Oral rehydration. Methods of rehydrating the body during dehydration: oral and parenteral agents Educational video of the degree of dehydration according to Pokrovsky and their correction

First, a little theory.

Human life is characterized by the continuous formation of fluids: digestive juices, saliva, sweat, mucus. The functioning of the respiratory system requires constant humidification of the inhaled air. Metabolism is accompanied by the formation of a number of substances that are unnecessary for the body, often dangerous and toxic. These substances are excreted in dissolved form (found in urine). Thus, even in a state of absolute health there are normal, completely natural physiological fluid loss. A person feels a lack of fluid instinctively, it manifests itself thirsty- the desire to get drunk.

The absolute majority of childhood diseases are infectious diseases, diseases that are accompanied by an increase in fluid loss, and these losses are not natural - this is a manifestation of the disease, its consequence, and there is a special name for this: pathological fluid loss.

Factors causing pathological fluid loss during illness:

• elevated body temperature provokes sweating and significantly increases fluid loss during breathing;
• rapid breathing, in turn, increases the amount of fluid required to humidify the inhaled air;
• mucus is actively formed (snot, sputum);
• vomiting and/or diarrhea.

The presence of pathological fluid losses during an acute infectious disease, as a rule, is aggravated by insufficient fluid intake into the body: the child eats less, but food, especially baby food, is often liquid - milk, kefir-yogurt, cereals, soups. And this situation is all the more relevant the younger the child.

Thus, during illness, physiological and pathological fluid losses occur, which must be replenished. We must not forget that the “formation of a number of unnecessary, often dangerous and toxic substances that are unnecessary for the body”, which we mentioned, noticeably increases during illness, and therefore is abundant, i.e. redundant drinking will activate the process of removing toxins.

Here we touched on the main thing: It is precisely during illness that thirst satisfaction is not enough. Real help, real treatment is not just drinking, but drinking too much, drinking not because you want to drink, but because you need to!

A treatment method aimed at introducing fluid into the body is called rehydration therapy. Rehydration - this, in fact, is the replenishment of fluid losses. There are two main methods of rehydration − intravenous, when the necessary solutions are injected into a vein through a dropper, and oral - when a person receives the necessary solutions through the mouth.

Knowing the meaning of these words is necessary, since there is a whole group of pharmacological drugs called “ rehydrating agents for oral administration " What it is? Sometimes it is a ready-made solution, but usually it is a powder, or tablet, or granules, which contain the sodium, potassium, chlorine and other substances necessary for the body in specially selected combinations and concentrations equivalent to pathological losses. Let me explain: sweating is a loss of not only fluid, but also sodium and chlorine (after all, sweat is salty, and everyone probably remembers the school formula NaCl). If you replenish fluid losses, but do not replenish salt losses, this is fraught with serious problems. How much salt do you still need? So smart scientists calculated the optimal amount of salts for a certain volume of water.

The formulas for rehydrating agents are based on these calculations. In addition to salts, the preparations often contain glucose; sometimes extracts of medicinal plants (chamomile extract, for example), and decoctions of cereals (rice, wheat, etc.) are added.

Oral rehydrating agents are an ideal option for quickly and effectively replenishing physiological and pathological fluid losses.

This is why oral rehydration products are over-the-counter medications.

That is why oral rehydration products should be an essential component of a home first aid kit.

• sodium chloride - 3.5 g;
• sodium bicarbonate - 2.5 g;
• potassium chloride - 1.5 g;
• glucose - 20 g;
• water 1 l.

In recent years, a modified WHO recipe has become widespread, which has shown even greater effectiveness and safety, especially in the treatment of children with intestinal infections.

Modified WHO recipe:

• sodium chloride - 2.6 g;
• trisodium citrate, anhydrous - 2.9 g;
• potassium chloride - 1.5 g;
• glucose - 13.5 g;
• water 1 l.

The simplest and most accessible recipe looks like this:

• ordinary table salt - 3 g;
• ordinary sugar (sucrose) - 18 g;
• water 1 l.

The vast majority of oral rehydration products available in pharmacies have a composition that corresponds to either the standard or modified WHO recipe.

• in the vast majority of cases, the product you purchase will need to be dissolved in water. Read the instructions carefully and be sure to get answers to the following questions:
  • In what volume of water should the medicine be dissolved?
  • what kind of water (usually boiled) and at what temperature (room, warm, hot) should I use?
  • where to store the prepared solution?
  • How long can the prepared solution be used?
• do not add any other components to the drug;
• remember that the closer the temperature of the drink is to body temperature, the more active the absorption of liquid from the stomach into the blood. Hence a very specific recommendation: you should strive in every possible way to ensure that the temperature of the oral rehydration solution is close to body temperature;
• the required volume of oral rehydration agent is determined by the presence of symptoms indicating a lack of fluid in the child’s body (every effort should be made to ensure that these symptoms do not exist). So, symptoms indicating fluid deficiency in organism:
  • thirst;
  • dry skin and mucous membranes;
  • rare urination;
  • rich (yellow) color of urine;
  • insignificant effectiveness of antipyretics.

(This publication is a fragment of the book by E. O. Komarovsky adapted to the format of the article

Content

With severe dehydration or exicosis, the water-salt balance in the body is disrupted, irreversible changes in the brain and blood vessels begin, and hypovolemic shock (a sharp decrease in circulating blood volume) and death are possible. To prevent these complications, the patient undergoes oral rehydration - a procedure for taking solutions with carbohydrates and electrolytes, aimed at replenishing fluid in the body.

