How are acute gastrointestinal illnesses treated?

Hospitalization is required for children with severe and complicated forms of the disease, children in their first year of life, children with an unfavorable premorbid background, and also when outpatient treatment is ineffective.

Regime. It is necessary to provide the child with thermal comfort, hygienic maintenance, access to fresh air. Isolation and compliance with the sanitary and epidemiological regime are important for intestinal infections.

An individual post is organized to carry out rehydration therapy.

Diet. It has been proven that even in severe forms of the disease, up to 70% of the intestinal absorption capacity is preserved, and starvation diets slow down the reparation processes, significantly weaken the body's defenses and lead to dystrophy of the child. Dietary restrictions are allowed for a short time in the acute period of the disease. A child on natural feeding continues to be fed with breast milk, canceling complementary foods for 2-3 days. For children on artificial feeding with mild forms of acute gastrointestinal diseases, the daily food volume is reduced by 15-20% (according to appetite), children over one year old are prescribed food with mechanical sparing (table 4 "pureed") and additionally introduced fermented milk mixtures 2 times a day. The normal food volume is restored in 3-4 days.

In moderate and severe forms of the disease, it is recommended to reduce the volume of food to 50% and increase the frequency of feedings to 7-8 times a day with the restoration of the volume of food after 5-7 days. Children on mixed and artificial feeding are prescribed their usual milk formulas, but preference should be given to adapted fermented milk formulas (NAN fermented milk, Agusha, Adalakt). Children over one year old can be given dairy products in which representatives of normal microflora are used as a starter - lactobacilli (actimel, vitalakt, biolact) or bifidobacterin (bifilin, bifidok, aktivna). Children over one year old need mashed food (boiled rice, soups, vegetable puree) with limited fat and the addition of steamed meat and fish from the 3rd-4th day in the first days of the disease.

In severe forms of acute gastrointestinal diseases (especially dysentery and salmonellosis), protein deficiency may occur already in the acute period of the disease. Such children are prescribed adapted formulas enriched with protein, amino acid preparations (alvezin, aminone, levamine) are administered orally at a rate of 10 ml/kg/day in 5-6 doses during feedings.

In case of viral diarrhea with signs of lactase deficiency (restlessness during feeding, regurgitation, flatulence, abundant splashing foamy stool with a sour smell), it is recommended to limit or cancel milk formulas and prescribe low-lactose or dairy-free soy formulas. In the presence of breast milk, partial replacement (no more than 1/3) with low-lactose and lactose-free formulas is permissible.

When limiting the amount of food, in all cases the child must be given additional neutral solutions (water, tea, compote, carotene mixture) in small portions to bring the child's food intake up to the age-appropriate volume.

Etiotropic therapy. Etiotropic therapy is prescribed only for bacterial infections of the gastrointestinal tract.

The drugs of choice for mild forms of intestinal infections are specific bacteriophages, biopreparations containing representatives of normal intestinal microflora, and biopreparations containing laboratory strains of bacteria that suppress the growth of pathogenic and opportunistic flora.

Bacteriophages:

• staphylococcal;
• dysenteric polyvalent;
• salmonella polyvalent;
• coliproteic;
• Klebsiella polyvalent;
• interstiphage (contains phagolysates of Escherichia coli, Shigella, Salmonella);
• combined bacteriophage (a mixture of staphylococcal, streptococcal, coli-, pseudomonas, and proteus bacteriophages);
• polyvalent pyobacteriophage (a mixture of phage lysates of E. coli, Klebsiella, Pseudomonas aeruginosa, staphylococci, streptococci, and Proteus).

For moderate forms of acute intestinal infections, the following is indicated:

• oxyquinoline derivatives (chlorinaldol, intetrix, mexaza, intestopan, nitroxoline);
• nitrofuran drugs (furazolidone, ersefuril, furagin);
• sulfonamide drugs (phthalazole, sulgin, phthazin);
• nalidixic acid preparations (negram, nevigramon).

