Oral rehydration. Oral rehydration preparations for children
Rehydration- replenishes fluid loss human body. Usually, we're talking about on restoring the water-electrolyte balance - the ratio of water content and main electrolytes (potassium, sodium, chlorine, etc.). Rehydration is carried out depending on the severity of the patient’s condition in 2 ways: oral or intravenous.
There are 2 options for rehydration: oral and parenteral. 
Oral rehydration
Involves the introduction of liquid through the mouth, that is, in fact it drinking plenty of fluids. Effective on initial stages disease, unless there is excessive repeated vomiting. Successful implementation oral rehydration involves using liquid in small portions, but often (several teaspoons every 7-10 minutes, in no case in one glass, as this will provoke vomiting). Use regular unsweetened tea or still mineral water (table water).
The ideal liquid for oral rehydration is special sachets with a dry mixture (Oralit, Regidron, Ionica). The dry mixture is mixed with boiled water in accordance with the instructions. The patient should drink 1-1.5 liters per day.
Parenteral rehydration
Implies introduction saline solutions intravenously. Carried out only as prescribed by a doctor and under supervision medical worker. Parenteral rehydration allows you to quickly restore water and electrolyte balance, regardless of clinical manifestations diseases. The method is more effective than oral fluid administration. The duration of intravenous infusion is determined by the severity of the patient's condition, usually taking several hours.
For parenteral rehydration The doctor may prescribe the following solutions:
- "Trisol";
- "Disol";
- "Acesol";
- "Quartasol";
- saline sodium solution;
- Ringer's solution;
- "Neohemodesis";
- "Reosorbilact".
The volume of solutions used is determined individually.
Factors contributing to moisture loss
Among possible factors, provoking dehydration, you need to consider external and internal.
External
Among the external ones, the following are significant:
- high ambient temperature;
- high wind force;
- incorrect (not appropriate for climatic conditions) clothing per person.
All of the above leads to profuse sweating. With sweat, a person loses both water and electrolytes. leads to severe (sometimes irreversible) changes in the functioning of the kidneys and cardiovascular system.
Domestic
TO internal factors Somewhat conditionally, diseases that are accompanied by loss of fluid and electrolytes can be classified as:
- oncological processes of the digestive canal;
- endocrine pathology (sugar and diabetes insipidus);
- (salmonellosis, cholera, foodborne illnesses).
A prerequisite for successful rehydration is the elimination of the provoking factor, otherwise the loss of water and electrolytes will continue.
Symptoms and degrees of dehydration
IN medical practice classification of degrees of dehydration is applied in accordance with a certain clinical symptoms. This allows the doctor to assess the severity of the patient’s condition and prescribe the necessary rehydration therapy without waiting for the results of a laboratory examination.
Table 1. Symptoms of dehydration depending on the degree of moisture loss from the body.
| Degree | Symptoms |
| Grade 1 (mild dehydration, losses do not exceed 1-3% of initial body weight) |
|
| 2nd degree (dehydration medium degree severity within 4-6% of body weight) |
|
| Grade 3 (severe dehydration, loss of 7-9% of initial body weight) |
|
| 4th degree – hypovolemic shock(extremely severe dehydration, condition, life-threatening patient) |
|
At home, only first-degree dehydration can be treated. Everything else is only under the supervision of a doctor.
When is it necessary to see a doctor?
- there is no effect of oral rehydration;
- the frequency of bowel movements and vomiting increases;
- the patient becomes lethargic and drowsy;
- blood pressure decreases, pulse rate increases;
- the amount of urine excreted decreases.
Rehydration is an essential component of the treatment of many diseases, but the rules for its implementation are important.
Caring for a sick child
Kanarskaya E. V., Lyutikova O. K.
