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Patients undergoing major abdominal surgery received restrictive or liberal intravenous fluids during surgery and up to 24 hours thereafter. The restrictive regimen did not improve disability-free survival and resulted in increased acute kidney injury.

Diabetic ketoacidosis in children may cause brain injury. In this randomized, controlled trial, neither the rate of administration nor the sodium chloride content of intravenous fluids significantly influenced neurologic outcomes in children with diabetic ketoacidosis.

Purpose Rapid gastric emptying and intestinal absorption of beverages is essential for rapid rehydration, and certain amino acids (AA) may augment fluid delivery. Three sugar-free beverages, containing differing AA concentrations (AA + PZ), were assessed for fluid absorption kinetics against commercial sugar-free (PZ, GZ) and carbohydrate-containing (GTQ) beverages. Methods Healthy individuals ( n  = 15–17 per study) completed three randomised trials. Three beverages (550–600 mL) were ingested in each study (Study 1: AA + PZ [17.51 g/L AA], PZ, GZ; Study 2: AA + PZ [6.96 g/L AA], PZ, GZ; Study 3: AA + PZ [3.48 g/L AA], PZ, GTQ), containing 3.000 g deuterium oxide (D 2 O). Blood samples were collected pre-, 2-min, 5-min, and every 5-min until 60-min post-ingestion to quantify maximal D 2 O enrichment (Cmax), time Cmax occurred (Tmax) and area under the curve (AUC). Results Study 1: AUC (AA + PZ: 15,184 ± 3532 δ‰ vs. VSMOW; PZ: 17,328 ± 3153 δ‰ vs. VSMOW; GZ: 17,749 ± 4204 δ‰ vs. VSMOW; P  ≤ 0.006) and Tmax ( P  ≤ 0.005) were lower for AA + PZ vs. PZ/GZ. Study 2: D 2 O enrichment characteristics were not different amongst beverages ( P  ≥ 0.338). Study 3: Cmax (AA + PZ: 440 ± 94 δ‰ vs. VSMOW; PZ: 429 ± 83 δ‰ vs. VSMOW; GTQ: 398 ± 81 δ‰ vs. VSMOW) was greater ( P  = 0.046) for AA + PZ than GTQ, with no other differences ( P  ≥ 0.106). Conclusion The addition of small amounts of AA (3.48 g/L) to a sugar-free beverage increased fluid delivery to the circulation compared to a carbohydrate-based beverage, but greater amounts (17.51 g/L) delayed delivery.

International recommendations advise against the use of intravenous rehydration therapy in children with severe acute malnutrition because of the concern about fluid overload, but evidence to support this concern is lacking. Given the high mortality associated with the current recommendations, the adoption of intravenous rehydration strategies might improve outcomes. We conducted a factorial, open-label superiority trial in four countries in Africa. Children 6 months to 12 years of age with severe acute malnutrition with gastroenteritis and dehydration underwent randomization in a 2:1:1 ratio to one of three rehydration strategies: oral rehydration, plus intravenous boluses for shock; a rapid intravenous strategy that consisted of lactated Ringer's solution (100 ml per kilogram of body weight) administered over a period of 3 to 6 hours, with boluses for shock; or a slow intravenous strategy that consisted of the same solution administered over a period of 8 hours, with no boluses. The primary end point was death at 96 hours. A total of 272 children underwent randomization; 138 were assigned to the oral strategy, 67 to the rapid intravenous strategy, and 67 to the slow intravenous strategy. Participants were followed for 28 days. A nasogastric tube was used for oral rehydration in 126 of 135 participants (93%) in the oral group and in 82 of 126 (65%) in the intravenous groups. Intravenous boluses were administered at admission in 12 participants (9%) in the oral group, 7 (10%) in the rapid intravenous group, and none in the slow intravenous group. At 96 hours, 11 participants (8%) in the oral group and 9 (7%) in the intravenous groups (5 in the rapid group and 4 in the slow group) had died (risk ratio, 1.02; 95% confidence interval [CI], 0.41 to 2.52; P = 0.69). At 28 days, 17 participants (12%) in the oral group and 14 (10%) in the intravenous groups had died (hazard ratio, 0.85; 95% CI, 0.41 to 1.78). Serious adverse events occurred in 32 participants (23%) in the oral group, 14 (21%) in the rapid intravenous group, and 10 (15%) in the slow intravenous group. No evidence of pulmonary edema, heart failure, or fluid overload was noted. Among children with severe acute malnutrition and gastroenteritis, no evidence of a difference in mortality at 96 hours was noted between oral and intravenous rehydration strategies. (Funded by the Joint Global Health Trials scheme and others; GASTROSAM Current Controlled Trials number, ISRCTN76149273.).