Indications for prescribing antibiotics are:

1. Severe forms of the disease.
2. Mixed infections (viral-bacterial).
3. The presence of concomitant inflammatory foci or complicated course of the disease.

The starting drugs are “inhibitor-protected” penicillins (amoxicillin, amoxiclav, augmentin), first-generation aminoglycosides (gentamicin, kanamycin), macrolides (midecamycin), chloramphenicol (for sensitive strains), and polymyxins.

Reserve drugs may include cephalosporins of the III-IV generations, aminoglycosides of the II-III generations, rovamycin, rifampicin, vancomycin, and carbenicillin.

After completing a course of antibiotics, it is necessary to prescribe biopreparations to restore normal intestinal microflora.

Biopreparations.

1. Bifidobacterium-containing:
   • bifidumbacterin;
   • bifilin;
   • bifinorm.
2. Lactose-containing:
   • lactobacterin;
   • laminolact;
   • bibactone;
   • biofructolact.
3. Containing acidophilic flora:
   • acipol;
   • acylact;
   • narine;
   • Vitaflor.
4. Combined:
   • Linex (lactobacterin + bifidobacteria);
   • bifidin (bifidobacteria + E. coli);
   • PrimaDophilus (bifidobacteria + lactobacterin);
   • bificol (bifidobacteria + E. coli);
   • bifacid (bifidobacteria + acidophilic flora).
5. Laboratory strains (do not live in the intestines, suppress the growth of pathogenic and opportunistic flora):
   • bactisubtil;
   • enterol;
   • sporobacterin;
   • biosporin;
   • bactisporin.

Pathogenetic therapy.The basis of pathogenetic therapy is rehydration and restoration of water-electrolyte balance.

Oral rehydration is currently preferred. It is effective in all cases of grade I exsicosis and in 70-80% of cases of grade II exsicosis.

Rehydration is carried out with salt-balanced preparations. For this purpose, a number of glucose-salt solutions are used (Regidron, Oralit, Glucosolan, Citroglucosolan, Gastrolit), containing, in addition to glucose, sodium and potassium salts in proportions adequate to those in the case of fluid loss with vomiting and diarrhea.

Calculation of the volume of solution for stage I of oral rehydration

Patient's weight at hospitalization	Age of the patient	Degree of dehydration
		Easy	Moderate severity
3-4 kg	1-2 months	120-200 ml	300-400 ml
5-6 kg	3-4 months	200-300 ml	500-600 ml
7-8 kg	6-9 months	300-400 ml	700-800 ml
9-10 kg	1-2 years	400-500 ml	900-1000 ml
11-12 kg	2-3 years	450-600 ml	1000-1100 ml

Solutions for stage II of oral rehydration

Hydrocarbonate mixture	Citrate mixture
Sodium chloride 3.5	Sodium chloride 3.5
Sodium bicarbonate 2.5	Sodium citrate 2.5
Potassium chloride 1.5	Potassium chloride 1.5
Glucose 20.0	Glucose 20.0
Boiled water 1 liter	Boiled water 1 liter

Oral rehydration is carried out in 2 stages:

1. Primary rehydration is aimed at correcting the water-salt deficit present at the start of treatment. It is calculated for 4-6 hours. The volume of glucose-salt solutions for stage I is calculated based on the mass deficit depending on the degree of exicosis: for stage I exicosis - 50 ml/kg of mass, for stage II exicosis - 60-90 ml/kg of mass.
2. Maintenance rehydration is aimed at compensating for ongoing losses of water and salts and providing additional fluid needs. It is carried out until the diarrhea syndrome stops and the water-salt balance is restored. For each subsequent 6 hours, as much solution is administered as the patient lost in the previous 6 hours, based on the calculation: for each loss with vomiting or stool, children under 2 years old need to drink 50-100 ml of solution, children over 2 years old - 100-200 ml.

