From the Guidelines
The initial treatment for pediatric patients with hyponatremic dehydration due to congenital chloride losing diarrhea should involve oral rehydration solution (ORS) as the first-line therapy for mild to moderate dehydration, as recommended by the 2017 Infectious Diseases Society of America clinical practice guidelines 1. This approach is supported by the guidelines, which state that reduced osmolarity ORS is recommended for mild to moderate dehydration in infants, children, and adults with acute diarrhea from any cause, including those with mild to moderate dehydration associated with vomiting or severe diarrhea. The guidelines also suggest that nasogastric administration of ORS may be considered in infants, children, and adults with moderate dehydration who cannot tolerate oral intake or are too weak to drink adequately 1. In cases of severe dehydration, shock, or altered mental status, isotonic intravenous fluids such as lactated Ringer’s and normal saline solution should be administered, with the option to add potassium chloride to correct electrolyte imbalances 1. Key points to consider in the treatment of pediatric patients with hyponatremic dehydration due to congenital chloride losing diarrhea include:
- The use of ORS as the first-line therapy for mild to moderate dehydration
- The consideration of nasogastric administration of ORS in patients who cannot tolerate oral intake
- The administration of isotonic intravenous fluids in cases of severe dehydration or shock
- The importance of individualizing treatment based on the patient's serum electrolyte levels and clinical status
- The need for frequent monitoring of serum electrolyte levels to guide treatment and prevent complications. It is essential to note that the goal of treatment is to replace ongoing losses of chloride, sodium, and potassium while maintaining fluid balance, and that without adequate chloride replacement, patients may experience chronic dehydration, growth failure, and potentially life-threatening electrolyte abnormalities 1.
From the Research
Initial Treatment for Pediatric Patients with Hyponatremic Dehydration
The initial treatment for pediatric patients with hyponatremic dehydration due to congenital chloride losing diarrhea involves addressing the dehydration and electrolyte imbalance.
- The use of balanced crystalloid solutions, such as Ringer's lactate, is likely to result in a slight reduction of the time in hospital compared to 0.9% saline 2.
- Balanced solutions probably produce a higher increase in blood pH and bicarbonate levels, and likely reduce the risk of hypokalaemia after intravenous correction 2.
- Individualized intravenous fluid therapy is recommended, as no single intravenous fluid management is optimal for all children 3.
Oral Rehydration and Electrolyte Replacement
- Full oral replacement of the faecal losses of Cl-, Na+, K+, and water is essential in treating congenital chloride diarrhoea 4.
- Oral supplements of water and electrolytes lost in the fecal fluid can be an effective initial treatment, as seen in a case of congenital sodium diarrhea 5.
- Butyrate, a short-chain fatty acid, has been reported as an effective treatment in reducing the severity of congenital chloride diarrhea, by stimulating intestinal water and ion absorption 6.
Key Considerations
- Close monitoring of serum electrolytes, creatinine, and blood gases is crucial in managing pediatric patients with hyponatremic dehydration due to congenital chloride losing diarrhea 3.
- The treatment should be tailored to the individual patient's needs, taking into account the degree of dehydration, serum electrolyte levels, and other factors 3.