The efficacy of oral rehydration solution (ORS) enriched with Lactobacillus reuteri DSM 17938 and zinc in infants with acute gastroenteritis, is poorly defined. The aim of this double-blind, randomized, placebo-controlled study, was to assess the efficacy of an ORS enriched with Lactobacillus reuteri DSM 17938 and zinc (ORS+Lr&Z) in well-nourished, non-hospitalized infants with acute diarrhoea. Fifty one infants with acute diarrhoea were randomly assigned to receive either ORS+Lr&Z (28 infants, mean ± SD age 1.7 ± 0.7 years, 21 males), or standard ORS (ORS−Lr 23 infants, mean ± SD age 1.8 ± 0.7 years, 16 males). Stools volume and consistency were recorded pre- and posttreatment using the Amsterdam Infant Stool Scale and were compared between the two groups, as well as lost work/day care days, drug administration and need for hospitalization. Both groups showed reduction in the severity of diarrhoea on day two (p < 0.001) while, all outcomes showed a trend to be better in the ORS+Lr&Z group, without reaching statistical significance, probably due to the relatively small number of patients. No adverse effects were recorded. In conclusion, both ORS were effective in managing acute diarrhoea in well-nourished, non-hospitalized infants. ORS enriched with L. reuteri DSM 17938 and zinc was well tolerated with no adverse effects.

In patients with severe sepsis, albumin replacement in addition to crystalloid administration conferred no benefit, as compared with crystalloids alone, with respect to mortality at 28 or 90 days. Post hoc analysis suggested a possible benefit in patients with septic shock. For decades, human albumin has been administered to patients to provide adequate oncotic pressure and intravascular volume. 1 In 1998, however, a report from the Cochrane Injuries Group Albumin Reviewers indicated that the administration of albumin may be potentially harmful in critically ill patients, as compared with the administration of crystalloid solutions. 2 Subsequent meta-analyses reported contradictory findings. 3 , 4 To clarify this issue, a large, double-blind, randomized trial (the Saline versus Albumin Fluid Evaluation [SAFE] study) 5 was conducted, in which 4% albumin solution was compared with normal saline as fluid replacement in critically ill patients, with results indicating that albumin administration was . . .

Although oral rehydration salt (ORS) solution is a lifesaving management for diarrhoea, its exertion is still surprisingly low among caregivers. As mothers are considered to be the primary caregivers, they bear the responsibility of administering medications to their children. We aimed to evaluate maternal perceptions along with the barriers and facilitators in play that are affecting ORS administration among children in Bangladesh. The study was conducted at Dhaka Hospital of the International Centre for Diarrhoeal Diseases Research, Bangladesh through a qualitative approach. In-depth Interviews (IDIs) were conducted on thirty-one mothers of under-5 children reporting to the hospital from February to April 2024. Qualitative content analysis method was used to describe and analyse the transcribed data. The mothers held several misconceptions regarding the administration of ORS. Majority of the participants thought their child could receive ORS through their breastmilk, which was an interesting finding. Along with this, mothers also lacked proper understanding regarding ORS preparation, storage, and use. Some of the key barriers were the lack of proper knowledge, motivation, and compliance, along with misdirection from the elders and pharmacy drug sellers. Additional key facilitators to ORS use were trust towards doctors, positive attitude towards learning about ORS, community education, instructions written on the packet, and support from the healthcare providers. A focused approach should be implemented to educate mothers on the correct preparation and administration of ORS for children, while also addressing and dispelling any misconceptions.

