Carbohydrate intolerance in infants with diarrhea

Lifshitz, Fima; Coello-Ramírez, P; G, Gutiérrez-Topete; Cornado-Cornet, Maria Cinta

doi:10.1016/s0022-3476(71)80388-8

Cited by 120 publications

(44 citation statements)

References 22 publications

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“…Whether be it by providing excess glucose, as such, or by addition of a complex carbohydrate with a potentially higher osmotic load, like corn syrup solids or other partially broken down starches, both approaches may result in less effective water absorption and more sodium losses. In diarrheal disease of infancy intestinal glucose transport is decreased (24), and there may be frequent intolerance to dietary carbohydrates, including monosaccharides such as glucose (25), and partially hydrolyzed starch (26).…”

Section: Discussionmentioning

confidence: 99%

Osmolality and Solute Concentration—Their Relationship with Oral Hydration Solution Effectiveness: An Experimental Assessment

Wapnir

Lifshitz

1985

Pediatr Res

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ABSTRACT. The role of electrolyte, carbohydrate, and base composition, a s well a s osmolality, of oral hydration solutions (OHS), was investigated using a nonabsorbable marker and tritiated water in an in vivo intestinal perfusion system in rats. The O H S tested were the World Health Organization recommended formula, containing 90 mEq/ liter sodium and 11 1 m M glucose, which was taken a s the reference solution; five variants of this solution with different sodium and glucose concentrations; and two solutions without sodium, i.e. isotonic glucose and deionized water. Also tested were one solution with acetate in lieu of bicarbonate, and two commercial preparations where citrate substituted for bicarbonate. The best water absorption rates were obtained with World Health Organization-type O H S characterized by a combination of low osmolality and moderate sodium and glucose content. Hypotonic O H S (190, 220, and 155 mosmol/kg) in which the sodium:glucose ratios were 60:30, 60:60, and 3055, respectively, produced mean jejunal water transport rates of 3.46, 3.20, and 2.91 pl/min/cm, respectively, whereas the standard World Health Organization O H S (330 mosmol/kg) resulted in a rate of 1.36 pl/min/cm ( p < 0.001). Similar good water absorption was achieved when Ac was the base (270 mosmol/kg and 60:111 sodium:glucose ratio) and with one of the commercial solutions (245 mosmol/kg and 50:111 sodium:glucose ratio). The reference World Health Organization O H S allowed for sodium absorption, a s did the O H S with sodium:glucose ratios of 90:45,60:30,60:60, and acetate-containing 60:111. Sodium a t a concentration of 30 mEq/liter or less resulted in the efflux of this electrolyte. High glucose concentration and lower osmolality exacerbated this effect. The results obtained in this investigation may assist in better evaluating O H S and in selecting modified formulae geared to specific hydration needs and possible replacement of water and sodium losses. (Pediatr Res 19: 894-898,1985 OHS, the cost factor, and other considerations (1-4). The most important points involved in the formulation of OHS have been sodium and carbohydrate concentrations and osmolality. The rationale for the amount of sodium, potassium, and chloride provided in the OHS has been related to the degree of potential electrolyte losses during the illness (5, 6).Several field and experimental studies have tested the suitability of the OHS proposed by the WHO, containing 90 mEq/liter sodium, or of a variant with a lower sodium content (7-10). It is generally accepted that both can accomplish rehydration, with the WHO formula also allowing for the replenishment of sodium. The amount of glucose added (20 g/liter or 1 1 1 mM) has been considered optimum.Earlier reports had provided conflicting information on the stoichiometry of sodium:glucose cotransport and the fluxes of electrolytes and water, either from in vitro (1 1-14) or from in vivo studies, including animal experimentation (15, 16) and clinical trials (I 6, 17).We previously evaluated the rela...

