[Past and present aspects of diarrheal disease in childhood. Clinical study and treatment (author's transl)]

Abstract

The etiologic and pathophysiologic findings described in the first part of this paper have important consequences: The recognition of the specific etiology of diarrhea requires new laboratory methods: most of these, however, are technically easy to perform and do not require a large laboratory. A long-ranging consequence of this changed concept is a well-founded modification of therapy. The most important discovery was, that in a well balanced glucose electrolyte solution sodium and glucose enhance their absorption mutually and increase the absorption of water by solvent drag. Since in most acute diarrheas the mechanisms of absorption of glucose and electrolytes are retained this mechanism can be utilized for fast oral rehydration and reinstitution of normal intestinal homeostasis. Prompt institution of a diet consisting of the previously mentioned glucose-electrolyte solution usually prevents severe dehydration and the need for stationary treatment. The elimination of lactose and long chain fatty acids from the diet prevents continuation of the pathologic osmotic and chemical conditions in the intestine. Antibiotics are not indicated in acute diarrhea with the exception of diarrhea caused by enteroinvasive E. Coli or Shigella, in the case of Salmonella-gastroenteritis even contraindicated. Further research concentrates on the development of drugs for neutralisation of E. Coli enterotoxin and the prevention of diarrheas by development of effective vaccines.

PIP: A discussion of causes, diagnosis, and treatment of childhood diarrhea is presented. If the pH of the stomach is not acidic enough, harmful bacteria may not be killed. If peristaltic action is not regular, defense against intestinal diseases is hindered. The proper bacteria and immunologlobulin (with secretory piece and J-chain) must be present in the intestine to prevent infection. Loss of large volumes of fluid is one clinical symptom of diarrhea. The changes in water volume can cause changes in the osmolarity of other body fluids, which can lead to fluid loss in other organs or increase in brain pressure. Acidosis can also accompany diarrhea, as can intracellular losses of potassium and other ions. Laboratory tests of the blood for hemoglobulin, hematocrit, and electrolyte levels can aid in the diagnosis of the cause of infantile diarrhea. The feces can be tested for leukocytes, erythrocytes, and pH value. Absence of leukocytes can indicate an enterotoxic or viral diarrhea; antibiotics are contraindicated. Determinations of E. coli and enterotoxins as well as immunoglobulin tests do not provide relevant information. Treatment can be effected by oral glucose-electrolyte therapy. In more severe cases, i.v. infusions of salt, plasma, salt-free albumin, or whole blood may be indicated. Medications such as ampicillin and clindamycin have been used to treat diarrhea, but any medication which inhibits peristaltic action is contraindicated in children.