Patients undergoing surgery for ileostomy creation frequently experience postoperative dehydration and subsequent renal injury. The use of oral rehydration solutions (ORS) has been shown to prevent dehydration, but compliance may be variable. Semi-structured qualitative interviews were conducted with 17 patients who received a postoperative hydration kit and dehydration education to assess barriers and facilitators to compliance with ORS kit instructions. Qualitative analysis revealed five themes affecting patient adherence to the ORS intervention: (1) patient's perception of the effectiveness of the ORS solution, (2) existing co-morbidities, (3) kit quality and taste of the ORS product, (4) quality of the dehydration education, and (5) social support. Given that patient adherence can greatly affect the success of an ORS intervention, the design of future ORS interventions should emphasize the educational component, the “patient friendliness” of the ORS kit, and ways that social supports can be leveraged to increase adherence. •Compliance with ORS interventions varies in patients who receive ileostomy surgery.•Patient interviews were conducted to identify barriers and facilitators to adherence.•Influences included perceived effectiveness and quality, education, and social support.•Interventions should emphasize education, “patient friendliness,” and social support.

Oral rehydration solutions (ORS) are specifically formulated with an osmolality to optimize fluid absorption. However, it is unclear how many ORS products comply with current World Health Organization (WHO) osmolality guidelines and the osmotic shelf-life stability is not known. Therefore, the purpose of this investigation was to examine the within and between ORS product osmolality variation in both pre-mixed and reconstituted powders. Additionally, the osmotic stability was examined over time. The osmolality of five different pre-mixed solutions and six powdered ORS products were measured. Pre-mixed solutions were stored at room temperatures and elevated temperatures (31 °C) for two months to examine osmotic shelf stability. Results demonstrated that only one pre-mixed ORS product was in compliance with the current guidelines both before and after the prolonged storage. Five of the six powdered ORS products were in compliance with minimal inter-packet variation observed within the given formulations. This investigation demonstrates that many commercially available pre-mixed ORS products do not currently adhere to the WHO recommended osmolality guidelines. Additionally, due to the presence of particular sugars and possibly other ingredients, the shelf-life stability of osmolality for certain ORS products may be questioned. These findings should be carefully considered in the design of future ORS products.

This randomized trial in 383 children in Vietnam who had moderately severe dengue shock syndrome compared the use of Ringer's lactate, 6 percent dextran 70, and 6 percent hydroxyethyl starch after initial resuscitation with colloid. The primary clinical outcomes were similar with the three solutions. The trial provides strong evidence that in moderately severe dengue shock syndrome the outcomes are as good with the use of Ringer's lactate as with either of the more expensive colloid solutions. This trial provides strong evidence that in moderately severe dengue shock syndrome the outcomes are as good with Ringer's lactate as with either of the more expensive colloid solutions. Dengue shock syndrome is the most serious manifestation of dengue hemorrhagic fever, a relatively new disease entity that has spread progressively throughout Asia and South America since its first appearance in Bangkok, Thailand, in the 1950s. 1 Dengue hemorrhagic fever is characterized by systemic vascular leakage and disordered hemostasis and may develop after infection with any of four dengue viral serotypes. 2 , 3 Between 250,000 and 500,000 cases of dengue hemorrhagic fever, mainly in children, are reported to the World Health Organization (WHO) annually, with mortality rates of 1 to 5 percent among patients with shock. 1 , 4 The pathophysiological mechanisms underlying the . . .