Moscow Regional Subject Commission
Pediatrics teachers
List of manipulation algorithms in pediatric practice when caring for a sick child (collection 3)
Oral rehydration. 3
Technique for performing a cleansing enema for children of different ages. 4
Staging technique medicinal enema children.. 6
Technique for inserting a gas tube into children of different ages. 8
Applying a warm compress to the parotid area. 9
Inhalation technique for children... 10
Techniques for performing foot and hand baths for children.. 11
Technique for placing mustard plasters on children.. 12
Technique for treating the oral cavity for stomatitis and thrush. 13
10.Technique for instilling drops into the child’s eyes, nose, and ears. 14
Dilution (preparation) and administration of antibiotics to children.. 16
Using heating pads to warm a premature baby. 18
Preparing and using an ice pack... 19
Gastric lavage. 20
Administration of anti-diphtheria serum. 22
Processing technique skin folds for diaper rash in an infant. 24
Processing technique umbilical wound and skin
At purulent infection in newborns. 25
Oral rehydration.
Target: --- restore the body’s water-salt balance;
Eliminate exicosis and prevent its re-development.
Indications: exicosis.
Contraindications: absolute contraindications No.
Equipment:--- measuring container (spoon, pipette, glass);
Paper, pen (for recording fluid losses);
Solutions:
Salt-free – sweet tea, boiled water, rice water, raisin water, carotene mixture;
Sugar-salt - dissolve 1 tsp in 1 liter of boiled water. salt and 8 tsp. sugar, “homemade rehydron” - boil 100 g of raisins or 500 g of carrots cut into pieces in 1 liter of water, strain, add 1 tsp. salt, ½ tsp. drinking soda, 4 tsp. granulated sugar, bring to a boil again and cool;
Glucose-salt - “Regidron”, “Oralit”, “Glucosolan”, “Citrogluco-solan”
Mineral water without gases
Notes: 1. Calculation of fluid per day for oral rehydration is made by a doctor
2. after diluting glucose-salt solutions, do not boil the finished solution, store for no more than 1 day
3.criteria for adequate rehydration: restoration of diuresis, pulse, skin color, increase in body weight.
| Stages | Rationale |
| Preparation for manipulation | |
| 1. Explain to the mother/child the purpose and progress of the procedure, obtain consent | Ensuring the right to information, participation in the procedure |
| 2. Prepare a salt-free solution, dilute the saline solution according to the instructions | |
| 3. Prepare the necessary equipment | Ensuring the accuracy of the procedure |
| 4. Pour the amount of liquid required for the first 6 hours into a measuring container and give it to the mother or child for drinking. | Ensuring adequate rehydration therapy |
| 5.Train the mother/child to count and record fluid losses | |
| Performing a manipulation | |
| 1.Give water infant 1-2 tsp each in 5-10 minutes. or drops under the tongue, older children 1-2 tbsp. in 5-10 minutes. Alternate salt-free and glucose-saline solutions | Prevention of vomiting. Ensuring optimal absorption (assimilation) of fluid by the body |
| 2. The nurse records and records: a) fluid consumed b) ongoing fluid loss | Evaluation of therapy effectiveness |
| 3. After 4-6 hours, check the signs of exicosis in the child (the condition of the large fontanel, skin, mucous membranes, etc.) There are 3 options for the condition: a) exicosis is increasing - switch to intravenous administration of solutions b) exicosis has decreased, but is still preserved - repeat the measures taken c) there is no exicosis - switch to maintenance rehydration - every 4-6 hours enter enterally as much solution as he lost over the previous 4-6 hours (see sheet for recording fluid losses) + record ongoing fluid losses | Assessing the effectiveness of the stage of oral rehydration The administered solution is not absorbed in the intestine The amount of solution calculated for primary rehydration could not replenish the child’s existing fluid losses Prevention of re-development of exicosis if ongoing fluid losses are not replenished |
| 4. In the absence of vomiting, gradually increase the drinking dose per dose | Adequate increase in circulating blood volume |
| Completion of manipulation | |
| Continue maintenance rehydration until vomiting stops and loose stool | Ensuring the effectiveness of oral rehydration |
Relevance. Restoring fluid and electrolyte balance and maintaining intravascular fluid volume are key factors in the treatment of many human diseases. This goal can be achieved using either intravenous solutions, or oral rehydration solutions - drinks containing electrolytes in isotonic concentrations. Oral rehydration (OR) may be necessary for pregnant women with oligohydramnia (oligohydramnia), patients with hypercalcemia and malignant neoplasms manifested by encephalopathy. It has been shown that in patients with mild degree hypercalcemia against the background of PR, a normal process of bone remodeling is observed. Dehydration is a common imbalance in bedridden older adults; A particularly high risk of electrolyte imbalance was found in women; This is where PR solutions can be useful. One study showed that elderly people living in high temperature air and humidity, it is better to maintain plasma volume by taking not ordinary water, but a carbohydrate-electrolyte solution. In patients who had not previously responded to antiepileptic drugs, against the background of PR, electroencephalography indices normalized and there were no seizures during the year of maintenance rehydration therapy. PR can help restore fluid and electrolyte imbalances in acute and chronic diarrhea.