Indications for rehydration

Oral use of solutions to eliminate dehydration and normalize water-electrolyte balance is effective only for low and moderate severity of the problem. For severe situations, intravenous administration of drugs is indicated. This is done for intestinal infections, poisoning (drug, chemical), thermal burns of 2-3 degrees, viral diseases with severe intoxication. The rehydration procedure begins before the arrival of the ambulance, in the first hours of the appearance of characteristic symptoms:

• pallor and dryness of mucous membranes and skin, cyanosis (blue discoloration);
• fever;
• tachycardia;
• convulsive twitching of the limbs;
• intoxication, vomiting (excessive and repeated vomiting requires intravenous rehydration);
• strong thirst;
• drop in blood pressure;
• frequent loose stools (up to 20 times per day);
• lack of salivation (salivation);
• loss of body weight (10-15%);
• retraction of the large fontanel (in infants).

Purpose of rehydration therapy

The effect of glucose-salt solutions (rehydrants) used for exicosis is based on the ability of glucose to transport potassium and sodium ions, which are lost due to excess fluid output. This property of rehydrants helps restore the water-salt balance. By reducing dehydration, which is the main goal of oral rehydration, the following positive changes occur in the body:

• accelerating the detoxification process in patients with intestinal infections;
• relief of symptoms of intoxication of various etiologies (origins), including medicinal ones;
• restoration of disturbed parameters of homeostasis (self-regulation);
• correction of ongoing fluid losses;
• restoration of normal diuresis (urination);
• normalization of hemodynamic parameters (blood pressure, pulse).

Stages of oral rehydration

Treatment of exicosis in adults and children is carried out over 3 days, but the most significant are the first ones, which reduce the likelihood of severe complications. Rehydration through oral administration of glucose-saline solutions is carried out in 2 stages:

1. Primary (intensive) rehydration - involves the active replenishment of salts and fluids that the patient lost before the start of treatment. He should receive 60 ml/kg for the 1st degree of exicosis and 80 ml/kg for the 2nd. For vomiting, the dosage is increased by 2-5 ml/kg after each attack, for diarrhea - by 5-10 ml/kg. The duration of the stage is 6 hours.
2. Corrective (compensatory) rehydration is intended to correct ongoing losses of fluid and electrolytes, ensuring the patient’s physical need for water. The amount of solution taken orally is determined by fluid excretion. The approximate dosage is 80-100 ml/kg, the drug is given in small portions after vomiting or diarrheal stool, 5 ml/kg. The duration of the stage is 18 hours, but can increase up to 2 days.

Drugs used

In official medicine, there are 3 types of dehydration. Isotonic is diagnosed with active sodium excretion, water deficiency is characterized primarily by the removal of fluid (while maintaining the water-salt balance), and with salt deficiency there is a lack of electrolytes. Drugs used for oral rehydration are selected according to this criterion:

Dosage

How much rehydration solution to drink, especially for a child, is determined by the doctor, based on the clinical picture, the patient’s body weight, and the selected drug. Recommended dosages for stage 1 (4-6 hours) of fluid replacement in adults and children:

Rehydration therapy at home

During the treatment of dehydration, oral solutions are given to the patient in small portions (1/2-2 tsp) at intervals of 5-10 minutes. Rehydration products are used in adults as follows:

1. Pour the powder into a glass of boiled water at a temperature of 35-40 degrees or put a tablet (depending on the form of the drug). The exact ratio of the drug and water is indicated in the instructions for the specific product.
2. Wait until completely dissolved and stir.
3. In case of nausea or vomiting, drink chilled; if not, leave the product at room temperature.
4. Take the medicine in small sips at intervals of 10 minutes. As the condition improves, the interval between taking the rehydrant can be increased.

Attention! The information presented in the article is for informational purposes only. The materials in the article do not encourage self-treatment. Only a qualified doctor can make a diagnosis and give treatment recommendations based on the individual characteristics of a particular patient.

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 the severity of acute intestinal infections in children, leading to death, is the development of dehydration. In this regard, the basis for the rational treatment of patients with ACI is the widespread use of 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 of the small intestine - this contributes to the rapid restoration of disturbances in the water-salt balance and normalization of metabolism.

WHO recommends the use of the oral rehydration method for acute intestinal infections accompanied by so-called “watery diarrhea” (cholera, enterotoxigenic escherichiosis, etc.), as well as for intestinal infections of other etiologies, occurring with symptoms of enteritis, gastroenteritis and enterocolitis (salmonellosis, rotavirus infection, etc. ). Oral rehydration is most effective when used from 1 hour after the onset of the disease. According to WHO, oral rehydration in the early stages of ACI 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:

• in case of 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 the intravenous administration of rehydration solutions, although the 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 the prevention of viral hepatitis with parenteral transmission of infection;
• the simplicity and accessibility of the method allows it to be used at the pre-hospital stage of 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;
• with high efficiency (in 80-95% of patients), the method, when used correctly, practically does not cause complications, while with infusion therapy, adverse reactions occur in 16% or more patients.

Indications for oral rehydration – initial manifestations of diarrhea, moderate (1-2 degrees) dehydration, not a serious condition of the 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 of the European Society of 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 relieves 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: