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Medical\tnutrition\ttherapy\nPrimary\tnutrition\ttherapy\tfor\tconstipation\tin\totherwise\thealthy\tpeople\tis\tconsumption\tof\tadequate\namounts\tof\tfluids\tand\tdietary\tfiber,\n\tsoluble\tand\tinsoluble.\tFiber\tincreases\tcolonic\tfecal\tfluid,\nmicrobial\tmass\t(which\taccounts\tfor\t60%\tto\t70%\tof\tstool\tweight),\tstool\tweight\tand\tfrequency,\tand\tthe
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rate\tof\tcolonic\ttransit.\tWith\tadequate\tintake\tof\tfluid,\tfiber\tmay\tsoften\tstools\tand\tmake\tthem\teasier\tto\npass.\tDietary\treference\tintakes\t(DRIs)\trecommend\tconsumption\tof\t14\tg\tdietary\tfiber\tper\t1000\tkcal,\nor\t25\tg\tfor\tadult\twomen\tand\t38\tg\tfor\n\tadult\tmen.\tTypical\tintake\tof\tdietary\tfiber\tin\tthe\tUnited\tStates\tis\nonly\tabout\t16.2\tg/day\t(\nGrooms\tet\tal,\t2013
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] |
only\tabout\t16.2\tg/day\t(\nGrooms\tet\tal,\t2013\n).\nDietary\tfiber\n\trefers\tto\tedible\tplant\tmaterials\tnot\tdigested\tby\tthe\tenzymes\tin\tthe\tGI\ttract\tand\tis\ncategorized\tas\tsoluble\tor\tinsoluble.\t\nSoluble\tfiber\n\tforms\ta\tgel,\tacting\tto\tslow\tdigestion\tand\tdoes\tnot\ngenerally\thave\ta\tlaxative\teffect.\t\nInsoluble\tfiber\n\tabsorbs\twater\tto\tadd\tbulk\tto\tstool
|
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] |
Insoluble\tfiber\n\tabsorbs\twater\tto\tadd\tbulk\tto\tstool\n\tand\taccelerate\nfecal\ttransit\tthrough\tthe\tintestines\t(\nBarco\tet\tal,\t2015\n).\tFiber\tconsists\tof\tcellulose,\themicellulose,\npectins,\tgums,\tlignins,\tstarchy\tmaterials,\tand\toligosaccharides\tthat\tare\tpartially\tresistant\tto
|
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] |
digestive\tenzymes.\tBoth\ttypes\tof\tfiber\tare\treadily\tavailable\tin\ta\twhole\tfoods\tdiet\tthat\tincludes\ta\nvariety\tof\twhole\tgrains,\tfruits,\tvegetables,\tlegumes,\tseeds,\tand\tnuts.\nA\thigh-fiber\n\ttherapeutic\tdiet\tmay\thave\tto\texceed\t25\tto\t38\tg/day.\tThe\t\nhigh-fiber\tdiet\n\tin\t\nBox\t27.4
|
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] |
high-fiber\tdiet\n\tin\t\nBox\t27.4\nprovides\tmore\tthan\tthe\tamount\tof\tfiber\ttypically\trecommended.\tIt\tis\timportant\tto\tassess\tdietary\tfiber\nintake\tbefore\tmaking\trecommendations\tfor\tfiber\tsupplementation.\tIf\ta\tpatient\tis\talready\ttaking\t25\tto\n30\tg\tof\tdietary\tfiber\tdaily,\tfiber\tsupplementation\tis\tunlikely\tto\tbe\thelpful.\tIf\tless\tthan\tthis\tamount\tis\nbeing
|
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] |
being\n\tconsumed,\tfiber\tshould\tbe\tadded\tslowly\tin\tgraduated\tdoses\tto\teventually\treach\t25\tto\t30\tg\tper\nday.\tAmounts\tgreater\tthan\t50\tg/day\tare\tnot\tnecessary\tand\tmay\tincrease\tabdominal\tdistention\tand\nexcessive\tflatulence\tdue\tto\tfermentation\tby\tthe\tcolonic\tflora.\nBOX\t27.4\nGuidelines\tfor\tHigh-Fiber\tDiets\n1.
|
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] |
BOX\t27.4\nGuidelines\tfor\tHigh-Fiber\tDiets\n1.\t\nIncrease\tconsumption\tof\twhole-grain\tbreads\tand\tcereals\tto\t6\tto\t11\tservings\tdaily.\n2.\t\nIncrease\n\tconsumption\tof\tvegetables,\tlegumes,\tfruits,\tnuts,\tand\tseeds\tto\t5\tto\t8\tservings\ndaily.\n3.\t\nConsume\thigh-fiber\tcereals,\tgranolas,\tand\tlegumes\tto\tbring\tfiber\tintake\tto\t25\tg\tin\twomen\nor\t38\tg\tin\tmen\tor\tmore\tdaily.
|
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] |
or\t38\tg\tin\tmen\tor\tmore\tdaily.\n4.\t\nIncrease\tconsumption\tof\tfluids\tto\tat\tleast\t2\tL\t(or\tabout\t2\tqt)\tdaily.\nNote:\tFollowing\tthese\tguidelines\tmay\tcause\tan\tincrease\tin\tstool\tweight,\tfecal\twater,\tand\tgas.\tThe\tamount\nthat\tcauses\n\tclinical\tsymptoms\tvaries\tamong\tindividuals,\tdepending\ton\tage\tand\tpresence\tof
|
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] |
gastrointestinal\t(GI)\tdisease,\tmalnutrition,\tor\tresection\tof\tthe\tGI\ttract.\nBran\tand\tfiber\tsupplements\tmay\tbe\thelpful\tin\tpersons\twho\tcannot\tor\twill\tnot\teat\tsufficient\namounts\tof\tfiber-containing\tfoods.\tSeveral\tof\tthese\tcommercial\tfiber\tsupplements\tcan\tbe\tadded\tto\ncereals,\tyogurts,\tfruit\tsauces,\tjuices,\tor\tsoups.