The process of human rehydration against the background of severe water and electrolyte balance disorders is not an easy task. Much is determined by the initial degree of water disorders. The standard (generally accepted) method for correcting water and electrolyte imbalance is intravascular infusion of electrolyte solutions. But in a number of clinical situations, when the volume of water loss does not exceed 3–5% of body weight, oral rehydration (OR) is possible, which, apparently, is the oldest way replenishment of fluid in the human body. The simplest type of rehydration is to drink water when you are thirsty or have a dry mouth.
Experts from the World Health Organization (WHO) have formulated clear indications and limitations for oral rehydration (OR). It has been determined that it can be used independently (without additional intravascular fluid infusions) only in patients with slight hypovolemia and in the absence of contraindications. The degree of dehydration is also indicated - less than 5% of body weight. PR should not be used in cases of severe hypovolemia, lack of consciousness in patients, lesions of the gastrointestinal tract or deterioration of peristalsis, in patients before a planned general anesthesia or before surgery.
Typical indications for PR are diarrhea, which is accompanied by large losses of water and electrolytes. If the degree of dehydration is more than 5% of body weight, then it is first necessary to carry out standard infusion therapy (IT) with polyionic solutions. In the future, when pronounced signs dehydration and electrolyte disturbances will be eliminated, you can prescribe an oral solution.
However, it should be remembered that plain water is not always able to quickly and fully restore the shaken balance in the water and electrolyte balance. The standard solution for PR is the solution recommended by WHO experts. It contains the following ingredients in 1 liter of solution: 3.5 g NaCl, 1.5 g KCl, 20 g glucose and trisodium citrate (or 2.5 g NaHCO3). The osmolarity of the solution is 331 mOsm/l. Patients with mild to moderate dehydration who are able to drink on their own may be given this solution for oral administration (approximately 75 ml/kg over 4 hours). This prescription is highly effective for PR in patients with diarrhea, both adults and children. The effectiveness of saline solutions for PR has been noted for a long time. For a number of years, issues related to changes in the standard prescription of solutions for PR, aimed at reducing the osmolarity of solutions and reducing sodium ions in them, have been discussed. Thus, the European Society of Pediatric Gastroenterology and Nutrition (ESPGAN) recommends the use of solutions for PR with an osmolarity of 200–250 mOsm/L, containing from 74–111 mmol/L glucose, 60 mmol/L Na+, 20 mmol/L K+ and 30 mmol/l bases. This statement is based on the results of a number of multicenter randomized studies. It was noted that a decrease in PR osmolarity reduces the need for additional IT compared to the standard solution for PR.
