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An evaluation of fluid management strategies and outcomes for children with acute diarrhoea and dehydration admitted to a regional hospital in the Western Cape
Thesis (MMed)--Stellenbosch University, 2021.
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Stellenbosch : Stellenbosch University
2021
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| _version_ | 1867614088246329344 |
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| access_status_str | Open Access |
| author | Greyling, Marnel |
| author2 | Slogrove, Amy |
| author_browse | Greyling, Marnel Slogrove, Amy |
| author_facet | Slogrove, Amy Greyling, Marnel |
| author_sort | Greyling, Marnel |
| collection | Thesis |
| dc_rights_str_mv | Stellenbosch University |
| description | Thesis (MMed)--Stellenbosch University, 2021. |
| format | Thesis |
| id | oai:scholar.sun.ac.za:10019.1/123629 |
| institution | Stellenbosch University (South Africa) |
| language | en_ZA |
| last_indexed | 2026-06-10T12:46:28.519Z |
| license_str | Other — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from SUNScholar — Stellenbosch University Repository |
| publishDate | 2021 |
| publishDateRange | 2021 |
| publishDateSort | 2021 |
| publisher | Stellenbosch : Stellenbosch University |
| publisherStr | Stellenbosch : Stellenbosch University |
| record_format | dspace |
| source_str | SUNScholar — Stellenbosch University Repository |
| spelling | oai:scholar.sun.ac.za:10019.1/123629 An evaluation of fluid management strategies and outcomes for children with acute diarrhoea and dehydration admitted to a regional hospital in the Western Cape Greyling, Marnel Slogrove, Amy Engelbrecht, Arnold Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Paediatrics and Child Health. Fluid therapy for children Diarrhea -- Acute Dehydration in children Western Cape UCTD Thesis (MMed)--Stellenbosch University, 2021. Introduction Globally, acute diarrhoea remains one of the most common ailments in children. Despite the fluid management of diarrhoeal disease being based on relatively simple principles, many different clinical practice guidelines have been published with variations in fluid choice, volume, rate and preferred route of rehydration. Consensus on the ideal resuscitation fluid in children has not yet been reached. Children admitted to Worcester Provincial Hospital (WPH) with dehydration due to diarrhoeal disease are managed according to a fluid management protocol that has been standard of practice for more than 10 years. Children assessed as critically dehydrated, defined as hypovolaemic shock and/or severe (10% or more) dehydration and/or severe metabolic acidosis (base deficit ≥ 10), receive empiric correction of metabolic acidosis as part of fluid resuscitation by means of a 20ml/kg fluid bolus consisting of 15ml/kg 0.9% saline and 5ml/kg 4.2% sodium bicarbonate. The aim of this study was to compare fluid management strategies received in children with acute diarrhoea managed at WPH who were non-critically dehydrated compared to critically dehydrated and to describe metabolic and electrolyte consequences in response to the fluid management strategies used. Methods A retrospective cohort study was conducted in children 3-59 months of age admitted to WPH from 1 December 2017 to 31 May 2018 with acute diarrhoea and dehydration by comparing non-critically to critically dehydrated children. Categorical and numerical data was compared for non-critically and critically dehydrated children with p-values determined by chi-squared and t-test respectively. Metabolic and electrolyte parameters were evaluated by calculating absolute change at individual level and subsequent comparison of means and paired t-test to compare values pre- and post-resuscitation using empiric correction of metabolic acidosis. Results One-hundred-and-twenty-five children were included in the study, 63 non-critically dehydrated and 62 critically dehydrated children. Seventy-two (58%) were male children with median age of 11.5 (interquartile range (IQR) 7.1-16.9) months with no difference between the two groups. Rehydration was required in 120 children, 116 (96.7%) were rehydrated intravenously and 4 (3.3%) received exclusive enteral rehydration. Empiric correction of metabolic acidosis was given in 100 (80%) children with varied effect on metabolic and electrolyte parameters. Metabolic and electrolyte changes were assessed in 67 children who had a repeat blood gas analysis within 6 (median 2.8, IQR 1.6-4.6) hours. Forty-six/67 (68.7%) children had improvement or resolution of metabolic acidosis and 15/67 (22.4%) children developed metabolic alkalosis. Six/63 (9.5%) children developed hypernatraemia. Worsening or persistence of hypokalemia was found in 28/64 (43.8%) children. Six/125 (4.8%) children required ICU admission and all 125 children survived to discharge. Conclusion Although the fluid management protocol under study is unconventional, there were no major clinical morbidities documented, there were no mortalities during the study period and very few children needed ICU admission. Suboptimal use of enteral rehydration and management of non-critically dehydrated children as critically dehydrated was demonstrated. Most children had improvement in their metabolic parameters, but electrolyte derangements developed or worsened in others, although a direct association with the evaluated fluid management protocol