|
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] |
cereals,\tyogurts,\tfruit\tsauces,\tjuices,\tor\tsoups.\n\tCooking\tdoes\tnot\tdestroy\tfiber,\tbut\tthe\tstructure\tmay\nchange.\tRecommending\tthe\tconsumption\tof\tadequate\tdaily\tfluid\tintake\tis\talso\tvery\timportant\tin\nfacilitating\tthe\teffectiveness\tof\ta\thigh-fiber\tintake.\tGastric\tobstruction\tand\tfecal\timpaction\tmay
|
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] |
occur\twhen\tboluses\tof\tfibrous\tgels\tor\tbran\tare\tnot\tconsumed\twith\tsufficient\tfluid\tto\tdisperse\tthe\nfiber.\nIncreasing\tdietary\tfiber\tfor\tlaxation\tis\tunlikely\n\tto\tprovide\trelief\tfor\tpatients\twith\tserious\ndysmotility\tsyndromes,\tneuromuscular\tdisorders,\tchronic\topioid\tuse,\tpelvic\tfloor\tdisorders,\tor\tother
|
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serious\tGI\tdisease.\tIn\tconditions\tsuch\tas\tneuromuscular\tdisorders\tor\twith\tchronic\topioid\tuse,\ta\nspecific\tlaxative\tmedication\tregimen\tor\tgut\tmotility\tstimulator\tmedication\t(i.e.\tmethylnaltrexone)\nmay\tbe\ta\tnecessary\tpart\tof\tdisease\tmanagement.\nDiarrhea\nDiarrhea\n\tis\tdefined\tby\tthe\tWorld\tHealth\tOrganization\tas\tthe\tpassage\tof\tthree\tor\tmore\tloose\tor
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] |
liquid\tstools\tper\tday.\tDiarrhea\toccurs\twhen\tthere\tis\taccelerated\ttransit\tof\tintestinal\tcontents\tthrough\nthe\tsmall\tintestine,\tdecreased\tenzymatic\tdigestion\tof\tfoodstuffs,\tdecreased\tabsorption\tof\tfluids\tand\nnutrients,\tincreased\tsecretion\tof\tfluids\tinto\tthe\tGI\ttract,\tor\texudative\tlosses.\nPathophysiology\n•
|
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] |
Pathophysiology\n•\t\nDiarrhea\tmay\tbe\trelated\tto\tinflammatory\tdisease;\tinfections\twith\tfungal,\tbacterial,\tor\tviral\nagents;\tmedications;\toverconsumption\tof\tsugars\tor\tother\tosmotic\tsubstances;\tan\tallergic\nresponse\tto\ta\tfood;\tor\tinsufficient\tor\tdamaged\tmucosal\tabsorptive\tsurface.\tThere\tare\tmany
|
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different\tsubtypes\tof\tdiarrhea\tassociated\twith\tvarious\tmedical\tconditions\tand/or\tsurgeries.\n•\t\nExudative\tdiarrheas\tare\n\talways\tassociated\twith\tmucosal\tdamage,\tleading\tto\tan\noutpouring\tof\tmucus,\tfluid,\tblood,\tand\tplasma\tproteins,\twith\ta\tnet\taccumulation\tof\nelectrolytes\tand\twater\tin\tthe\tgut.\tProstaglandin\tand\tcytokine\trelease\tmay\tbe\tinvolved.
|
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Diarrhea\tassociated\twith\tCrohn’s\tdisease,\tulcerative\tcolitis\t(UC),\tand\tradiation\nenteritis\tis\toften\texudative.\n•\t\nOsmotic\tdiarrheas\toccur\twhen\tosmotically\tactive\tsolutes\tare\n\tpresent\tin\tthe\tintestinal\ntract\tand\tare\tpoorly\tabsorbed.\tAn\texample\tis\tthe\tdiarrhea\tthat\taccompanies\tdumping
|
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syndrome\tin\tsomeone\tthat\tconsumes\ta\tbeverage\tcontaining\tsimple\tsugars\tafter\thaving\nvarious\tGI-tract\tresections\tsuch\tas\ta\tBillroth\tII\tprocedure\t(gastrojejunostomy).\n•\t\nSecretory\tdiarrheas\tare\tthe\tresult\tof\tactive\tintestinal\tsecretion\tof\telectrolytes\tand
|
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water\tby\tthe\tintestinal\tepithelium,\n\tresulting\tfrom\tbacterial\texotoxins,\tviruses,\tand\nincreased\tintestinal\thormone\tsecretion.\tUnlike\tosmotic\tdiarrhea,\tfasting\tdoes\tnot\nrelieve\tsecretory\tdiarrhea.\n•\t\nMalabsorptive\tdiarrheas\tresult\twhen\ta\tdisease\tprocess\timpairs\tdigestion\tor\tabsorption
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to\tthe\tpoint\tthat\tnutrients,\tsuch\tas\tfat,\tappear\tin\tthe\tstool\tin\tincreased\tamounts.\nExcess\tfat\tin\tthe\tstool\tis\tcalled\t\nsteatorrhea\n.\tDiarrhea\toccurs\tbecause\n\tof\tthe\tosmotic\naction\tof\tthese\tnutrients\tand\tthe\taction\tof\tthe\tbacteria\ton\tthe\tnutrients\tthat\tpass\tinto\nthe\tcolon.\tMalabsorptive\tdiarrhea\toccurs\twhen\tthere\tis\tnot\tenough\thealthy\tabsorptive
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] |
area\tor\tinadequate\tproduction\tor\tinterrupted\tflow\tof\tbile\tand\tpancreatic\tenzymes,\tor\nthere\tis\trapid\ttransit,\tsuch\tas\tin\tIBD\tor\tafter\textensive\tbowel\tresection.\t\nBox\t27.5\n\tlists\ndiseases\tand\tconditions\tassociated\n\twith\tmalabsorption\tand\tdiarrhea.\n•\t\nMedication-induced\tdiarrheas\tare\tfrequent\tin\thospitalized\tand\tlong-term\tcare\tpatients.