Currently on the world pharmaceutical market There are many different modifications of solutions for oral rehydration therapy. However, in our country, the greatest experience of use has been accumulated with the drug Regidron, which has been used in clinical medicine for more than 30 years, and can be classified as a “traditional” solution for PR. Also effective means for PR, especially in pediatric practice, is the drug Gastrolit (containing, in addition to the above components, also dry chamomile extract). In the absence of ready-made solutions for PR, in some cases they can be replaced in children with a solution homemade(8 teaspoons sugar, 1 teaspoon table salt, juice of 2 oranges per 1 liter of water). In adults, instead of special solutions for PR, salted soups (sodium) are used, fruit juices(potassium) and sources of carbohydrates (biscuits, rice, crispbread, potatoes) to provide the patient with monosaccharides for glucose-sodium cotransport.
One of the most common pathological conditions in children of all ages it is considered poisoning. They are most often accompanied by unpleasant symptoms, among which vomiting and diarrhea are not the least important. Both of these phenomena are quite dangerous for the body, especially when it comes to a child, since such symptoms are fraught with rapid loss of fluid from the body. Accordingly, if such manifestations occur, it is necessary to quickly take measures to restore water-salt balance, namely, take special solutions for rehydration.
For oral rehydration child's body At home, you can use various medicinal formulations that can be purchased at any pharmacy. The most common medications of this type are considered to be Humana Electrolyte, Gastrolit, as well as Regidron and Gidrovit. Let's talk about the features of oral rehydration; we'll take a closer look at medications for children.
Regidron
Given medicine is one of the most common among rehydration compositions. It is manufactured in Finland by the Orion Corporation. In the pharmacy, this medication is sold in the form of a dosed powder, which contains three and a half grams of sodium chloride, two and a half grams of potassium chloride, almost three grams of sodium citrate, and ten grams of glucose. One package of Regidron contains twenty sachets, each of which contains slightly less than nineteen grams of crystalline powder, colored White color, and highly soluble in water. The liquid obtained as a result of diluting this composition has both a sweetish and salty taste.
The main purpose medicinal composition Rehydron (like other rehydration solutions) is to restore, as well as correct acid-base balance, which was disrupted due to the removal of electrolytes from tissues, which is observed with diarrhea or vomiting.
Since this drug is a source of glucose, it effectively maintains the proper level of salts and citrates, maintaining optimal acid balance. Rehydron is recommended to be used most often, since it contains a slightly lower sodium content and slightly more potassium.
For cooking medicinal solution you just need to dilute the contents of the sachet with a liter of warm, pre-boiled water; for young children, the concentration can be made weaker, but it is worth slightly increasing the amount of the drug consumed. The resulting product should be given to the baby in small sips after each attack of vomiting or loose bowel movements. The solution should be mixed before each use. The optimal dosage of Regidron is ten milliliters per kilogram of body weight per hour; if diarrhea is accompanied by vomiting, then this volume should be doubled or even tripled.
It is worth considering that this medicine is not used for kidney problems, as well as for diabetes mellitus or intestinal obstruction. Contraindications also include unconsciousness patient or high blood pressure.
Since Regidron does not contain any flavoring additives, children are usually reluctant to drink it. In this case, such a medicine can be replaced with compounds that are more pleasant to taste.
Humana Electrolyte
This medication is excellent for treating children from the first days of life, if we are talking about using a solution with fennel. Banana composition is allowed to be used in relation to children from three years of age. The medicine is available in the form of a powder for preparing a solution, while the cardboard package contains twelve sachets of 6.25 g each. This volume should be diluted with one glass of pre-boiled warm water. Children under three months of age should be given two hundred to six hundred milliliters of the drug in three to eight doses; in general, the dosage can range from fifty to one hundred (one hundred and fifty) milliliters per kilogram of body weight.
The main advantage of Humana Electrolyte is its pleasant taste. In addition, the addition of fennel helps eliminate colic and bloating, and the presence of banana pectin in the composition helps bind and eliminate from the body various kinds toxins.
