Оральная регидратация при диарее: от истории к современным рекомендациям

Захарова И.Н., Бережная И.В., Камилова А.Т., Гостюхина А.Д. Оральная регидратация при диарее: от истории к современным рекомендациям. Педиатрия. Consilium Medicum. 2024;2:187–192.
DOI: 10.26442/26586630.2024.2.202962

© ООО «КОНСИЛИУМ МЕДИКУМ», 2024 г.

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Zakharova IN, Berezhnaya IV, Kamilova AТ, Gostyukhina AD. Oral rehydration in diarrhea: From history to current guidelines. A review. Pediatrics. Consilium Medicum. 2024;2:187–192. DOI: 10.26442/26586630.2024.2.202962

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Аннотация

Острый гастроэнтерит (ОГЭ) обычно определяется как изменение консистенции стула (жидкий или неоформленный) и/или увеличение частоты дефекаций, которое также может сопровождаться рвотой и повышением температуры тела. Повышенная температура увеличивает скорость метаболизма более чем в 1,5 раза, на каждый 1°C повышения температуры тела потери жидкости возрастают на 10%. ОГЭ относится к распространенным причинам заболеваемости и смертности среди младенцев и детей. Прогноз является благоприятным, если состояние распознано вовремя и начато соответствующее лечение. Основная цель терапии ОГЭ – восстановление водного баланса и предотвращение обезвоживания, чего можно достичь с помощью раствора для пероральной регидратации. Состав и пропорция компонентов средств для регидратации прописаны в рекомендациях Европейским обществом детских гастроэнтерологов, гепатологов и нутрициологов, коллективным членом которого является Российское общество детских гастроэнтерологов, и таким средствам в полной мере соответствуют сбалансированные составы средств для регидратации РегидроСтандарт и Регидрон Био. В состав последнего включен хорошо изученный и рекомендованный Европейским обществом детских гастроэнтерологов, гепатологов и нутрициологов при острых кишечных инфекциях пробиотический штамм Lactobacillus rhamnosus GG, благодаря которому, согласно результатам исследований, сокращается продолжительность и выраженность диареи. Регидрон Био и РегидроСтандарт могут быть рекомендованы для применения в клинической педиатрической практике.

Ключевые слова: понос, диарея, эксикоз, дегидратация, регидратация, острый гастроэнтерит, дети, орально-регидратационный раствор, осмолярность

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Acute gastroenteritis (AGE) is usually defined as a change in stool consistency (liquid or unformed) and/or an increase in the frequency of bowel movements, which can also be accompanied by vomiting and fever. Fever increases the metabolic rate by more than 1.5 times; for every 1°C increase in body temperature, fluid loss increases by 10%. AGE is a common cause of morbidity and mortality among infants and children. The prognosis is favorable if the condition is recognized promptly and appropriate treatment is started. The main goal of AGE therapy is to restore water balance and prevent dehydration, which can be achieved with an oral rehydration solution. The composition and proportion of the components of rehydration agents are described in the guidelines of the European Society for Paediatric Gastroenterology Hepatology and Nutrition, of which the Russian Society of Pediatric Gastroenterologists is a collective member, and such agents are fully consistent with the balanced formulations of RehydroStandard and Rehydron Bio rehydration agents. The latter includes the probiotic strain Lactobacillus rhamnosus GG, well studied and recommended by the European Society for Paediatric Gastroenterology Hepatology and Nutrition for acute intestinal infections since this strain reduces the duration and severity of diarrhea according to the results of studies. Rehydron Bio and RehydroStandard can be recommended for use in clinical pediatric practice.

Keywords: diarrhea, exsiccosis, dehydration, rehydration, acute gastroenteritis, children, oral rehydration solution, osmolarity

