Intestinal exsycosis in children

Intestinal exsicosis - one of the most frequent emergent conditions, is caused by the action of thermolabile enterotoxin of gram-negative bacteria and some viruses on enterocytes. At the heart of the pathogenesis of intestinal exsycosis lie the loss of fluid and electrolytes, as well as buffer bases with diarrheal masses, which leads to the development of dehydration, metabolic acidosis, violations of central and peripheral blood circulation and oxygen-transport function of the blood.

There are three degrees of excoxicosis (from 5 to 10-12% of acute weight loss) and its three types are isotonic, hypertonic and hypotonic exsicosis. A feature of early childhood (children under 5 years with OCI) is the development of an isotonic form of dehydration, which is associated with hyperaldosteronism and a low sodium content in diarrhea. Depending on the volume of fluid loss with a stool and the type of OCD, the child loses from 60 to 80 mmol / l sodium, while the adult patient loses 140-145 mmol / l. But, unlike adults, a child loses twice as much potassium (25 mmol / l) with diarrhea. For this reason, when there is an isotonic form of exsicosis and a normal sodium content in the plasma, in children of early age there is always a relative (with grade II exacerbosis) or absolute hypokalemia (with grade III exacerbosis). With infusion rehydration therapy, these features are important to consider.

[1], [2], [3]

Pathogenetic intensive therapy of intestinal exciticosis of II and III degree

The basic requirements for pathogenetic, intensive therapy of a patient with intestinal exciticosis of II-III degree:

• compensation of lost salts and liquid,
• increase in the buffer capacity of blood,
• reduction of pathological losses with the help of enterosorbents.

Pathological losses are the result of three components of the fluid deficit, the physiological needs of a particular patient and the continuing pathological losses (vomit and feces) whose volume is determined gravimetrically. For correction, the following sodium solution is used: 78 mmol / L, potassium 26 mmol / L, chlorine 61 mmol / L, sodium hydrogen carbonate 11.8 mmol / L, sodium acetate 31.6 mmol / L, water 1 L .

Isotonic solution with pH 7.4 From the total volume of liquid calculated per day, 25-30% the child is able to assimilate enterally even on the first day. The fluid deficit is compensated fairly quickly, approximately 6 hours, if the patient's condition permits. In the first two hours, 50% of the fluid is injected at a rate of 40-50 drops per minute, the second half in 4 hours. After covering the deficit, the liquid is injected at a rate of 10-14 drops per minute to cover physiological needs and pathological losses. The rate of infusion at this stage depends on the volume of pathological losses.

Pathological losses:

• severe diarrhea - loss up to 3 ml / (kghh),
• severe diarrhea - from 3 to 5 ml / (kghh),
• Cholera-like, profuse diarrhea - more than 5 ml / (kghh).

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

• an increase in body weight by 3-7% for the first day,
• normalization of plasma electrolytes concentration and reduction of metabolic acidosis,
• positive CVP,
• a decrease in body temperature, an increase in diuresis, the cessation (reduction) of vomiting, an improvement in the general condition of the child.

In parallel, etiotropic and symptomatic therapy is carried out, which includes:

• antibacterial agents from the group of aminoglycosides or cephalosporins, beginning with the third generation (parenterally and inward), in cases of bacterial or mixed OCI and enterosorbents (smecta, neosmectin, enterosgel, etc.)
• diet - divided food according to age without water-tea breaks,
• Dosed fluid intake (in case of repeated vomiting, the stomach is pre-washed),
• probiotics, biopreparations and enzyme preparations (according to indications) during the reconvalescence period.

The prognosis in children with intestinal exsycosis is favorable, and the terms of intensive treatment in acute cases do not exceed 2-3 days.

Symptoms of intestinal exsycosis

The most characteristic signs of intestinal excision:

• the westing of the great fontanel,
• symptom of a "standing" fold,
• decreased diuresis,
• dry skin and mucous membranes,
• cold extremities,
• dyspnea,
• hypocapnia,
• zero or negative CVP,
• subcompensated or decompensated metabolic acidosis.

Signs of dehydration at the second and third degree of exsicosis

Symptoms and Laboratory Data	Degree of exsicosis and fluid deficiency,%
II (5-9%)		III (10% and more)
1	2	3
The symptom of a "standing fold"	The fold is extended to 2 seconds	The folding spreads over 2 seconds
Large fontanel	Wants	Sharply sinks
Chair	Loss of 2.7-3.9 ml / (kghh)	Loss of more than 4 ml / (kghh)
Vomiting	1-3 times a day	More than 3 times a day
Eye Symptoms	"Shadows" under the eyes, sunken eyes	Eyes, the sunken eyelids are not completely closed
Mucous membranes	Dry, hyperemic	Dry, bright, shed tears
CVP	Zero or negative	Negative
PH	7.26 + 0 016	7 16 + 0.02
BE	-13.6 + 1.2	-17.5 + 1.3
PCO2, mm ppm	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

A body weight deficit of up to 5% corresponds to the first degree of exsicosis, 6-9% to a second degree of exsicosis, and 10% or more to a third degree exci cosis.

Control of the reliability of the diagnosed degree of exsicosis can be a retrospective evaluation of the patient's body weight gain in percentage after 2-3 days after corrective therapy, provided that the concentration of basic electrolytes, CBS parameters and elimination of symptoms of exsicosis are normalized in plasma. The increase in body weight by 3-5% corresponds to the second degree of exsicosis, and 5-9% corresponds to the third degree exciticosis.