how well the procedure was performed. It should be remembered that when soldering with a large volume of the solution, a vomiting may occur in the patient, so the liquid must be injected gradually: 1-2 teaspoons every 5-10 minutes. If nausea is present, you should wait a little and continue with the fluid.

The use of drugs for rehydration usually lasts until the moment of stopping diarrhea.

The effectiveness of the procedure is assessed on several grounds:

• Weight gain;
• Improvement of general condition;
• Decrease in volume of fluid lost with stool and vomiting.

Oral rehydration for children

There are cases when the elimination of symptoms of exsicosis in young children should be started immediately, at home, before the arrival of physicians. Therefore, the mother must clearly represent the purpose and the course of the forthcoming procedure. The following should be done:

• Treat the hands with an antiseptic;
• Wear gloves;
• Put the child on a horizontal surface, while turning the head to one side;
• Use a ready-made solution or, using powder and liquid, prepare the preparation yourself (it is important to follow the instructions clearly, consult a specialist if possible);
• For six hours every 5-10 minutes to solder the child one teaspoon of the solution (in particularly severe cases, the liquid can be injected through the probe - through the nose); Rehydration procedure is carried out until the symptoms of vomiting and diarrhea persist;
• If urination is absent for more than 6-8 hours, begin infusion therapy - the introduction of solutions into the bloodstream, the dosage should be strictly calculated;
• Treat the spoon and the container in which the solution was contained;
• Remove gloves, hand treat antiseptic.

Comparison of oral and intravenous rehydration

Elimination of the symptoms of exsicosis and replenishment of fluid lost by the body is possible not only by oral, but also by intravenous rehydration. These two methods are constantly compared, research is conducted on their effectiveness. To date, the results are as follows: both methods help achieve the goals set at approximately the same level, but each has its own characteristics.

It was found that oral rehydration shows the best results in the treatment of children. Drugs are introduced in a traditional way, without unnecessary injury to the child. Medicines are combined with the broths of natural products. This technique is recommended as the main therapy for mild and moderate dehydration in children.

These conclusions came after two-year studies, in which children aged 2 months to 3 years with symptoms of mild dehydration participated. Seventy-three small patients were divided into two groups - ORT was assigned to one category of children, the other was WIT.

As a result, patients who were prescribed oral rehydration spent less time. After oral rehydration, the need for further hospitalization was reduced.

However, the vast majority of pediatricians, in spite of the results of the studies, continue to use intravenous infusion therapy (VIT) to eliminate the consequences of moderate degree of exacerbation in children.

Advantages of the ORT method

The ORT technique restores the concentration of potassium and sodium much faster in the body. At the same time, normalization of the stool can be observed 1-2 days later in comparison with VIT.

The use of oral rehydration automatically reduces the number of intravenous infusions in hospitals, contributing, on the one hand, to lower patient care costs, and on the other hand provides antiepidemic protection by preventing viral hepatitis that can enter the body through blood or mucous membranes.

In addition, the simplicity of the method, as well as its availability, make it possible to use ORT in a polyclinic or at home. The early use of oral rehydration virtually eliminates the need for hospitalization of the patient.

Correct application of the method practically does not cause complications, whereas during the infusion therapy side effects appear in more than 15% of patients.

If the ORT is not properly performed, the following negative reactions can occur:

• Vomiting - due to the rapid soldering of the patient with a large volume of solution;
• Edema - occur with an incorrect proportion of water and saline.

Degrees of exsicosis

As noted earlier, the technique of oral rehydration is indicated for mild or moderate dehydration. To understand whether ORT can be carried out at home or other ways of restoring the body, it is necessary to know the classification of exsicosis and the signs that accompany each of the degrees of pathology. This is especially true in case of illness of infants and toddlers of the first years of life.

There are three degrees of exsicosis:

• The first - characterized by a small loss of fluid (up to 5% of body weight). This condition is accompanied by a moderate thirst, normal skin elasticity, the presence of tear fluid, normal breathing. Children have a large fontanelle does not sink.
• At the second degree of pathology, failures in the cardiovascular system are observed. In this case, the body loses more fluid (up to 10% of body weight). The patient is noted for inhibition or, conversely, anxiety; sunken eyes; Absence of tear fluid; Weak and frequent pulse. Children have a large fontanel.
• The third degree of exsicosis results in loss of fluid more than 10% of body weight. The patient is in serious condition, he has hemodynamic disorders, hypovolemic shock. The condition is characterized by such signs as drowsiness, a lack of desire to take a liquid, cold extremities, very dry oral mucosa, no urination for six hours or more.

If the loss of fluid exceeds 20% of body weight, in most cases the disease ends in death.