Mar 05, 2018
Dyspepsia is a simple - a disease that develops mainly in children of the first year of life. Causes: improper feeding of a child( abundant frequent feeding, overfeeding, underfeeding, food not corresponding to age, rapid transition to artificial feeding, overload with fat, carbohydrates or protein), violation of the regime, care( overheating, weaning during hot season),intestinal infection( increased activity of opportunistic flora), as well as various other diseases( pneumonia, otitis, acute respiratory disease), against which the development of so-called parenteral dyspepsia. A combination of these factors is possible. More often dyspepsia is observed in weakened children, suffering exudative diathesis, rickets, hypotrophy.
At the heart of the disease is a decrease in the enzymatic activity of the gastrointestinal tract, intensification of fermentation processes with the formation of a large number of gases, and a reduction in the absorptive function of the intestine.
The onset is often acute;there is a regurgitation, sometimes a vomiting, the appetite decreases. Stool 8-10 times a day, liquid, with a sour smell, yellow-green color with a small amount of mucus, in the feces of white lumps of saponified fats( similar to chopped chicken eggs).The flatulence is expressed, therefore the child periodically is disturbed, cries, after leaving of gases quickly calms down. The general condition suffers a little, the temperature is normal. The intensity of the weight gain is somewhat slowed down.
It is necessary to find out the cause, which caused dyspepsia, to eliminate overfeeding or age-appropriate food, to exclude mixtures rich in fat and sugar. The first 6-9 hours pass one or two feedings, give the child at this time, drink plenty of isotonic sodium chloride solution and tea at the rate of 150 ml of liquid per 1 kg of body weight per day. With parenteral dyspepsia with small dyspepsia, you can not arrange a break in feeding, ie, continue to breast-feed, and with artificial feeding, replace the milk mixtures with acidic( kefir, churning).
After a pause in feeding, the baby is applied to the breast only for 5 minutes or gives expressed milk, and when fed, they are acidic mixtures, but in half. Then in the next 2-3 days the amount of food is gradually adjusted to the age norm( under the control of the stool).The missing amount of food is compensated with a liquid. Assign vitamins, pepsin with hydrochloric acid or natural gastric juice, pancreatin.
Rp.: Ac.hydrochlorici diluti 1.0 Pepsini 2.0 Aq.destill.100.0
M.D. S. 1 teaspoon 3 times daily before meals
Rp.: Pancreatini 0,15-0,2 Calcii carbonati 0,25 M. f.pulv. D. t.d. N. 10 S.
1 powder 3 times a day after meals
With flatulence, abdominal pain shows warmth on the abdomen, warming the compress, dill water, otv, chamomile 1 teaspoon several times a day, gas pipe. With parenteral dyspepsia, in addition to diet, treatment of the underlying disease is necessary;prescribe antibiotics, sulfonamide preparations. With proper, timely treatment, the course and outcome of the disease are favorable.
Toxic syndrome can develop against a background of various diseases( acute gastrointestinal, pneumonia, influenza, acute respiratory infections, staphylococcal infection), especially in young children. The comparative frequency of toxic forms of diseases at this age is due to the special vulnerability of the central nervous system, the lability of metabolic processes, increased vascular permeability. The younger the child's age, the greater the possibility of developing toxicosis. Clinically, there are two variants of toxicosis: toxicosis with a predominant violation of water-salt metabolism( exsicosis) and hemodynamics and neurotoxicosis with a predominant response from the central nervous system and the autonomic nervous system.
Toxicosis with exsicosis is more common in infants, especially the first months of life, weakened, suffering from hypotrophy, in which the enzymatic activity of the digestive apparatus and the bactericidal activity of the digestive juices are reduced. Under these conditions, under the influence of various unfavorable factors of the external and internal environment, the growth and pathogenicity of the intestinal microflora and its distribution increase. Bacterial toxins, microbes and products of their vital activity, along with other pathological components of the contents of the intestine, are easily pierced through the intestinal and hepatic barriers into the bloodstream and have a toxic effect on the central nervous system and its regulatory mechanisms, while the function of other organs and systems is also distorted,, the immunity decreases.
The onset of the disease is more often acute, violent, the child is nervous, restless, but lethargy, adynamia develop rapidly. There are frequent vomiting and the urge to vomitise regardless of food intake, in vomit masses of food remnants, mucus, an admixture of bile. The amount of vomit exceeds the volume of food and water received by the child. The chair is frequent - up to 8-20 times a day, plentiful, watery, sometimes splashing, poor in stale masses, with an admixture of mucus. In connection with the violation of water absorption and rapid loss of fluid, dehydration develops, the body weight rapidly decreases( by 1 kg or more for 2-3 days).
When dehydrated, facial features are sharpened, dryness of the sclera and mucous membranes appear, the big fontanel and eyes fall, the lips are bright, dry, the skin covers acquire an earthy-gray hue, the skin taken in the fold is poorly straightened, the turgor of the tissues is reduced. It can develop a sclera, mainly on the lower limbs( thickening of the subcutaneous fat reaches a cartilaginous consistency).There is toxic breathing - breathing noisy "driven beast", the cardiovascular system is disturbed( pulse is frequent, small, tones are deaf, blood pressure is lowered, cold extremities), kidneys. Consciousness is periodically darkened, the view is directed to the distance, automatic movements of the fingers can develop, then the convulsive syndrome is a coma.