Gatsrolite
This medicine, unlike the formulations already described above, is available in tablet form; the package contains thirty tablets. A couple of tablets of this substance must be dissolved in one hundred milliliters of ordinary hot water. The resulting solution should be cooled to body temperature. This medicine is given to children literally from birth, and as in previous treatment options, infants drinks should be given in fractional, minimal portions. For one kilogram of body weight, it is worth consuming ninety to one hundred and thirty milliliters of solution.
The main advantage of this Gastrolite is its pleasant chamomile taste, in addition, the extract of this medicinal plant, which is part of the drug, has a good antispasmodic effect, copes with inflammatory processes, optimizes peristalsis, and also prevents intestinal bloating from developing.
It is worth considering that diarrhea and vomiting in children is serious reason call a doctor as soon as possible, because similar conditions may become more complicated and require more serious treatment.
Due to their widespread prevalence, acute intestinal infections in children pose a significant public health problem. According to WHO, mortality from acute intestinal infections (AEI) is high, amounting in some countries to 50-70% of the total mortality of children under 5 years of age. The leading cause of severity of acute intestinal infections in children, leading to fatalities, is the development of dehydration. In this regard, the basis rational treatment patients with ACI is wide use oral rehydration using glucose-saline solutions in combination with proper nutrition.
The use of glucose-salt solutions for oral rehydration is physiologically justified, since it has been established that glucose has the property of enhancing the transfer of potassium and sodium through the mucosa small intestine– it contributes rapid recovery disturbances of water-salt balance and normalization of metabolism.
WHO recommends using the oral rehydration method for acute intestinal infections accompanied by so-called “watery diarrhea” (cholera, enterotoxigenic escherichiosis, etc.), as well as for intestinal infections other etiology, occurring with the phenomena of enteritis, gastroenteritis and enterocolitis (salmonellosis, rotavirus infection and etc.). Oral rehydration is most effective when used from 1 hour after the onset of the disease. According to WHO, oral rehydration therapy is early dates OCI led to a 2-14-fold reduction in mortality and a halving of the need for hospitalization of patients.
The oral rehydration method has the following advantages:
- with exicosis of 1-2 degrees, with the help of oral rehydration, the restoration of the concentration of potassium, sodium and CBS occurs faster than with intravenous administration rehydration solutions, although normalization of stool may be delayed by 1-2 days;
- the introduction of the oral rehydration method in hospitals makes it possible to reduce the number of intravenous infusions, which, on the one hand, reduces the cost of treating the patient and reduces the length of his stay in bed, and on the other hand, has anti-epidemic significance in terms of prevention viral hepatitis with parenteral transmission of infection;
- the simplicity and accessibility of the method allows it to be used for up to hospital stage treatment of patients with acute intestinal infections - in the clinic and even at home, and if used early in the initial period of the disease, it can make hospitalization unnecessary;
- at high efficiency(in 80-95% of patients) the method, when used correctly, gives virtually no complications, while with infusion therapy adverse reactions occur in 16% or more patients.
Indications for oral rehydration – initial manifestations diarrhea, moderate (1-2 degrees) dehydration, not serious condition child.
Indications for parenteral rehydration:
- severe forms of dehydration (2-3 degrees) with signs of hypovolemic shock;
- infectious-toxic shock;
- combination of exicosis (any degree) with severe intoxication;
- oliguria or anuria that does not disappear during the first stage of rehydration;
- uncontrollable vomiting;
- an increase in stool volume during oral rehydration over 2 days of treatment. These phenomena may be caused by congenital or acquired during the disease malabsorption of glucose (rare).
- ineffectiveness of oral rehydration during the day.
To combat dehydration, it is recommended to use the drug "Regidron", containing in 1 powder: 3.5 g of sodium chloride, 2.9 g of sodium citrate, 2.5 g of potassium chloride and 10.0 g of glucose (or domestic "Glucosolan", containing in 1 powder 3.5 g of sodium chloride, 2.5 g of sodium bicarbonate, 1.5 g of potassium chloride and 20 g of glucose). Before use, 1 powder of these drugs is diluted in 1 liter of boiled water and in diluted form can be stored for no more than a day.
