ZIN-THETKHINE ET AL.
Sodium Balance During Acute Diarrhoea in Malnourished Children by Zin-Thet-Khine,** Khin-Maung-U,* Myo-Khin,* Yi-Yi-Myint,*** Myat-Thif and Kyi-Kyi-May*** *Clinical Research Division, The Department of Medical Research, Ministry of Health, Rangoon, Burma **Physiology Department, Institute of Medicine (2), Rangoon, Burma ***Physiology Department, Institute of Medicine (1), Rangoon, Burma \Paediatric Wards, North Okkalapa General Hospital, Rangoon, Burma
Introduction In developing countries where childhood malnutrition is prevalent, acute diarrhoea may be associated with high mortality. Using anthropometric indices from 2019 Bangladeshi children surveyed for 24 months to determine the risk of diarrhoeal diseases according to nutritional status of children, Chen et al. reported that malnutrition may or may not increase diarrhoea incidence, but diarrhoea is more prolonged and more severe in malnourished children, and is associated with a higher rate of mortality.' Although in Western countries, hypernatraemia is frequently recorded in diarrhoea associated with a higher mortality rate, 2 ' 3 the incidence of specific types of dehydration in developing countries where malnutrition is prevalent is not well-documented. A few reports*' 5 indicate a higher incidence of hyponatraemia during diarrhoea Acknowledgements We thank Drs Kyaw-Zin-Wai, Ohnmar-Han, Nwe-Oo, and Nwe-Theingi, the doctors and nurses of pedialric wards of the North Okkalapa General Hospital for their help with patient care, and the technical staff of the Clinical Research Division and the Nuclear Medicine Research Division of the Department of Medical Research for assistance with laboratory work. This study was carried out as part of a research project which received financial support from the South-East Asian Regional Office of the World Health Organization under a CTSA research grant (ID Number SN 526). Correspondence: Dr Khin-Maung-U, Department of Pediatrics, International Institute for Infant Nutrition and Gastrointestinal Disease, Hahnemann University, Mail Stop 402, Broad and Vine Streets, Philadelphia, PA 19102-1192, USA. Journal of Tropical Pediatrics
Vol.38
August 1992
in malnourished children. Recently, in a review of 1330 Bangladeshi children hospitalized for diarrhoea, 6 a significant relationship between serum sodium concentrations and nutritional states was found (hyponatraemia being associated with severe malnutrition) and case fatality rates were strongly associated with low sodium values, being higher (10 per cent) in hyponatraemic dehydration, less in isonatraemic dehydration (4 per cent) and the least (1 per cent) in hypernatraemic dehydration. They suggested that in a child with malnutrition, sodium balance during an episode of diarrhoea is impaired, and the resulting hyponatraemia may contribute to a relatively higher case fatality rate. The purpose of the present study is to compare the state of sodium balance during acute diarrhoea in children with and without malnutrition. Patients and Methods Patients Forty-six male children, 12-59 months of age, admitted to the pediatric wards of North Okkalapa General Hospital, Rangoon, for acute watery diarrhoea of less than 48 hours duration before hospitalization were studied. Children with diarrhoea having a concomitant illness (such as pneumonia, tuberculosis, urinary tract infection) or shock or a history of diarrhoea within 3 weeks of the present episode or history of gross blood and mucus in the stools, were not included in the study. All children had Grade II (moderately severe) dehydration, 7 with about 5 per cent of body weight loss or plasma specific gravity of 1.035 and above. The study groups consisted of 19 male children l Oxford University Press 1992
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Downloaded from http://tropej.oxfordjournals.org/ at Sheffield University on September 4, 2015
Summary Forty-six male children 12-59 months old (27 malnourished and 19 with normal nutrition) admitted for acute water diarrhoea of
Sodium Balance During Acute Diarrhoea in Malnourished Children by Zin-Thet-Khine,** Khin-Maung-U,* Myo-Khin,* Yi-Yi-Myint,*** Myat-Thif and Kyi-Kyi-May*** *Clinical Research Division, The Department of Medical Research, Ministry of Health, Rangoon, Burma **Physiology Department, Institute of Medicine (2), Rangoon, Burma ***Physiology Department, Institute of Medicine (1), Rangoon, Burma \Paediatric Wards, North Okkalapa General Hospital, Rangoon, Burma
Introduction In developing countries where childhood malnutrition is prevalent, acute diarrhoea may be associated with high mortality. Using anthropometric indices from 2019 Bangladeshi children surveyed for 24 months to determine the risk of diarrhoeal diseases according to nutritional status of children, Chen et al. reported that malnutrition may or may not increase diarrhoea incidence, but diarrhoea is more prolonged and more severe in malnourished children, and is associated with a higher rate of mortality.' Although in Western countries, hypernatraemia is frequently recorded in diarrhoea associated with a higher mortality rate, 2 ' 3 the incidence of specific types of dehydration in developing countries where malnutrition is prevalent is not well-documented. A few reports*' 5 indicate a higher incidence of hyponatraemia during diarrhoea Acknowledgements We thank Drs Kyaw-Zin-Wai, Ohnmar-Han, Nwe-Oo, and Nwe-Theingi, the doctors and nurses of pedialric wards of the North Okkalapa General Hospital for their help with patient care, and the technical staff of the Clinical Research Division and the Nuclear Medicine Research Division of the Department of Medical Research for assistance with laboratory work. This study was carried out as part of a research project which received financial support from the South-East Asian Regional Office of the World Health Organization under a CTSA research grant (ID Number SN 526). Correspondence: Dr Khin-Maung-U, Department of Pediatrics, International Institute for Infant Nutrition and Gastrointestinal Disease, Hahnemann University, Mail Stop 402, Broad and Vine Streets, Philadelphia, PA 19102-1192, USA. Journal of Tropical Pediatrics
Vol.38
August 1992
in malnourished children. Recently, in a review of 1330 Bangladeshi children hospitalized for diarrhoea, 6 a significant relationship between serum sodium concentrations and nutritional states was found (hyponatraemia being associated with severe malnutrition) and case fatality rates were strongly associated with low sodium values, being higher (10 per cent) in hyponatraemic dehydration, less in isonatraemic dehydration (4 per cent) and the least (1 per cent) in hypernatraemic dehydration. They suggested that in a child with malnutrition, sodium balance during an episode of diarrhoea is impaired, and the resulting hyponatraemia may contribute to a relatively higher case fatality rate. The purpose of the present study is to compare the state of sodium balance during acute diarrhoea in children with and without malnutrition. Patients and Methods Patients Forty-six male children, 12-59 months of age, admitted to the pediatric wards of North Okkalapa General Hospital, Rangoon, for acute watery diarrhoea of less than 48 hours duration before hospitalization were studied. Children with diarrhoea having a concomitant illness (such as pneumonia, tuberculosis, urinary tract infection) or shock or a history of diarrhoea within 3 weeks of the present episode or history of gross blood and mucus in the stools, were not included in the study. All children had Grade II (moderately severe) dehydration, 7 with about 5 per cent of body weight loss or plasma specific gravity of 1.035 and above. The study groups consisted of 19 male children l Oxford University Press 1992
153
Downloaded from http://tropej.oxfordjournals.org/ at Sheffield University on September 4, 2015
Summary Forty-six male children 12-59 months old (27 malnourished and 19 with normal nutrition) admitted for acute water diarrhoea of