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Список литературы

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2020;70(5):694-701. DOI:10.1097/MPG.0000000000002669
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21. Учайкин В.Ф., Новокшонов А.А. Клиническая эффективность применения гипоосмолярного перорального раствора с Lactobacillus GG для регидратации при кишечных инфекциях у детей. Детские инфекции. 2015;14(1):20-6 [Uchaikin VF, Novokshonov AA. The clinical efficacy of hypoosmolyarny oral solution with Lactobacillus GG for Rehydration in intestinal infections in children. Children Infections. 2015;14(1):20-6 (in Russian)].
22. Tuerk MJ, Fazel N. Zinc deficiency. Curr Opin Gastroenterol. 2009;25(2):136-43. DOI:10.1097/MOG.0b013e328321b395
23. Patro B, Golicki D, Szajewska H. Meta-analysis: zinc supplementation for acute gastroenteritis in children. Aliment Pharmacol Ther. 2008;28(6):713-23.
DOI:10.1111/j.1365-2036.2008.03787.x
24. Lazzerini M, Ronfani L. Oral zinc for treating diarrhoea in children. Cochrane Database Syst Rev. 2012;(1):CD005436. DOI:10.1002/14651858.CD005436.pub4
25. Patel A, Mamtani M, Dibley MJ, et al. Therapeutic value of zinc supplementation in acute and persistent diarrhea: A systematic review. PLoS One. 2010;5(4):e10386. DOI:10.1371/journal.pone.0010386
26. Dhingra U, Kisenge R, Sudfeld CR, et al. Lower-dose zinc for childhood diarrhea – A randomized, multicenter trial. N Engl J Med.
2020;383(13):1231-41. DOI:10.1056/NEJMoa1915905