|
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] |
Medications\tthat\tcause\tdiarrhea\tdo\tso\tby\tdifferent\tmechanisms.\tFor\texample,\nmedications\tsuch\tas\tlactulose\t(used\tin\tthe\tmanagement\tof\thepatic\tencephalopathy)\nand\tsodium\tpolystyrene\tsulfonate\twith\tsorbitol\t(used\tto\ttreat\thyperkalemia)\tcreate\nincreased\tbowel\tmovements\tas\tpart\n\tof\ttheir\tmechanism\tof\taction.\tSome\tantibiotics
|
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] |
of\ttheir\tmechanism\tof\taction.\tSome\tantibiotics\nhave\tdirect\teffects\ton\tGI\tfunction.\tExamples\tinclude\terythromycin,\twhich\tacts\tas\ta\nmotilin\tagonist\tand\tincreases\tlower\tGI\tmotility,\tas\twell\tas\tclarithromycin\tand\nclindamycin,\twhich\tincrease\tGI\tsecretions.\nBOX\t27.5\nDiseases\tand\tConditions\tAssociated\tWith\tMalabsorption\nInadequate\tdigestion
|
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Inadequate\tdigestion\nPancreatic\tinsufficiency\nGastric\tacid\thypersecretion\nGastric\tresection\nAltered\tbile\tsalt\tmetabolism\twith\timpaired\tmicelle\tformation\nHepatobiliary\tdisease\nInterrupted\tenterohepatic\tcirculation\tof\tbile\tsalts\nBacterial\tovergrowth\nDrugs\tthat\tprecipitate\tbile\tsalts\nGenetic\tabnormalities\tof\tmucosal\tcell\ttransport
|
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0.09641768783330917,
0.126169353723526,
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] |
Genetic\tabnormalities\tof\tmucosal\tcell\ttransport\nDisaccharidase\tdeficiency\nMonosaccharide\tmalabsorption\nSpecific\tdisorders\tof\tamino\tacid\tmalabsorption\nAbetalipoproteinemia\nVitamin\tB\n12\n\tmalabsorption\nCeliac\tdisease\nInflammatory\tor\tinfiltrative\tdisorders\nCrohn’s\tdisease\nAmyloidosis\nScleroderma\nTropical\tsprue\nGastrointestinal\tallergy
|
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] |
Amyloidosis\nScleroderma\nTropical\tsprue\nGastrointestinal\tallergy\nInfectious\tenteritis\nWhipple\tdisease\nIntestinal\tlymphoma\nRadiation\tenteritis\nDrug-induced\tenteritis\nEndocrine\tand\tmetabolic\tdisorders\nShort-bowel\tsyndrome\t(SBS)\nAbnormalities\tof\tintestinal\tlymphatics\tand\tvascular\tsystem\nIntestinal\tlymphangiectasia\nMesenteric\tvascular\tinsufficiency
|
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0.03656162694096565,
0.11275593191385269,
0.10187351703643799,
0.07999055087566376
] |
Intestinal\tlymphangiectasia\nMesenteric\tvascular\tinsufficiency\nChronic\tcongestive\theart\tfailure\nData\tfrom\tBeyer\tPL:\tShort\tbowel\tsyndrome.\tIn\tCoulston\tAM\tet\tal,\teditors:\t\nNutrition\tin\tthe\tprevention\tand\ntreatment\tof\tdisease\n,\ted\t1,\tSan\tDiego,\t2001,\tAcademic\tPress;\tBranski\tD\tet\tal:\tChronic\tdiarrhea\tand\nmalabsorption,\t\nPediatr\tClin\tNorth\tAm
|
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] |
malabsorption,\t\nPediatr\tClin\tNorth\tAm\n\t43:307,\t1996;\tFine\tKD:\tDiarrhea.\tIn\tMitra\tAD\tet\tal:\n\tManagement\tof\ndiarrhea\tin\tHIV-infected\tpatients,\t\nInt\tJ\tSTD\tAIDS\n\t12:630,\t2001;\tPodolsky\tDK:\tInflammatory\tbowel\tdisease,
|
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N\tEngl\tJ\tMed\n\t347:417,\t2002;\tSundarum\tA\tet\tal:\tNutritional\tmanagement\tof\tshort\tbowel\tsyndrome\tin\nadults,\t\nJ\tClin\tGastroenterol\n\t34:207,\t2002.\nIn\tthose\twith\tunderlying\tillnesses\tsuch\tas\thuman\timmunodeficiency\tvirus\t(HIV)\tand\tother\timmune\ndeficiency\tstates,\tthe\tcauses\n\tof\tdiarrhea\tare\toften\tmultifactorial\tand\tcan\tinclude\tside\teffects\tof
|
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] |
of\tdiarrhea\tare\toften\tmultifactorial\tand\tcan\tinclude\tside\teffects\tof\nmedications,\tproliferation\tof\topportunistic\torganisms,\tand\tGI\tmanifestations\tof\tthe\tdisease\titself\n(\nPavie\tet\tal,\t2012\n)\t(see\t\nChapter\t36\n).\tIncreased\trisk\tof\topportunistic\tinfection\tis\talso\tassociated\twith
|
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] |
).\tIncreased\trisk\tof\topportunistic\tinfection\tis\talso\tassociated\twith\nuse\tof\tantineoplastic\tagents\t(such\tas\tchemotherapy)\tor\tin\tthose\twith\tmalnutrition.\nAntibiotic-associated\tdiarrhea\nThe\thuman\n\tintestinal\ttract\tis\thome\tfor\ttrillions\tof\tbacteria\t\nmicrobiota\n\t(\nFig.\t27.2\n).\tIn\tthe\tnormal\tGI
|
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] |
microbiota\n\t(\nFig.\t27.2\n).\tIn\tthe\tnormal\tGI\ntract,\tcommensal\tgut\tmicrobiota\tferment\tsloughed\tintestinal\tcells\tand\tundigested\tfoodstuffs\tto\tgases\nand\tshort-chain\tfatty\tacids\t(SCFAs).\tAbsorption\tof\tSCFAs\tfacilitates\tabsorption\tof\telectrolytes\tand\nwater\tfrom\tthe\tcolon.\tBroad-spectrum\tantibiotics\tdecrease\tthe\tnumber\tof\tcommensal\tbacteria\tin\tthe\nbowel
|
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] |
bowel\n\tand\tmay\tresult\tin\tdecreased\tfermentation\tbyproducts,\treducing\tthe\tabsorption\tof\telectrolytes\nand\twater,\tthereby\tcausing\tdiarrhea.\nFIG.\t27.2\nThe\thuman\tgut\tmicrobiota\n\tSource:\t(Illustration\tby\tDavid\tSchumick,\tBS,\tCMI.\tCleveland\tClinic\tCenter\tfor\tMedical\nArt\t&\tPhotography\t©2015.\tAll\trights\treserved.\tCCF,\tCleveland\tClinic\tFoundation).