cannot definitively be made. Agtergrond Akute diarree verteenwoordig een van die mees algemene siektes in kinders wêreldwyd. Al is die vogterapie vir diarree-verwante siektes op relatief eenvoudige beginsels gebaseer , is daar reeds baie verskillende kliniese praktykriglyne gepubliseer met variasies in vogkeuse, - volume, -spoed en voorkeur roete van toediening. Konsensus oor die ideale resussitasie vog in kinders is nog nie bereik nie. Kinders wat toegelaat word in Worcester Provinsiale Hospitaal (WPH) met dehidrasie weens diarree-verwante siektes word hanteer volgens ‘n voghanteringsprotokol wat standaard praktyk is vir langer as 10 jaar. Kinders wat geassesseer is as krities gedehidreerd, gedefinieer deur hipovolemiese skok en/of erge (10% of meer) dehidrasie en/of erge metaboliese asidose (basis oormaat ≥ 10), ontvang empiriese korreksie van hul metaboliese asidose as deel van hul vogresussitasie met ‘n 20ml/kg vogbolus bestaande uit 15ml/kg 0.9% saline en 5ml/kg 4.2% natriumbikarbonaat. Die doel van hierdie studie was om ‘n vergelyking te tref tussen die voghanteringstrategieë gebruik in kinders met akute diarree behandel by WPH wat nie-krities gedehidreerd teenoor die wat krities gedehidreerd was en om metaboliese en elektroliet veranderinge in respons tot die voghanteringstrategieë te beskryf. Metodes ‘n Retrospektiewe kohort studie is gedoen in kinders 3-59 maande oud wat toegelaat was in WPH vanaf 1 Desember 2017 tot 31 Mei 2018 met akute diarree en dehidrasie, deur vergelykings te tref tussen nie-krities en krities gedehidreerde kinders. Kategoriese en numeriese data is vergelyk vir die twee groepe en p-waardes bepaal met behulp van chi- kwadraat en t-toets onderskeidelik. Metaboliese en elektroliet parameters is beoordeel deur berekening van absolute verandering op individuele vlak en vergelyking van gemiddeldes en gepaarde t-toets om waardes pre- en post-resussitasie, met empiriese korreksie van metaboliese asidose, te vergelyk. Resultate Eenhonderd vyf-en-twintig kinders is in die studie ingesluit, 63 nie-krities gedehidreerd en 62 krities gedehidreerd. Twee-en-sewentig (58%) was manlik en die mediaan ouderdom was 11.5 (interkwartielvariasiewydte 7.1-16.9) maande, met geen verskil tussen die twee groepe. Rehidrasie terapie was nodig in 120 kinders, waarvan 116 (96.7%) binneaars en 4 (3.3%) eksklusief enteraal gerehidreer is. Empiriese korreksie van metaboliese asidose was gedoen vir 100 (80%) kinders met varierende gevolge. Metaboliese en elektroliet veranderinge is geassesseer in 67 kinders wat ‘n herhaal bloedgas bepaling gehad het binne 6 (mediaan 2.8, interkwartielvariasiewydte 1.6-4.6) ure. Ses-en-veertig/67 (68.7%) kinders het ‘n verbetering of opklaring van metaboliese asidose ondervind en 15/67 (22.4%) kinders het metaboliese alkalose ontwikkel. Ses/63 (9.5%) kinders het hipernatremie ontwikkel. Verergering of persistering van hipokalemie het voorgekom in 28/64 (43.8%) kinders. Ses/125 (4.8%) kinders het intensiewe sorgeenheid toelating benodig en al 125 kinders het oorleef tot ontslag. Slotsom Ten spyte daarvan dat die bestudeerde voghanteringsprotokol ongewoon is, was geen beduidende kliniese morbiditeite gedokumenteer nie, was daar geen mortaliteit gedurende die studie periode nie en het min kinders intensiewe sorg benodig. Suboptimale gebruik van enterale rehidrasie en hantering van nie-krities gedehidreerde kinders as krities gedehidreerd is aangetoon. Meeste kinders het verbetering ondervind in hul metaboliese parameters, maar elektrolietstoornisse het ontwikkel of vererger in ander, alhoewel ‘n direkte verband met die geevalueerde voghanteringsprotokol nie beslissend aangetoon kan word nie. Masters 2021-07-08T08:18:40Z 2021-12-22T14:13:00Z 2021-07-08T08:18:40Z 2021-12-22T14:13:00Z 2021-12 Thesis http://hdl.handle.net/10019.1/123629 en_ZA Stellenbosch University 47 pages application/pdf Stellenbosch : Stellenbosch University |
| spellingShingle | Fluid therapy for children Diarrhea -- Acute Dehydration in children Western Cape UCTD Greyling, Marnel An evaluation of fluid management strategies and outcomes for children with acute diarrhoea and dehydration admitted to a regional hospital in the Western Cape |
| title | An evaluation of fluid management strategies and outcomes for children with acute diarrhoea and dehydration admitted to a regional hospital in the Western Cape |
| title_full | An evaluation of fluid management strategies and outcomes for children with acute diarrhoea and dehydration admitted to a regional hospital in the Western Cape |
| title_fullStr | An evaluation of fluid management strategies and outcomes for children with acute diarrhoea and dehydration admitted to a regional hospital in the Western Cape |
| title_full_unstemmed | An evaluation of fluid management strategies and outcomes for children with acute diarrhoea and dehydration admitted to a regional hospital in the Western Cape |
| title_short | An evaluation of fluid management strategies and outcomes for children with acute diarrhoea and dehydration admitted to a regional hospital in the Western Cape |
| title_sort | evaluation of fluid management strategies and outcomes for children with acute diarrhoea and dehydration admitted to a regional hospital in the western cape |
| topic | Fluid therapy for children Diarrhea -- Acute Dehydration in children Western Cape UCTD |
| url | http://hdl.handle.net/10019.1/123629 |
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