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November 27, 2016 00:18

Intestinal exsicosis children

Intestinal exsicosis - one of the most commonly occurring emergency conditions due to the action of heat labile enterotoxin of Gram-negative bacteria and some viruses on the enterocytes.The pathogenesis of intestinal exsicosis are fluid loss and electrolyte and buffer bases diarrheal masses, which leads to the development of dehydration, metabolic acidosis, disorders of the central and peripheral blood circulation and the oxygen-transport function of blood.

exsicosis are three degrees (5 to 10-12% acute weight loss) and three of its kind isotonic, hypertonic and hypotonic exsicosis.The peculiarity of early childhood (children under 5 years with OCI) - the development of only isotonic form of dehydration, which is associated with hyperaldosteronism and low sodium content in diarrheal masses.Depending on the amount of fluid loss with a chair and a kind of OCI child loses from 60 to 80 mmol / l sodium, while the adult patient loses 140-145 mmol / L.But, in contrast to adults, the child loses diarrheal ma

ss twice the potassium (25 mmol / l).For this reason, isotonic form exsicosis and normal sodium content in plasma in young children is always a relative (with exsicosis II degree) or absolute (for exsicosis III degree) hypokalemia.When fluid rehydration therapy is important to consider these features.

Symptoms of intestinal exsicosis

The most characteristic symptoms of intestinal exsicosis:

  • retraction of a large fontanelle,
  • symptom of "standing" folds,
  • decreased urine output,
  • dry skin and mucous membranes,
  • cold extremities,
  • shortness of breath,
  • hypocapnia,
  • zero or negative CVP,
  • subcompensated or decompensated metabolic acidosis.

Signs of dehydration during the second and third degree exsicosis

symptoms and laboratory data degree exsicosis and fluid deficit,%
II (5-9%) III (10% or more)

1

2

3

Symptom "standing pleats»

pinch goes back to 2 with

pinch goes back more than 2

Large fontanelle

sink

Very sinks

Chair

losses 2,7-3,9 ml / (kghchas)

losses of more than 4 mL / (kghchas)

Vomiting

1-3 times a day

More than 3 times a day

eye symptoms

«Shadow" under the eyes, sunken eyes

eyessharply sunken eyelids are closed not completely

Mucous membranes

dryly, bloodshot

Dry, bright, IET tears

CVP

zero or negative

negative

pH

7,26 + 0016

July 16 + 0,02

BE

-13,6 + 1,2

-17,5 + 1,3

pCO2 mm Hg

28,2 + 2,9

23,3 + 1,7

Na +, mmol/ l

137-141

135-138

K +, mmol / l

3,5-4, 0

3,1-3,3

hematocrit

36-38

38-40

Underweight corresponds to 5% of I degree exsicosis, 6-9% - exsicosis II degree, and 10%more - exsicosis III degree.

Control reliability diagnosed exsicosis degree can serve as a retrospective evaluation of the patient's body weight increase as a percentage of 2-3 days after corrective therapy provided in the normalization of plasma concentrations of the major electrolytes indices CBS exsicosis and eliminate symptoms.Weight gain of 3-5% corresponds exsicosis II degree, and 5-9% - exsicosis III degree.

Pathogenic intensive therapy intestinal exsicosis II and III degree

Basic requirements for pathogenic, intensive care patients with intestinal exsicosis II-III degree:

  • compensation of lost salts and fluids,
  • increase the buffer capacity of the blood,
  • decrease pathological loss via enterosorbents.

Abnormal loss - the result of three components of fluid deficit, the physiological needs of the individual patient and the ongoing pathological loss (vomit and feces), the amount of which is determined gravimetrically.For the next correction sodium solution was used - 78 mmol / L, potassium - 26 mmol / l chlorine - 61 mmol / l sodium bicarbonate - 11.8 mmol / l sodium acetate - 31.6 mmol / l, water - 1 liter.

isotonic solution with pH 7,4 From the total volume of fluid calculated on day 25-30% child is able to absorb enteral, even on the first day.fluid deficiency is compensated fairly quickly, in about 6 hours if the patient's condition allows.In the first two hours, 50% of the injected fluid lost at a rate of 40-50 drops per minute, the second half -. 4 hours after the liquid coating deficit introduced at a rate of 10-14 drops per minute for coating physiological and pathological needs losses.Infusion rate at this stage depends on the amount of pathological loss.

Pathological losses:

  • severe diarrhea - loss of up to 3 ml / (kghch),
  • severe diarrhea - from 3 to 5 ml / (kghch),
  • cholera, profuse diarrhea - more than 5 ml / (kghch).

Rehydration, corrective therapy usually lasts an average of two days.The criteria for its effectiveness are:

  • increase in body weight by 3-7% for the first day,
  • normalization of plasma electrolyte concentrations and a decrease in metabolic acidosis,
  • positive CVP,
  • drop in body temperature, increase diuresis, termination (curtailment)vomiting, improvement of the general condition of the child.

parallel wires etiotropic and symptomatic therapy, which includes:

  • antibacterial agents from the group of aminoglycosides and cephalosporins, starting with generation III (parenteral and oral), in cases of bacterial or mixed OCI and chelators(smectite, neosmektin, enterosgel etc.),
  • diet - split meals in accordance with the age without water and tea breaks,
  • dosed liquid reception (in the case of repeated vomiting pre-washed stomach),
  • probiotics, biological products and enzyme preparations (if indicated) in the period of convalescence.

prognosis in children with intestinal exsicosis favorable terms and intensive treatment in acute cases, do not exceed 2-3 days.