|
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] |
Some\tantibiotics\tallow\tproliferation\tof\topportunistic\tpathogenic\tmicroorganisms\tnormally\nsuppressed\tby\tcompetitive\tmicroorganisms\tin\tthe\tGI\ttract.\tThe\ttoxins\tproduced\tby\tsome\nopportunistic\n\tmicroorganisms\tcan\tcause\tcolitis\tand\tincreased\tsecretion\tof\tfluid\tand\telectrolytes.\tA\nrise\tin\tantibiotic\tuse\thas\tled\tto\tan\tincrease\tin
|
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rise\tin\tantibiotic\tuse\thas\tled\tto\tan\tincrease\tin\t\nantibiotic-associated\tdiarrhea\t(AAD)\n\tand\novergrowth\tof\t\nClostridium\tdifficile\n\twith\tresultant\t\nClostridium\tDifficile\t(C.\tDifficile)\n\tinfection\n(CDI)\n.\nC.\tdifficile\n\tis\ta\tspore-forming\torganism,\tand\tthe\tspores\tare\tresistant\tto\tcommon\tdisinfectant\nagents.\tThe\tspore-forming\n\tability\tof\t\nC.\tdifficile
|
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agents.\tThe\tspore-forming\n\tability\tof\t\nC.\tdifficile\n\tallows\tthe\torganism\tto\tbe\tspread\tinadvertently\tto\nother\tpatients\tby\thealth\tcare\tproviders\t(iatrogenic\tinfection)\tif\tstrict\tinfection\tcontrol\tprocedures\nare\tnot\tfollowed.\tThe\tpresence\tof\tthis\tinfection\tis\tdetected\tby\tanalysis\tof\ta\tstool\tsample\tfor\tthe
|
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presence\tof\tthe\ttoxin\tproduced\tby\tthe\torganisms.\tClindamycin,\tpenicillin,\tand\tcephalosporins\tare\nassociated\tmost\toften\twith\n\tthe\tdevelopment\tof\t\nC.\tdifficile\n\tinfection.\tIts\toccurrence\tdepends\ton\tthe\nnumber\tof\tantibiotics\tused,\tthe\tduration\tof\texposure\tto\tantibiotics,\tand\tthe\tpatient’s\tage\tand\toverall
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] |
health.\tChronic\tsuppression\tof\tstomach\tacid\twith\tproton\tpump\tinhibitor\tmedications\tduring\tbroad-\nspectrum\tantibiotic\ttherapy\talso\tmay\tincrease\tsusceptibility\tto\tCDI\t(\nTarig\tet\tal,\t2017\n;\t\nTrifan\tet\tal,\n2017\n).\nC.\tdifficile\n\twas\n\thistorically\tconsidered\ta\tnosocomial\t(hospital-acquired)\tdiarrheal\tinfection
|
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] |
associated\twith\tantibiotic\texposure.\tMore\trecently,\tits\tprevalence\thas\tincreased\tto\tinclude\ta\thigher\nincidence\tin\tpopulations\tpreviously\tconsidered\tat\tlow\trisk\t(\nDePestel\tand\tAronoff,\t2013\n).\t\nC.\tdifficile\nmay\tcause\tcolitis,\tsecretory\tdiarrhea,\tsevere\tdilation\tof\tthe\tcolon\t(toxic\tmegacolon),\tperforation\tof\nthe\tbowel\twall,
|
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] |
the\tbowel\twall,\n\tperitonitis,\tor\teven\tdeath\t(\nPattani\tet\tal,\t2013\n).\tAdding\tfurther\tcomplication\tto\neradicating\tCDI,\tresistant\tstrains\tare\tless\tsusceptible\tto\ttreatment\twith\tantimicrobials\tand\tcause\ta\nmore\tsevere\tform\tof\tthe\tdisease\twith\tincreased\thealth\tcare\tcosts\tand\thigher\tmortality\t(\nO’Keefe,\n2010\n).
|
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0.0013038822216913104
] |
O’Keefe,\n2010\n).\nAccording\tto\tthe\tCenters\tfor\tDisease\tControl\tand\tPrevention\t(CDC),\t\nC.\tdifficile\n\twas\testimated\tto\ncause\talmost\n\t500,000\tinfections\tin\tthe\tUnited\tStates\tin\t2011\talone.\tOf\tthose,\t83,000\tpatients\npresented\twith\tat\tleast\tone\trecurrence,\tand\talmost\t29,000\tdied\twithin\t30\tdays\tof\tthe\tinitial
|
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] |
diagnosis.\tPrescribing\tunnecessary\tor\tincorrect\tantibiotics\toccurs\tin\t30%\tto\t50%\tof\thospitalized
|
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] |
patients\twho\treceive\tthem.\tThis\toversight\tis\tthought\tto\tbe\tan\timportant\tcontributor\tto\tincreased\trisk\nfor\tthis\tlife-threatening\tinfection\n\t(\nCDC,\t2015\n).\tFortunately,\twith\tincreased\tinfection\trisk\tprotocols,\ngreater\tprecautions\twith\tantibiotic\tuse,\tand\tclinician\tawareness,\tthere\twas\tan\t8%\tdecrease\tin\tCDI\nfrom\t2011\tto\t2014\t(\nCDC,\t2018\n).\tSee
|
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] |
from\t2011\tto\t2014\t(\nCDC,\t2018\n).\tSee\t\nFig.\t27.3\n\tinfographic\treviewing\timportant\tdetails.\nFIG.\t27.3\nDeadly\tDiarrhea:\t\nC.\tDifficile\n\tcauses\timmense\tsuffering,\tdeath\t(CDC,\t2015).\nMedical\tmanagement\nBecause\tdiarrhea\tis\ta\tsymptom,\tnot\ta\tdisease,\tthe\tfirst\tstep\tin\tmedical\ttreatment\tis\tto\tidentify\tand
|
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] |
treat\tthe\tunderlying\tproblem.\tThe\tnext\tgoal\tis\tto\tmanage\tfluid\tand\telectrolyte\treplacement.\tIn\tcases\nof\tsevere\tdiarrhea,\trestoring\tfluid\tand\telectrolytes\tis\tfirst\tpriority.\tElectrolyte\n\tlosses,\tespecially\npotassium\tand\tsodium,\tshould\tbe\tcorrected\tearly\tby\tusing\toral\tglucose\telectrolyte\tsolutions\twith
|
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] |
added\tpotassium.\tOral\trehydration\tsolutions\t(ORS)\twork\tbecause\tthey\tcontain\tconcentrations\tof\nsodium\tand\tglucose\tthat\tare\toptimal\tfor\tinteraction\twith\tthe\tsodium-glucose\ttransport\t(SGLT)\nproteins\tin\tthe\tintestinal\tepithelial\tcells\t(see\t\nChapter\t1\n).\nWith\tintractable\tdiarrhea,\tespecially\n\tin\tan\tinfant\tor\tyoung\tchild,\tparenteral\tfeeding\tmay\tbe
|
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] |
in\tan\tinfant\tor\tyoung\tchild,\tparenteral\tfeeding\tmay\tbe\nrequired.\tParenteral\tnutrition\t(PN)\tmay\teven\tbe\tnecessary\tif\texploratory\tsurgery\tis\tanticipated,\tor\tif\nthe\tpatient\tis\tnot\texpected\tto\tresume\tfull\toral\tintake\twithin\t5\tto\t7\tdays\t(see\t\nChapter\t12\n).\nSupplementation\twith\tprobiotics,\tdefined\tbelow,\tshows\tsome\tpromise\tto\tprevent\tAAD\tand\tCDI\tand
|
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research\tis\tongoing,\tbut\tthere\tare\tinadequate\tdata\n\tto\trecommend\tprobiotics\tas\ta\tprimary\ttreatment\nfor\tCDIs\t(\nPattani\tet\tal,\t2013\n)\t(see\t\nFocus\tOn:\n\tProbiotics\tand\tPrebiotics\tand\tthe\tGut\tMicrobiota\n).\nCurrently,\tthe\tbest\ttreatment\tfor\trefractory\tCDI\tis\tto\temploy\t\nfecal\tmicrobiota\ttransplant\t(FMT)\n.