Note: Other solutions can be used for oral rehydration - Oralite, biorice or carrot-rice decoction, "Children's Doctor".
For intestinal infections of the “invasive” and “osmotic” type, preference should be given to oral rehydration hypoosmolar glucose-saline solution with chamomile extract “Gastrolit”. The electrolyte composition of this drug is developed in accordance with the latest recommendations European Society Pediatric Gastroenterology and Nutrition (ESPGAN). Dry matter content per 1 liter: sodium chloride – 1.75 g, potassium chloride – 1.5 g, sodium bicarbonate – 2.5 g, glucose – 14.5 g, chamomile extract – 0.5 g, osmolarity solution – 240 mmol/l. The drug not only replenishes water and electrolyte losses, but also stops metabolic acidosis. Chamomile extract additionally has an anti-inflammatory, antiseptic and antispasmodic effect on the intestines, and has moderate antidiarrheal properties. Available in powders of 4.15 g for preparing a solution of 200 ml. water.
Methodology for calculating fluid for oral rehydration. Oral rehydration in the presence of degree 1-2 dehydration is carried out in two stages:
Stage I: in the first 6 hours, the existing mass deficit is eliminated the child's body due to exicosis . The volume of fluid required for this stage is equal to the body weight deficit as a percentage and is calculated by the formula:
where, ml/hour – the volume of fluid administered to the patient in 1 hour
M – actual body weight of the child in kg
P – percentage of acute body weight loss due to exicosis
10 – proportionality factor
When determining the degree of dehydration based on clinical data, you can also use approximate data on the volume of fluid required by the patient during the first 6 hours of rehydration, taking into account the actual body weight and the degree of dehydration:
| Body weight (kg) | Amount (ml) of solution required for the first 6 hours with exicosis: | ||
| 1st degree | 2nd degree | 3rd degree | |
| 5 |
250
2000 |
400
3200 |
500
3500 |
Stage II – maintenance therapy , which is carried out depending on the ongoing loss of fluid and salts through vomiting and bowel movements. The approximate volume of solution for maintenance therapy in the next 18 hours of the first day of oral rehydration is 80 - 100 ml/kg body weight per day. The total volume of liquid in the following days (until the cessation of loose stools) is equal to the volume physiological need a child of this age + the volume of pathological losses through vomiting and stool, which is approximately 10 ml/kg for each bowel movement.
Oral rehydration technique Oral rehydration can be carried out in a hospital, starting from the emergency department, in a clinic, and, under appropriate circumstances, even at home. Feeding can be carried out by a nurse or mother (after appropriate instructions). The amount of liquid calculated by the doctor for 1 hour is poured into a special graduated container and the child is given 1-2 teaspoons or from a pipette every 5-10 minutes, and if swallowing is impossible, dropwise through a naso-gastric tube. In case of vomiting, after a short pause (5-10 minutes), oral administration of fluid must be continued, since vomiting usually causes loss of fluid. less water and salts than are introduced. Vomiting when " secretory diarrhea» usually stops after elimination of exicosis and hypokalemia.
Regidron (or glucosolan) must be combined with the administration of salt-free solutions - sweet tea, boiled water, sugar-free compote, etc. (* when using gastrolit - additional prescription of salt-free solutions is not necessary), as well as with the child’s nutrition. During oral rehydration, fluid losses in stool, urine and vomit are recorded by first weighing dry and then used diapers, as well as measuring temperature. All data is recorded on an oral rehydration sheet, which is kept by a nurse or the child's mother, and then pasted into the medical record. The doctor calculates the volume of daily losses and the amount of fluid obtained through rehydration and nutrition per day. The effectiveness of oral rehydration is assessed by the disappearance and reduction of symptoms of dehydration, cessation of watery diarrhea, and weight gain.