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Section: Discussionmentioning

confidence: 99%

Osmolality and Solute Concentration—Their Relationship with Oral Hydration Solution Effectiveness: An Experimental Assessment

Wapnir

Lifshitz

1985

Pediatr Res

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“…Mean stool pH in five adults, one studied twice over a 2-wk interval, was 6.6±0.3. Homogenization in phosphate-saline solutions of pH 10.0 (n = 6), 7.0 (n = 6), 5.0 (n = 5) and 3.0 (n = 3) produced fecal incubates of pH 7.6±0.15, 7.0±0.09, 6.2+0.10, and 5.5 ±0.25, respectively. H2 per hour produced by fecal homogenates incubated with glucose did not differ (P > 0.05) at pH 7.6 and 7.0 (16.5±3.2 and 16.1±2.6 ,umol, respectively).…”

Section: Analysesmentioning

confidence: 99%

Role of pH in production of hydrogen from carbohydrates by colonic bacterial flora. Studies in vivo and in vitro.

Perman¹,

Modler²,

Olson³

1981

J. Clin. Invest.

191

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A B S T R A C T Hydrogen produced by colonic bacteria and excreted in breath is a useful index ofcarbohydrate malabsorption. Since colonic contents are often acidic in individuals with carbohydrate malabsorption and in normal newborns, we determined the effect of colonic acidification on H2 production. Acidification of colonic contents by dietary means significantly reduced excess breath H2 excretion from 55.4+ 11.1 (SEM) to 12.2 ±3.1 ml/4 h (P < 0.05) after administration of 0.3 g/kg of the nonabsorbable sugar lactulose to five normal adult subjects. Similarly, the breath H2 response to lactose was reduced or eliminated in two proven lactose malabsorbers after acidification. The correlation between pH and H2 production from carbohydrate was further investigated in adults and neonates, using an in vitro fecal incubation system. Glucose disappearance and H2 production were pH dependent and highly correlated (r = 0.94) in the pH range 5.5-7.6. Maximal production of H2 from glucose by fecal incubates occurred at pH 7.0-7.45. Inhibition of H2 production from carbohydrate occurred at acid pH. H2 per hour from glucose at pH 6.2 and 5.5 averaged 60.2% and 24.2%, respectively, of that produced at neutral pH. Rapid reversal of pH-induced inhibition by neutralization indicated a metabolic, rather than a bactericidal process. The observations indicate that the breath H2 response to malabsorbed carbohydrate is affected by colonic pH. It appears that the efficiency of bacterial carbohydrate metabolism in the colon is pH dependent.

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“…[8][9][10] Los mecanismos de acción de los agentes infecciosos asociados con la enfermedad diarreica son muy diversos, ya que mientras los virus no suelen inducir respuesta inflamatoria, en las infecciones por bacterias enteroinvasoras pueden presentarse evacuaciones con moco y sangre, además de leucocitos en las heces. [2][3][4]6 En contraste con la disminución en la mortalidad asociada con enfermedad diarreica en México en la última década, [11][12][13][14] su prevalencia se ha mantenido estable e incluso muestra una tendencia ascendente hacia el final de la década de los noventa, 11,12 por lo que es evidente que este problema de salud sigue siendo un motivo de consulta frecuente y cotidiano en el primer nivel de atención.…”

Section: Introductionunclassified

Utilidad del estudio de las heces para el diagnóstico y manejo de lactantes y prescolares con diarrea aguda

Larrosa‐Haro¹,

Ruiz-Pérez²,

Aguilar-Benavides³

2002

Salud pública Méx

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Carbohydrate intolerance in infants with diarrhea

Cited by 120 publications

References 22 publications

Osmolality and Solute Concentration—Their Relationship with Oral Hydration Solution Effectiveness: An Experimental Assessment

Osmolality and Solute Concentration—Their Relationship with Oral Hydration Solution Effectiveness: An Experimental Assessment

Role of pH in production of hydrogen from carbohydrates by colonic bacterial flora. Studies in vivo and in vitro.

Utilidad del estudio de las heces para el diagnóstico y manejo de lactantes y prescolares con diarrea aguda

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