|
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fecal\tmicrobiota\ttransplant\t(FMT)\n.\nWith\tthe\tconcept\tof\tthe\thuman\tgut\tmicrobiota\tas\tan\torgan,\tFMT\tmay\tbe\tconsidered\tan\torgan\ntransplant.\tIn\tthis\tprocedure,\tthe\tgut\tmicrobiota\tof\tthe\tperson\tinfected\n\twith\t\nC.\tdifficile\n\tis\treplaced\nwith\thealthy\tdonor\tstool,\ttypically\tfrom\ta\tfamily\tmember\twith\tsimilar\tdietary\tand\tliving\thabits.\tA
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recent\tstudy\tfound\ta\t>90%\tsuccess\trate\tin\tparticipants\treceiving\tFMT\tfor\teradication\tof\tCDI,\twith\nno\tdisease\trecurrence\tafter\tprocedure\t(\nKonturek\tet\tal,\t2016\n).\n\t\nFocus\tOn\nProbiotics\tand\tPrebiotics\n\tand\tthe\tGut\tMicrobiota\nSome\tgastrointestinal\tconditions\tsuch\tas\t\nClostridium\tdifficile\n\tinfection\t(CDI),\tsmall\tintestinal
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] |
Clostridium\tdifficile\n\tinfection\t(CDI),\tsmall\tintestinal\nbacterial\tovergrowth\t(SIBO),\tantibiotic-associated\tdiarrhea,\tand\tperhaps\tinflammatory\tbowel\ndisease\tmay\tresult\tor\thave\texacerbated\tsymptoms\twhen\tthere\tare\talterations\tto\tthe\tcolonies\tof\nmicroorganisms\tthat\texist\tin\tthe\tsmall\tor\tlarge\tintestines.\tExposure\tto\tbroad-spectrum\tantibiotics
|
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] |
causes\tdramatic\talterations\tto\tgut\tmicrobiota,\tplacing\tthe\tpatient\tat\trisk\tfor\tovergrowth\tof\npotentially\tpathogenic\tmicrobes\tand\topportunistic\tgastrointestinal\t(GI)\tinfections.
|
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A\t\nprobiotic\n\tis\tdefined\tby\tthe\tFood\tand\tAgriculture\tOrganization\tof\tthe\tUnited\tNations\tand\tthe\nWorld\tHealth\tOrganization\t(FAO/WHO)\tas\t“live\tnonpathogenic\torganisms\t(bacteria\tor\tyeast)\nwhich\twhen\tadministered\tin\tadequate\n\tamounts\tconfer\ta\thealth\tbenefit\ton\tthe\thost.”\tTo\tbe\ta
|
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] |
amounts\tconfer\ta\thealth\tbenefit\ton\tthe\thost.”\tTo\tbe\ta\nprobiotic,\tmeaning\t“for\tlife,”\ta\tlive\tmicrobial\tstrain\tmust\tmeet\tvery\tstringent\tcriteria.\tAccording\nto\tthe\tFAO/WHO,\tthese\tcriteria\tinclude\tbeing\tsafe\tfor\thuman\tconsumption,\tbeing\ta\tlive\tand\tviable
|
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] |
organism\twith\tstrain\tidentification,\tbeing\tof\thuman\torigin,\tbeing\tresistant\tto\tacid\tand\tbile,\tbeing\nable\tto\tsurvive\tthe\tupper\tintestinal\ttract\tenvironment\n\tand\treach\tthe\tdistal\tintestine\t(ileum\tand\ncolon)\tto\tattach\tto\tthe\tintestinal\tepithelium,\tand\tbeing\table\tto\tcolonize\tthe\tdistal\tintestine,\tconfer
|
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] |
health\tbenefit\tto\tthe\thost,\tand\thave\tscientifically\tproven\thealth\tbenefits\t(\nCresci\tand\tIzzo,\t2017\n).\nUnfortunately,\tsuch\ta\tregulatory\tframework\tdoes\tnot\texist\tin\tthe\tUnited\tStates\tat\tpresent.\nTherefore\tbecause\tof\tthese\tstrict\tcriteria,\tsome\tsupplements\n\ttermed\t“probiotics”\tare\tnot\ttruly
|
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] |
termed\t“probiotics”\tare\tnot\ttruly\nprobiotics\tand\ttheir\tuse\tmay\tbe\tmisleading\tto\tclinicians\tand\tconsumers.\nCertain\tstrains\tof\tbacteria\thave\tbeen\tidentified\tas\tprobiotics.\tThese\tmay\tbe\tavailable\tin\nsupplement\tform\t(e.g.,\tcapsules,\tpowders)\tor\tincluded\tin\tfermented\tfood\tproducts\t(e.g.,\tyogurts,
|
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] |
kefir).\tThe\texact\tdose,\tmeans\tfor\tdelivery,\tor\tthe\tduration\tof\tviability\tare\tuncertain,\tprobably\tvary\nfor\tdifferent\tprobiotic\tstrains,\tand\tmay\tdepend\ton\tthe\tcondition\tto\tbe\ttreated.\tIt\thas\tbeen\nsuggested\tthat\tprobiotics\tmay\trestore\tthe\tbalance\tof\tintestinal\tmicrobes\tand\timprove\tsymptoms
|
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] |
and\tprevent\tor\ttreat\tconditions\tin\twhich\ta\tgut\tdysbiosis\thas\toccurred,\tsuch\tas\tantibiotic-\nassociated\tdiarrhea\t(\nPattani\tet\tal,\t2013\n).\t\nSaccharomyces\tboulardii\n,\ta\tprobiotic\tyeast,\thas\tbeen\nshown\tto\treduce\trecurrence\n\tin\tthose\twith\tCDI\twhen\thigh-dose\toral\tvancomycin\twas\talso\tused\n(\nCresci\tand\tIzzo,\t2017
|
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] |
(\nCresci\tand\tIzzo,\t2017\n).\tCertain\ttypes\tof\tprobiotics\tmay\tbe\teffective\tin\treducing\tthe\tduration\tof\nenterovirus-induced\tacute\tinfectious\tdiarrhea\tin\tpediatric\tand\tadult\tpatients\tand\tin\tthose\twith\ninflammatory\tbowel\tdisease\t(IBD).\nLike\tprobiotics,\tprebiotics\thave\tstrict\tcriteria\tfor\ttheir\tclassification.\tPrebiotics,\tundigested\npolysaccharides,
|
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polysaccharides,\n\tand\tsloughed\tproteins\tare\tthe\tfood\tsource\tfor\tthe\tcommensal\tgut\tmicrobiota.\nA\t\nprebiotic\n\tis\tdefined\tas\t“a\tselectively\tfermented\tingredient\tthat\tallows\tspecific\tchanges,\tboth\nin\tthe\tcomposition\tand\tactivity\tin\tthe\tgut\tmicrobiota,\tthat\tconfer\tbenefits\tupon\thost\twell-being\nand\thealth”\t(\nCresci\tand\tIzzo,\t2017
|
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] |