It is necessary to give the solution in small portions, 2-3 teaspoons every 3-5 minutes or from a bottle, but not more than 100 ml in 20 minutes. If vomiting occurs, then the solution is stopped for 5-10 minutes, and then resumed using the usual method. The solution can be administered through the nose with a gastric tube at 10-20 ml/kg for 1 hour.

Signs of sufficient rehydration: reduction in the volume of fluid loss, weight gain of 6-7% per day, normalization of diuresis, disappearance of clinical signs of dehydration, improvement in the general condition of the child, normalization of the pulse rate and its volume.

Children undergoing oral rehydration should be examined every 3-6 hours.

The need for parenteral rehydration occurs in 5-10% of patients with acute gastrointestinal diseases. Indications for intravenous administration of solutions are:

• exsicosis grade III;
• coma;
• uncontrollable vomiting;
• oliguria (absence of urination for more than 8 hours);
• ineffectiveness of oral rehydration.

The volume of fluid for infusion therapy consists of the following components:

1. Ensuring the body's physiological needs for fluids necessary for normal life.
2. Replenishment of the initial fluid and electrolyte deficit.
3. Compensation for pathological losses of fluid and electrolytes as a result of ongoing vomiting, diarrhea, shortness of breath, hyperthermia - the so-called pathological losses.
4. Correction of acid-base balance and osmolarity disorders.

Detoxification involves additional administration of fluid orally or parenterally, most often in the amount of age-related diuresis.

If careful accounting of losses is not carried out, then the following scheme can be used: to compensate for losses with vomiting and loose stools, an additional 20-40 ml/kg/day is prescribed; for shortness of breath - 10 breaths above the norm - 10 ml/kg/day, for hyperthermia - for each degree above 37 C - 10 ml/kg/day.

A 5% or 10% glucose solution, Ringer's solution are administered; for detoxification - hemodez, rheopolyglucin (10-15 ml/kg); to restore the volume of circulating blood - polyglucin, polyvinyl, gelatinol.

All solutions except glucose contain sodium ions and are collectively called crystalloids.

The ratio of glucose and crystalloids for infusion should correspond to the type of axicosis:

• water-deficient type of exsicosis - 4 (3) glucose solution: 1 crystalloids;
• salt deficiency type of exsicosis - 1:1;
• isotonic type of exsicosis - 2:1.

Volume solutions are especially indicated for the salt-deficient (hypotonic) type of exsicosis to restore the BCC.

The drip is placed for at least 8-12 hours, extended according to indications after examining the child, with clarification of the volumes of fluid administered according to needs at the time of examination.

All children with acute gastrointestinal disease are prescribed enzymatic preparations containing pancreatic enzymes or combinations as their diet expands.

Enterosorbents are prescribed to young children with caution; preference is given to carbon or natural sorbents.

Enterosorbents.

Coal:

• activated carbon;
• carbolong (activated bone charcoal);
• vaulene (fibrous carbon sorbent);
• microsorb II.

Polyvalent:

• lignin-polyphepane;
• bilignin;
• lignosorb.

Natural:

• smecta;
• vegetables and fruits rich in pectin (carrots, apples, bananas).

The use of astringent mixtures (decoctions of St. John's wort, alder cones, galangal, and blueberries) is indicated.

During the reparation period, vitamins and methyluracil are prescribed; for children who have had colitis - enemas with a solution of chamomile, vinylin, sea buckthorn oil, and rosehip oil.

Recovery criteria: persistent normalization of stool, negative results of stool tests for the intestinal group of pathogenic bacteria.

After an acute gastrointestinal disease, a child is subject to dispensary observation and must follow a diet for one month.

Prevention (according to WHO recommendations)

1. The fight for natural breastfeeding.
2. Rational nutrition, correct introduction of new products.
3. Use of clean water.
4. Sanitary and hygienic skills in the family.

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