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      Hypernatraemic dehydration: Do we have consensus on its treatment?

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      South African Journal of Child Health
      Health & Medical Publishing Group

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          Management of Diarrhoeal Dehydration in Childhood: A Review for Clinicians in Developing Countries

          The survival of a child with severe volume depletion at the emergency department depends on the competency of the first responder to recognize and promptly treat hypovolemic shock. Although the basic principles on fluid and electrolytes therapy have been investigated for decades, the topic remains a challenge, as consensus on clinical management protocol is difficult to reach, and more adverse events are reported from fluid administration than for any other drug. While the old principles proposed by Holliday and Segar, and Finberg have stood the test of time, recent systematic reviews and meta-analyses have highlighted the risk of hyponatraemia, and hyponatraemic encephalopathy in some children treated with hypotonic fluids. In the midst of conflicting literature on fluid and electrolytes therapy, it would appear that isotonic fluids are best suitable for the correction of hypotonic, isonatraemic, and hypernatraemic dehydration. Although oral rehydration therapy is adequate to correct mild to moderate isonatraemic dehydration, parenteral fluid therapy is safer for the child with severe dehydration and those with changes in serum sodium. The article reviews the pathophysiology of water and sodium metabolism and, it uses the clinical case examples to illustrate the bed-side approach to the management of three different types of dehydration using a pre-mixed isotonic fluid solution (with 20 or 40 mmol/L of potassium chloride added depending on the absence or presence of hypokalemia, respectively). When 3% sodium chloride is unavailable to treat hyponatraemic encephalopathy, 0.9% sodium chloride becomes inevitable, albeit, a closer monitoring of serum sodium is required. The importance of a keen and regular clinical and laboratory monitoring of a child being rehydrated is emphasized. The article would be valuable to clinicians in less-developed countries, who must use pre-mixed fluids, and who often cannot get some suitable rehydrating solutions.
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            Pre-hospital management and risk factors in children with acute diarrhoea admitted to a short-stay ward in an urban South African hospital with a high HIV burden

            BACKGROUND: Diarrhoea remains a major cause of childhood morbidity and mortality in the developing world. Implementation of World Health Organization Integrated Management of Childhood Illness (IMCI) guidelines and pre-hospital use of oral rehydration therapy (ORT) in the Western Cape Province of South Africa are not well described. OBJECTIVES: To document pre-hospital home and primary care management of diarrhoea, and certain risk factors and complications of diarrhoea. METHODS: We used a prospective descriptive convenience sample of children admitted to the short-stay ward at Tygerberg Hospital, Parow, Cape Town, between 1 February 2007 and 31 May 2008. Caregivers were interviewed, and demographic, clinical and laboratory variables were collected. RESULTS: We recruited 142 children, median age 8.9 months. A third had moderate malnutrition. Twenty-four (16.9%) were HIV-exposed, with 9 (6.3%) HIV-infected. HIV-exposed children were significantly younger than unexposed children (p=0.03). Weight-for-age Z-scores (WAZ) were significantly lower in HIV-infected than in HIV-exposed, uninfected children (p=0.02). Eighty per cent of caregivers gave ORT and 35.2% stopped feeds. Only 1 of 43 children aged under 6 months was exclusively breastfed. Advice at primary care level rarely complied with IMCI guidelines. CONCLUSIONS: Most caregivers do give ORT, but advice given at primary care level is often suboptimal. Many hospitalised children with diarrhoea are malnourished. Children with HIV infection are at increased risk of diarrhoeal disease and malnutrition, and HIV exposure appears to increase the risk of early presentation with diarrhoea. Ongoing strategies are needed to ensure optimal prevention policies, prehospital management and nutritional rehabilitation.
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              Hypernatremic Dehydration in Young Children: Is There a Solution?

              Hypernatremic dehydration is a common and potentially life-threatening condition in children. There is currently no consensus as to the optimal strategy for fluid management.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Journal
                sajch
                South African Journal of Child Health
                S. Afr. j. child health
                Health & Medical Publishing Group (Cape Town, Western Cape Province, South Africa )
                1994-3032
                1999-7671
                March 2018
                : 12
                : 1
                : 2
                Affiliations
                [01] Johannesburg orgnameUniversity of the Witwatersrand orgdiv1Department of Paediatrics South Africa john.pettifor@ 123456wits.ac.za
                [02] orgnameUniversity of the Witwatersrand orgdiv1Department of Paediatrics
                [03] Johannesburg orgnameChris Hani Baragwanath Academic Hospital South Africa
                Article
                S1999-76712018000100001
                10.7196/sajch.2018.v12i1.1554
                6bb03547-61bf-4685-82d3-aa654479487e

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

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                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 8, Pages: 1
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                SciELO South Africa


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