and\thealth”\t(\nCresci\tand\tIzzo,\t2017\n).\tImportantly,\tprebiotics\tmust\tbe\tresistant\tto\tgastric\tacidity,\tto\nhydrolysis\tby\tmammalian\n\tenzymes,\tand\tto\tGI\tabsorption;\tmust\tbe\tfermented\tin\tthe\tGI\ttract\tby\tthe\ngut\tmicrobiota;\tand\tmust\tbe\tselective\tin\tthe\tstimulation\tof\tthe\tgut\tmicrobiota\tgrowth\tand\tactivity
|
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] |
that\tcontribute\tto\thealth\tand\twell-being.\tPrebiotics\tare\tnaturally\toccurring\tor\tsynthetic\tsugars\nand\tare\tnot\tavailable\tto\tall\tgut\tmicrobial\tspecies.\tUpon\treaching\tthe\tdistal\tintestine\t(ileum\tand\ncolon),\tprebiotics\tare\tfermented\n\tby\tthe\tgut\tmicrobiota\tto\tyield\tshort-chain\tfatty\tacids\t(SCFAs)\tand
|
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by\tthe\tgut\tmicrobiota\tto\tyield\tshort-chain\tfatty\tacids\t(SCFAs)\tand\ngases\t(carbon\tdioxide,\thydrogen,\tand\tmethane).\tSCFAs\t(acetate,\tpropionate,\tbutyrate)\tserve\nmany\tbiologic\troles,\tincluding\taiding\twith\twater\tand\telectrolyte\tabsorption,\tdecreasing\nintraluminal\tpH,\taltering\tcell\tproliferation\tand\tdifferentiation,\tand\tmodifying\tintestinal\timmune
|
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] |
and\tinflammatory\tprocesses\t(\nCresci\tand\tIzzo,\t2017\n).\n\tAlthough\tprobiotics\thave\treported\tsafety\nissues\twith\tselect\tclinical\tconditions,\tprebiotics\tcarry\tfew\tsafety\tconcerns.\tHowever,\tlike\nprobiotics,\tprebiotics\tmay\talso\tcontribute\tto\tGI\tdiscomfort\t(bloating,\tgas)\tif\tintroduced\ttoo\trapidly\ninto\tthe\tdiet.
|
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] |
into\tthe\tdiet.\nBecause\tthere\tis\tpromise\tin\ttheory\tand\tin\tselect\tstudies\tfor\timproving\tgut\tdysbiosis\twith\nsupplements,\tfurther\tstudies\tevaluating\tthe\toptimal\tdose,\n\ttiming,\tduration,\tand\tindications\tfor\nprobiotics,\tprebiotics,\tand\ttheir\tcombinations,\tare\twarranted.\tRegular\tintake\tof\tfood\tsources\tof
|
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prebiotics\tand\tprobiotics\tcan\talso\tencourage\tincreased\tmicrobial\tdiversity\tin\tthe\tgut,\treducing\nreliance\ton\tsupplements\twhen\tappropriate.\nProducts\tthat\tcombine\tprobiotic\tmicroorganisms\tand\ta\tprebiotic\tfiber\tsource\thave\tbeen\tdescribed\nas\t\nsynbiotics\n\tfor\ttheir\n\tsynergistic\teffects.\tA\trecent\treview\tevaluated\tefficacy\tof\tprobiotics,
|
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prebiotics,\tand\tsynbiotics\tfor\timprovements\tin\tthe\tmicrobiota\tfor\ta\tvariety\tof\tdisorders.\tSynbiotics\nwere\tfound\teffective\tfor\thepatic\tencephalopathy,\timproved\thigh-density\tlipoprotein\t(HDL)\tand\nfasting\tglucose,\tbut\talso\tdemonstrated\tpositive\tresults\tfor\ttreating\tinfectious\tdiarrhea\tin\tchildren\n(\nPatel\tand\tDuPont,\t2015\n).\nThere
|
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] |
(\nPatel\tand\tDuPont,\t2015\n).\nThere\n\tis\ta\tlong\thistory\tof\tsafe\tuse\tof\tmany\tstrains\tof\t“live\tactive\tcultures”\tin\tfoods\tin\thealthy\nhumans.\tHowever,\tthe\tbody\tof\tevidence\tis\tlimited\ton\tthe\tuse\tof\tlarge\tdoses\tof\tconcentrated\tprobiotic\nsupplements,\tespecially\tof\tspecific\tstrains\tthat\texhibit\tgreater\tresistance\tto\tgastric\tacid\tor\thave
|
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this\tsupplement\tto\n\tcritically\till\tpatients\thave\tbeen\tinstated\tto\tavoid\tsuch\tcomplications.\tIn\ta\tlarge\ndouble-blind,\trandomized\tstudy\tof\ta\thigh-dose\tmultispecies\tprobiotic\tadministered\tvia\tjejunal\nfeeding\ttube\tin\tpatients\twith\tsevere\tacute\tpancreatitis,\tthere\twere\tsignificantly\tmore\tdeaths\tin\tthose
|
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who\treceived\tprobiotics\tcompared\twith\tthose\treceiving\tthe\tinactive\tplacebo,\tand\ta\treduced\trisk\tof\ninfectious\tcomplications\n\twas\tnot\tdemonstrated\tin\tthe\tprobiotic\tgroup\t(\nBesselink\tet\tal,\t2008\n).\nAlthough\tthis\thistorical\tstudy\twas\tconcerning\tand\tprovides\twarning\tbefore\tadministering\tlive
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cultures\tto\tcritically\till\tpatients,\tthere\twere\tstudy\tflaws\tand\tlimitations,\twhich\tlead\tto\tquestions\nwhether\tthe\tincreased\tmortality\twas\tsolely\tthe\tresult\tof\tprobiotic\tsupplementation;\tfurther\tstudy\tis\nneeded\tin\tthis\tarea.\nProbiotic\n\tpreparations\thold\tpromise\tas\tan\tadjunctive\tor\tprimary\ttreatment\tin\tseveral
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] |
gastrointestinal\tconditions,\tbut\tresearch\tis\tongoing\ton\tmodifying\tthe\tmicrobiota\tand\tthere\tremain
|
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inadequate\tdata\tthus\tfar\tto\tmake\tlarge\tgeneralizations\tregarding\tprobiotic\tsafety\tfor\tall\tpopulations\n(\nBafeta\tet\tal,\t2018\n).\tIn\tcontrast,\tas\tan\temerging\tarea\tof\tscientific\tresearch,\tthere\tis\talso\ta\tmovement\nto\tdetermine\thow\n\tmanipulating\tthe\tmicrobiota\tcan\tconfer\tbenefit\tto\tthe\thost\t(\nWalsh\tet\tal,\t2014\n).\tTo
|
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] |
Walsh\tet\tal,\t2014\n).\tTo\nlearn\tmore\tand\tfollow\tthis\texciting\tarea\tof\tnutrition\tresearch,\tthe\tInternational\tScientific\tAssociation\nfor\tProbiotics\tand\tPrebiotics\t(\nhttps://isappscience.org/\n)\tis\tan\texcellent\tresource.\nMedical\tnutrition\ttherapy\nAll\tnutrition\tinterventions\trelated\tto\tdiarrhea\tmust\tbe\tviewed\twithin\tthe\tcontext\tof\tthe\tunderlying
