الفهرس 
Material and methodsOnly 14 pages are availabe for public view
 |  | from | 236 |  |  |
| | | from | 236 | | |
Abstract
Egyptian infants below two years of age and the commonest causes of morbidity and mortality among Egyptian infants and
pre-school children.. Diarrhoea is de.fined as excessive losses
of fluid and electrolytes from the gasero intestinal tract.
The infectious agents that cause diarrhoea are usually spread
by the fecal-oral route which include the ingestion of
fecally contaminated water or food and also direct contact
with infected feces.
Diarrhoeal disease are heterogenous in etiology, they
may be due to enteral infection caused by a wide variety of
Dehydration is the commonest and the most serious
complication of diarrhoea. Dehydration is classified either
according to its severity into mild, moderate and severe or
according to serum sodium concentration into hypernatreamic,
important line of treatment of dehydration is the rehydration
therapy which consists of oral rehydration solution and
nutritional therapy.
Summary
Oral rehydration therapy has been described as
potentially the most important medical advance of this
century. Nevertheless, though the glucose based WHO formula
is a historical break through in the management of acute
diarrhoea, yet it does not reduce volume, frequency or
duration of diarrhoea.
The applied new physiologic knowledge of the role of
organic solutes in stimulating water and electrolyte
absorption demonstrating intact glucose linked sodium
absorption in acute diarrhoeal disease has revolutionized the
management of diarrhoeal disease in the last decade or so.
Application of the previous physiologic knowledge open.the
way for the use of enriched oral rehydration solution to
overcome the previous drawbacks of the glucose based WHO
formula. Various studies have shown that many complex organic
moLecuLaa can be coupled with sodium thus further enhancing
absorption, one of such molecules may be rice powder. Rice
starch is unique, it contains a mixture of two different poly
glucose, amylose and amylopectin. Intra-luminal digestion of
rice powder liberates the monosaccharide glucose slowly
withbut causing an osmolar load, which makes it possible to
give a higher quantity of rice powder without lossing its
effectiveness or causing an osmolar drag of fluid from the
vascular space to the gut lumen.
-193-
Summary
This study aimed to evaluate the efficacy of an instant
rice based oral rehydration solution on the outcome of acute
diarrhoea in infants versus glucose based oral rehydration
solution. We chosen one handred male infants sixty of them
breast fed and forty exclusively formula fed under certain
inclusion and exclusion criteria.
The infants were randomized by the random permuted block
of length 10 to receive either the rice based oral
rehydration solution (50 gm rice/L) or the glucose based oral
rehydration solution. Clinical History and physical
examination were carried out. While observations were
performed 3 hourly until recovery.
The either solutions was offered to the child in the
initial stage of rehydration (six hours) in amount calculated
as 100 ml/kg. The child received the solution by cup ·and
spoon in ad libitum amount. After initial stage of
rehydration the child was offered his solution in amount of
100 ml/kg to match measured stool output. The child ingested
it in ad libitum amount which were accurately recorded. In
the first six hours nothing was given apart from the
rehydration solution. After that breast fed infants were
allowed to fed normally on demand but formula fed ones were
fed four hourly by isocaloric cow’s milk based formula in
amounts calculated on the basis of 150 ml/kg/twenty four
-194-
Summary
hours divided into six feeds. The dilution was half strength
in the first twenty four hours and full strength afterward.
For both breast and formula fed infants a cereal based diet
was offered once/twenty four hours in a dose of twenty five
ml/kg.body weight. Regarding its preparation one leveled
table spoon i.e 10 gm powder was added to 30 ml of water. The
outcome of the’ study was assessed through the following
response variables :-
- Duration of diarrhoea, the end point of diarrhoea would be
ascertained by the time of the last watery stool passed out
followed either by two consecutive formed stool or 12 hours
without defecation.
Stool output during the initial six hours, twenty four
hours. and at the end of diarrhoea as expressed by gm/kg.
body weight.
Purging rate during the initial six hours, twenty four
hours and at the end of diarrhoea as expressed by gm/kg.
body weight/hour.
Oral rehydrat.ion solution (either glucose or r Lce based)
intake at six hours, twenty four hours and all period of
admission.
Weight gain as percentage of recovery weight.
- Serum sodium and potassium at admission and twenty four
hours after admission.
The st.udy came to end for an infant when one of the
following was met :-
-195-
---~---
Summary
A) Success, this was verified as the time when the last
watery stool was passed accertained by either two
consecutive formed stools or 12 hours without defecation.
S- Failure :-
- Persistence of signs of dehydration after the initial six
hours of rehydration.
The child persistently rejects the rehydration formula in
presence of signs of dehydration in the first six hours.
Recurrence of signs of dehydration after initial
rehydration.
Clinical deterioration requiring I.V therapy.
Persistance of diarrhoea more than 120 hours after
beginning the study.
The obtained data and results were statistically
analysed and the differences between groups were tested by
student test (t test), Z test and X2 test.
Our study showed that rice based oral rehydration
solution like glucose based oral rehydration solution, can be
used effectively in the treatment of cases with acute
diarrhoea. Rice based oral rehydration solution was however
found to be superior to glucose based oral rehydration
solution with regard to the decreased amount of stool output, mean duration of diarrhoea as well as the rate of solution consumption especially in breast fed group.