Fluid and Electrolyte Replacement

Oral Rehydration Solutions

The greatest risk to life for a patient owing to SD is dehydration or electrolyte loss. It is, therefore, essential that these patients be adequately rehydrated and electrolyte loss corrected. In patients with mild to moderate SD (< 1 to 1.5 L/d), this can frequently be accomplished using oral rehydration solutions (ORSs). Some patients with severe diarrhea may have normal absorptive function retained, and oral rehydration or replacement can be effective in them. Because nutrient absorption is coupled with sodium absorption, glucose or amino acids in combination with sodium can enhance the absorption of electrolytes and water. It is important to remember that standard ORSs are primarily designed to increase electrolyte and fluid absorption and may not reduce stool output, and, in fact, stool output may increase. The World Health Organization's (WHO) ORS recommendation contains sodium (90 mmol/L), potassium (20 mmol/L), chloride (80 mmol/L), citrate (30 mmol/L), and glucose (111 mmol/L). This is prepared by adding 3.5 g of sodium chloride, 1.5 g of potassium chloride, 2.9 g of trisodium citrate dihydrate, and 20 g of glucose per liter of water. Rice-based ORSs have been shown to not only increase absorption but also to decrease stool volume. Most sport drinks, such as Gatorade, are designed to replenish electrolytes primarily lost from sweat and do not have enough sodium to fully replace diarrheal sodium loss. Commercial solutions available that approximate the WHO's ORS include Resol, Ricalyte, Ceralyte, Pedialyte, and Rehydralyte.

Intravenous Replacement

In patients with severe diarrhea, such as frequently occurs with vIPomas, with the need to adequately correct the dehydration, hypokalemia, and metabolic alkalosis, the fluid and electrolyte replacement needs to be given intravenously. This can be accomplished by using parenteral hyperalimentation or administration of saline solutions supplemented with potassium and sodium bicarbonate. Restoration of hydration and electrolytes can best be monitored by serial assessment of serum electrolytes and urine output.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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