|
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] |
pathologic\tcondition\tresponsible\tfor\tthe\tdiarrhea.\tReplacement\tof\tnecessary\tfluids\tand\telectrolytes\tis\nthe\tfirst\tstep,\tusing\tORS,\tsoups\tand\tbroths,\tvegetable\tjuices,\tand\tisotonic\tliquids.\tRestrictive\tdiets,\nsuch\tas\tthe\tBRAT\tdiet\tmade\tup\tof\tbananas,\trice,\tapplesauce,\tand\ttoast,\tare\tnutrient\tpoor;\tno
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evidence\tindicates\tthat\tthey\tare\tnecessary\tduring\tacute\tdiarrheal\tillness.\tAlthough\tthere\tis\tlimited\nresearch\tto\tsupport\tdoing\tso,\tsome\tclinicians\talso\trecommend\ta\tprogression\tof\tstarchy\ncarbohydrates\tsuch\tas\tcereals,\tbreads,\tand\tlow-fat\tmeats,\tfollowed\tby\tsmall\tamounts\tof\tvegetables
|
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] |
and\tfruits,\tfollowed\tby\tfats.\tThe\tgoal\twith\tthis\tprogression\tis\tto\tlimit\tlarge\tamounts\tof\thyperosmotic\ncarbohydrates\tthat\tmay\tbe\tmaldigested\tor\tmalabsorbed,\tfoods\tthat\tstimulate\tsecretion\tof\tfluids,\tand\nfoods\n\tthat\tspeed\tthe\trate\tof\tGI\ttransit.\nSugar\talcohols,\tlactose,\tfructose,\tand\tlarge\tamounts\tof\tsucrose\tmay\tworsen\tosmotic\tdiarrheas.\tIBS
|
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] |
may\talso\tbe\tassociated\twith\tdiarrhea\tor\ta\tmix\tof\tconstipation\tand\tdiarrhea.\tSeveral\tdiet\tchanges\nwithin\tthe\tlow\tFODMAP\tdiet\tsimilar\tto\tthe\tfoods\tmentioned\tabove\tmay\timprove\tsymptoms\t(see\nIrritable\tBowel\tSyndrome\n\tin\tthis\tchapter).\tBecause\tthe\tactivity\tof\tthe\tdisaccharidases\n\tand\ttransport
|
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] |
and\ttransport\nmechanisms\tdecrease\tduring\tinflammatory\tand\tinfectious\tintestinal\tdisease,\tsugars\tmay\thave\tto\tbe\nlimited,\tespecially\tin\tchildren.\tMalabsorption\tis\tonly\tone\tpotential\tcause\tof\tdiarrhea,\tand\tdiarrhea\nmay\toccur\twithout\tsignificant\tmalabsorption\tof\tmacronutrients\t(carbohydrate,\tfat,\tand\tprotein).
|
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0.0274954941123724,
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-0.013401655480265617,
-0.010850233025848866,
0.040722236037254333,
0.044170185923576355,
0.12068716436624527,
-0.05546622350811958
] |
Absorption\tof\tmost\tnutrients\toccurs\tin\tthe\tsmall\tintestine;\tdiarrhea\trelated\tto\n\tcolonic\tinflammation\nor\tdisease\tpreserves\tthe\tabsorption\tof\tmost\tingested\tnutrients.\nMinimal\tfiber\tand\tlow-residue\tdiets\tare\trarely\tindicated\t(\nTable\t27.1\n).\tPatients\tare\tencouraged\tto
|
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0.06199164316058159,
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0.07046281546354294,
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0.06946372240781784,
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0.043804436922073364,
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0.053049080073833466,
0.10350743681192398,
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] |
Table\t27.1\n).\tPatients\tare\tencouraged\tto\nresume\ta\tregular\tdiet\tas\ttolerated\tthat\tcontains\tmoderate\tamounts\tof\tsoluble\tfiber.\tThe\tmetabolism\nof\tsoluble\tfiber\tand\tresistant\tstarches\tby\tcolonic\tbacteria\tleads\tto\tproduction\tof\t\nshort-chain\tfatty\nacids\t(SCFAs)\n,\twhich\tin\tphysiologic\tquantities\tserve\tas\ta\tsubstrate\tfor\tcolonocytes,\tfacilitate\tthe
|
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] |
absorption\tof\tfluid\tand\tsalts,\tand\tmay\thelp\tto\tregulate\tGI\tmotility.\nTABLE\t27.1\nFood\tto\tLimit\tin\ta\tLow-Fiber\t(Minimal-Residue)\tDiet\nFood\nComments\nLactose\t(in\tlactose\nmalabsorbers)\n6\tto\t12\tg\tis\tnormally\ttolerated\tin\thealthy\tlactase-deficient\tindividuals\tbut\tmay\nnot\tbe\tin\tsome\tindividuals.\nInsoluble\n\tfiber\n(quantities\t>20\tg)
|
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] |
not\tbe\tin\tsome\tindividuals.\nInsoluble\n\tfiber\n(quantities\t>20\tg)\nModest\tamounts\t(10\tto\t15\tg)\tmay\thelp\tmaintain\tnormal\tconsistency\tof\ngastrointestinal\t(GI)\tcontents\tand\tnormal\tcolonic\tmucosa\tin\thealthy\tstates\nand\tGI\tdisease.\nSorbitol,\tmannitol,\tand\nxylitol\t(excess,\t>10\ng/day)\nWell\ttolerated\tin\tmoderate\tamounts;\tlarge\tamounts\tmay\tcause\thyperosmolar
|
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] |
diarrhea.\nFructose\t(excess,\t20\tto\n25\tg/meal)\nSucrose\t(excess,\t>25\tto\n50\tg/meal)\nCaffeine\nIncreases\tGI\tsecretions,\tcolonic\tmotility\nAlcoholic\tbeverages\n(especially\twine\tand\nbeer)\nIncrease\tGI\tsecretions\nFibrous\tmaterial\ttends\tto\tslow\tgastric\temptying,\tmoderate\toverall\tGI\ttransit,\tand\tpull\twater\tinto
|
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] |
the\tintestinal\tlumen.\tProviding\tfiber\tto\tpatients\twith\tdiarrhea\tdoes\tincrease\tthe\tvolume\tof\tstool,\tand\nin\tsome\tcases\t(such\tas\tsmall\tintestinal\tbacterial\tovergrowth\t[SIBO])\n\tinitially\tcan\tincrease\tgas\tand\nbloating.\tModest\tintake\tof\tprebiotic\tcomponents\tand\tsoluble\tfibers\tsuch\tas\tpectin\tor\tgum\tslows\ntransit\tthrough\tthe\tGI\ttract.