________________________________________________

1. Guarino A, Ashkenazi S, Gendrel D, et al.; European Society for Pediatric Gastroenterology, Hepatology, and Nutrition; European Society for Pediatric Infectious Diseases. European Society for Pediatric Gastroenterology, Hepatology, and Nutrition, European Society for Pediatric Infectious Diseases evidence-based guidelines for the management of acute gastroenteritis in children in Europe: update 2014. J Pediatr Gastroenterol Nutr. 2014;59(1):132-52. DOI:10.1097/MPG.0000000000000375
2. Alhammad MA, Alanazi SS, Almadan ZH, et al. Acute gastroenteritis in children, overview, etiology, and management: Literature review. Entomol Appl Sci Lett. 2020;7(2):76-82..
3. Hartman S, Brown E, Loomis E, Russell HA. Gastroenteritis in Children. Am Fam Physician. 2019;99(3):159-65. [Corrected to: Am Fam Physician. 2019;99(12):732]. PMID:30702253
4. Guarino A, Aguilar J, Berkley J, et al. Acute gastroenteritis in children of the world: what needs to be done? J Pediatr Gastroenterol Nutr.
2020;70(5):694-701. DOI:10.1097/MPG.0000000000002669
5. Dagnino J. Wren, Boyle, and the origins of intravenous injections and the Royal Society of London. Anesthesiology. 2009;111(4):923-4; author reply 924. DOI:10.1097/ALN.0b013e3181b56163
6. O’Shaughnessy W.B. Proposal of a new method of treatment of the blue epidemic of cholera by introduction of highly oxidizing salts into the venous system. Lancet.
1831;17(Is. 432):366-71.
7. Baskett TF. William O’Shaughnessy, Thomas Latta and the origins of intravenous saline. Resuscitation. 2002;55(3):231-4. DOI:10.1016/s0300-9572(02)00294-0
8. MacGillivray N. Dr Latta of Leith: pioneer in the treatment of cholera by intravenous saline infusion. J R Coll Physicians Edinb. 2006;36(1):80-5. PMID:17146955
9. Janakan G, Ellis H. Dr Thomas Aitchison Latta (c1796–1833): Pioneer of intravenous fluid replacement in the treatment of cholera. J Med Biogr. 2013;21(2):70-4. DOI:10.1258/jmb.2012.012004
10. Farthing MJJ. History and rationale of oral rehydration therapy and recent developments in the formulation of an optimal solution. Drugs. 1988;36(Suppl. 4):80-90. PMID:3069448
11. Palmer DL, Koster FT, Islam AFMR, et al. Comparison of sucrose and glucose in the oral electrolyte therapy of cholera and other severe diarrheas. New Engl J Med. 1977;297(20):1107-10. PMID:333291
12. Bhattacharya SK, Dutta P, Bhattacharya MK, et al. Efficacy & safety of glycine fortified oral rehydration solution in the treatment of acute dehydrating diarrhoea in children. Indian J Med Res. 1989;90:426-9. PMID:2697690
13. Moenginah PA, Suprapto Soenarto J, Bachtin M, et al. Sucrose electrolyte solution for oral rehydration in diarrhea. J Trop Pediatr Environ Child Health. 1978;24(3):127-30.
14. Gore SM, Fontaine O, Pierce NF. Impact of rice based oral rehydration solution on stool output and duration of diarrhoea: Meta-analysis of 13 clinical trials. Br Med J. 1992;304(6822):287-91. DOI:10.1136/bmj.304.6822.287
15. Farthing M, Salam MA, Lindberg G, et al.; WGO. Acute diarrhea in adults and children: a global perspective. J Clin Gastroenterol.
2013;47(1):12-20. DOI:10.1097/MCG.0b013e31826df662
16. Guarino A, Guandalini S, Lo Vecchio A. Probiotics for prevention and treatment of diarrhea. J Clin Gastroenterol. 2015;49 (Suppl. 1):S37-45. DOI:10.1097/mcg.0000000000000349
17. Szajewska H, Guarino A, Hojsak I, et al. Use of probiotics for management of acute gastroenteritis: a position paper by the ESPGHAN Working Group for Probiotics and Prebiotics. J Pediatr Gastroenterol Nutr. 2014;58(4):531-9. DOI:10.1097/MPG.0000000000000320
18. Majamaa H, Isolauri E, Saxelin M, Vesikari T. Lactic acid bacteria in the treatment of acute rotavirus gastroenteritis. J Pediatr Gastroenterol Nutr. 1995;20(3):333-8.
19. Sanklecha M, Verma L, Pai U, et al. Lactobacillus rhamnosus GG Evaluation in Acute Diarrhea (LEAD): An Observational Study. Cureus. 2022;14(4):e24594. DOI:10.7759/cureus.24594
20. Rautanen T, Isolauri E, Salo E, Vesikari T. Management of acute diarrhoea with low osmolarity oral rehydration solutions and Lactobacillus strain GG. Arch Dis Child.
1998;79(2):157-60. PMID:9797599
21. Uchaikin VF, Novokshonov AA. The clinical efficacy of hypoosmolyarny oral solution with Lactobacillus GG for Rehydration in intestinal infections in children. Children Infections. 2015;14(1):20-6 (in Russian).
22. Tuerk MJ, Fazel N. Zinc deficiency. Curr Opin Gastroenterol. 2009;25(2):136-43. DOI:10.1097/MOG.0b013e328321b395
23. Patro B, Golicki D, Szajewska H. Meta-analysis: zinc supplementation for acute gastroenteritis in children. Aliment Pharmacol Ther. 2008;28(6):713-23.
DOI:10.1111/j.1365-2036.2008.03787.x
24. Lazzerini M, Ronfani L. Oral zinc for treating diarrhoea in children. Cochrane Database Syst Rev. 2012;(1):CD005436. DOI:10.1002/14651858.CD005436.pub4
25. Patel A, Mamtani M, Dibley MJ, et al. Therapeutic value of zinc supplementation in acute and persistent diarrhea: A systematic review. PLoS One. 2010;5(4):e10386. DOI:10.1371/journal.pone.0010386
26. Dhingra U, Kisenge R, Sudfeld CR, et al. Lower-dose zinc for childhood diarrhea – A randomized, multicenter trial. N Engl J Med.
2020;383(13):1231-41. DOI:10.1056/NEJMoa1915905

Авторы

И.Н. Захарова*¹, И.В. Бережная¹, А.Т. Камилова², А.Д. Гостюхина^1,3

¹ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России, Москва, Россия;
²Республиканский специализированный научно-практический медицинский центр педиатрии Минздрава Республики Узбекистан, Ташкент, Узбекистан;
³ГБУЗ «Детская городская клиническая больница им. З.А. Башляевой» Департамента здравоохранения г. Москвы, Москва, Россия
*zakharova-rmapo@yandex.ru

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Irina N. Zakharova*¹, Irina V. Berezhnaya¹, Altinoy Т. Kamilova², Anastasia D. Gostyukhina^1,3

¹Russian Medical Academy of Continuous Professional Education, Moscow, Russia;
²Republican Specialized Scientific Practice Medical Center of Pediatrics, Tashkent, Uzbekistan;
³Bashlyayeva Children's City Clinical Hospital, Moscow, Russia
*zakharova-rmapo@yandex.ru

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