Blood condenses, with a false increase in hemoglobin and the number of red blood cells. Urine is separated little, it shows protein, red blood cells, leukocytes, cylinders, in extreme cases can be anuria. At the onset of the disease, the temperature almost always rises to 39-40 ° C and then rapidly decreases.
Clinical manifestations of toxicosis with exsicosis may vary somewhat depending on the preferential loss of water or salts, which should be taken into account when prescribing treatment.
With salt deficiency, the loss of electrolytes predominates, the acid-base state shifts sharply toward acidosis, the content of potassium, sodium, chlorides, and sometimes calcium decreases. Leading in the clinic is a deficit of potassium - a sharp inhibition, drowsiness, lethargy, adynamia, confusion, muscle hypotension, decreased reflexes. In connection with a sharp decrease in muscle tone, breathing is broken, the borders of the heart are widened and a special deafness of heart sounds is noted, blood pressure is lowering, paresis of the intestine accompanied by flatulence develops.
"Pure" water-deficient exciticosis is rare, it is characterized by a sharp excitement of the child, motor anxiety, high temperature, sleep disturbance, propensity to hypertonic muscles, tension of the occipital muscles, convulsions, increased thirst;with it sharply reduced flow, salivation and urination.
Isotonic eoscosis is most often observed, in which the loss of fluid and electrolytes is uniform and the clinical picture depends on the degree and depth of disturbance of metabolic processes.
Usually, the toxicosis develops within 2-3 days, with proper treatment passes after 3-4 days, but complete recovery lasts 2-3 weeks. During this period, under adverse conditions, a secondary infection( stomatitis, otitis, pyuria, pneumonia and other intercurrent diseases) may join. Always after the transferred toxicosis in the child, hypotrophy and hypovitaminosis progress. If the child is not given timely help, a fatal outcome is possible.
Treatment is complex, including combating toxicosis and the causes that caused it, eliminating dehydration and acidosis, fighting infection, restoring enzymatic activity and normal digestive processes, and symptomatic therapy.
Detoxification and dehydration elimination is achieved by immediate intravenous injection of plasma or its substitutes at the rate of 10-20 ml / kg of body weight, the appointment of a hungry water-tea diet for 12-24 hours depending on the severity of the condition. During this period, the fluid is administered at the rate of 100-150 ml / kg of body weight, which should be in a child at this age. Fluid is administered through the mouth, in / in, under the skin, in enemas. Drinking gives about 1/3 of the total amount of fluid administered per day - water, tea with 3% sugar or Ringer's solution in half with 5% glucose solution. Drinking is given on a dosage of 1 teaspoon every 5-10 minutes;if vomiting persists, the liquid is instilled in the mouth with a pipette. In / in the liquid is injected slowly for a few hours, at first 20 drops, then 10-15 drops per minute. The composition of the injected fluid is determined by the nature of the exsicosis. If the clinical nature of the toxicosis is unclear, it is desirable to use a mixture of equal parts of Ringer's solution and a 5% solution of glucose. With water-deficient exsicosis the ratio of Ringer's and glucose solution is 1: 3, while the solder deficiency is 2: 1.It should be remembered that the abundant introduction into the body of any one liquid( only glucose or only Ringer's solution) can lead to serious complications. Potassium deficiency should be injected with a 0.3% solution of potassium chloride in the form of drinking at 30-50 ml / kg of body weight, for intravenous use of 7.5% potassium chloride solution, which is administered in a mixture with Ringer's solution or 5% glucose solution.
After a hunger-water discharge, it is recommended to feed 10 ml of thoracal expressed milk every 2 hours, i.e., 10 times a day. If there is no breast milk, B-rice, B-kefir or mixture No. 2 is prescribed in the same amount. Each next day for feeding add 10 ml of milk, gradually bringing the volume to the age norm. Starting from the 5th-6th day, gently apply to the breast for 3-5 minutes, and then supplemented with expressed milk. With rapidly decreasing toxemia, the rate of a quantitative increase in diet can be slightly increased, but one must do it carefully. The resumption of flatulence, regurgitation, vomiting, anxiety indicates an overload in the diet, which the child is not yet cope with, and may have a toxicosis again.
Antibiotics acting on the intestinal group( levomycetin, tetracyclines in age doses) in combination with phthalazole and other sulfanilamide preparations are prescribed to fight infection( According to indications).It is necessary to prescribe enzymes early: pepsin with hydrochloric acid, natural gastric juice, pancreatin. Apply symptomatic means - heart drugs, cordiamin, caffeine, a complex of vitamins. Starting from the 2nd week, stimulating therapy is being expanded: gamma globulin is injected, blood and plasma are poured.
It is necessary to provide the child with very good care, careful monitoring of the skin and mucous membranes, a long stay in the fresh air, a calm sleep.
Leading in his clinical picture are the symptoms of the nervous system, as a result of intoxication develops cerebral edema, there may be hemorrhages in the brain and necrosis. Exicosis is absent, but consciousness is quickly broken, convulsions, violation of the functions of the cardiovascular system, kidneys occur. The child can fall into a coma.
Need to improve diuresis, reduce intracranial pressure, conduct antipyretic therapy. To dehydrate IV, 20-40% glucose solution is injected, the plasma is transfused, hypothiazide, furosemide( Lasix) is prescribed in age-related doses. Corticosteroids are indicated - prednisolone 1 mg / kg body weight per day short course. Antibacterial therapy is carried out depending on the nature of the underlying disease that caused neurotoxicosis. On special indications, with pronounced meningeal syndrome, with a diagnostic and therapeutic purpose, a spinal puncture is necessary.