|
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] |
transit\tthrough\tthe\tGI\ttract.\nSeveral\tprobiotics\thave\tbeen\tstudied\tfor\tpreventing\tAAD.\tCurrently,\tof\tthose\ttested,\nSaccharomyces\tboulardii\n\tand\t\nLactobacillus\n-based\tformulations\tappear\tto\tbe\tmost\teffective\tin\nreducing\tAAD\t(\nPattani\tet\tal,\t2013\n).\tA\tmore\trecent\tmeta-analysis\n\tspecifically\tfound\t\nSaccharomyces\nboulardii
|
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] |
specifically\tfound\t\nSaccharomyces\nboulardii\n\tto\tbe\teffective\tin\treducing\trisk\tof\tAAD\tin\tboth\tchildren\tand\tadults\twithout\tadverse\tside\neffects,\tbut\talso\tencouraged\tcaution\tin\tpatients\twho\tare\timmunocompromised\tor\twith\tlife-\nthreatening\tillnesses\tmanaged\tin\tthe\tintensive\tcare\tunit\t(ICU)\tsetting\t(\nSzajewska\tand\tKotodziej,\n2015
|
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] |
Szajewska\tand\tKotodziej,\n2015\n).\tStudies\tare\tstill\tneeded\tto\tfind\tthe\toptimal\tcombination\tof\tprobiotics\tand/or\n\tprebiotics,\ntesting\tfor\tdosing\tschedules,\tand\tconcentrations.\nSevere\tand\tchronic\tdiarrhea\tis\taccompanied\tby\tdehydration\tand\telectrolyte\tdepletion.\tIf\talso
|
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] |
accompanied\tby\tprolonged\tinfectious,\timmunodeficiency,\tor\tinflammatory\tdisease,\tmalabsorption\tof\nvitamins,\tminerals,\tand\tprotein\tor\tfat\talso\tmay\toccur,\tand\tnutrients\tmay\thave\tto\tbe\treplaced\nparenterally\tor\tenterally.\tIn\tsome\tforms\tof\tinfectious\n\tdiarrhea,\tloss\tof\tiron\tfrom\tGI\tbleeding\tmay\tbe
|
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diarrhea\tbegins\tto\tresolve,\tthe\taddition\tof\tmore\tnormal\tamounts\tof\tfiber\tto\tthe\tdiet\tmay\thelp\tto\nrestore\tnormal\tmucosal\tfunction,\tincrease\telectrolyte\tand\n\twater\tabsorption,\tand\tincrease\tthe\nfirmness\tof\tthe\tstool.\nFood\tin\tthe\tlumen\tis\tneeded\tto\trestore\tthe\tcompromised\tGI\ttract\tafter\tdisease\tand\tperiods\tof
|
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fasting.\tEarly\trefeeding\tafter\trehydration\treduces\tstool\toutput\tand\tshortens\tthe\tduration\tof\tillness.\nMicronutrient\treplacement\tor\tsupplementation\talso\tmay\tbe\tuseful\tfor\tacute\tdiarrhea,\tprobably\nbecause\tit\taccelerates\tthe\tnormal\tregeneration\tof\n\tdamaged\tmucosal\tepithelial\tcells.\nTreating\tdiarrhea\tin\tinfants\tand\tchildren
|
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Treating\tdiarrhea\tin\tinfants\tand\tchildren\nAcute\tdiarrhea\tis\tmost\tdangerous\tand\ta\tleading\tcause\tof\tmortality\tin\tinfants\tand\tsmall\tchildren,\twho\nare\teasily\tdehydrated\tby\tlarge\tfluid\tlosses.\tProvision\tof\textra\tfluids,\tincluding\tbreastmilk,\tcan\nprevent\tdehydration,\tbut\tin\tthe\tmost\tsevere\tcases\treplacement\tof\tfluid\tand\telectrolytes\tmust\tbe
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aggressive\tand\timmediate.\n\tSince\t1978,\tthe\tWorld\tHealth\tOrganization\t(WHO)\thas\trecommended\ta\nstandard\t\noral\trehydration\tsolution\t(ORS)\n\tfor\tthis\tacute\tsituation\tas\ta\tway\tfor\tparents\tto\tbe\table\nto\tparticipate\tin\ttheir\tchildren’s\tcare\tat\thome\twith\ta\treduced\tneed\tfor\tIV\thydration\tor
|
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] |
hospitalization.\tThe\tstandard\tWHO-recommended\tORS\thistorically\thad\tan\tosmolarity\tof\t311\tmOsm/L\nand\tcontained\tspecific\tconcentrations\tof\tsodium\t(90\n\tmEq),\tpotassium\t(20\tmEq/L),\tchloride\t(80\nmEq/L),\tand\tglucose\t(20\tg/L)\t(\nSuh\tet\tal,\t2010\n).\nFor\tover\t25\tyears,\tthe\tstandard\tsolution\twas\tused,\tdecreasing\tthe\tmortality\trate\tfrom\t5\tmillion\tto
|
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1.3\tmillion\tdeaths\tannually\t(\nWHO,\t2002\n).\tWhile\tincredibly\teffective\tat\trehydrating,\treducing\tfecal\nvolume\tor\tduration\tof\tillness\twas\tstill\tan\timportant\tconcern,\tleading\tto\tresearch\tand\tdevelopment\tof\na\tnew\tsolution.\n\tThe\tresult\tof\tthis\twork\tcame\tto\tfruition\tin\t2003,\twhen\tthe\tWHO\tmade\ta\tchange\tto
|
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] |
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