RESUMEN
No disponible
Asunto(s)
Femenino , Preescolar , Lactante , Masculino , Niño , Humanos , Recién Nacido , Trastornos de la Nutrición del Niño/tratamiento farmacológico , Cisaprida/uso terapéutico , Recien Nacido Prematuro/fisiología , Hepatopatías/tratamiento farmacológico , Cardiopatías/tratamiento farmacológico , Hipersensibilidad a las Drogas/diagnóstico , Hipersensibilidad a las Drogas/etiología , Sociedades Médicas/normas , Factores de Riesgo , Arritmias Cardíacas/diagnóstico , Diarrea/diagnóstico , Diarrea Infantil/diagnóstico , Encefalitis/diagnóstico , Insuficiencia Cardíaca/diagnóstico , Isquemia Miocárdica/diagnóstico , Diabetes Mellitus/diagnóstico , Fenómenos Fisiológicos de la Nutrición/educación , Hipopotasemia/diagnóstico , Enfermedades del Prematuro/diagnóstico , Cisaprida/efectos adversos , Metoclopramida/farmacocinética , Metoclopramida/uso terapéutico , Domperidona/efectos adversos , Domperidona/uso terapéutico , Vómitos/diagnóstico , Vómitos/etiologíaRESUMEN
OBJECTIVE: The purpose of this study was to experimentally develop and clinically evaluate the safety and potential usefulness of a rice-based, short glucose polymer oral rehydration solution (ORS), Amylyte, in the treatment of acute diarrhea. Amylyte has a similar osmolality but a higher caloric density than the WHO ORS. METHODS: Different amounts of rice were cooked in 500 ml of water containing salts (1.5 g NaCl, 600 mg KCl, and 150 mg CaCl2) with varying amounts of thermophilic amylase (252,500 modified Wohlgemuth units). Amylase (25 mg) thinned the gluey rice water when 100 g of rice was cooked in 500 ml of water for 10 minutes. The volume of the resultant supernatant (Amylyte) was approximately 250 ml. A two-part, clinical case study was performed. In study 1, 12 children with diarrhea and mild dehydration were studied to determine the safety of Amylyte. In study 2, Amylyte and the WHO ORS were given to 24 and 31 male children with acute diarrhea and moderate to severe dehydration, respectively. RESULTS: 92-96% of the rice amylose and amylopectin were converted to short polymers of glucose (3-9 molecules of glucose). The osmolality of 7,994 packages used to make the Amylyte solution ranged between 277-340 mOsm/kg. The mean electrolyte composition was Na+ = 68 mEq/L, K+ = 20 mEq/L, Cl = 73 mEq/L, the caloric density 425 kcal/L and rice proteins 0.7 g/L. In study 1, 12 children with diarrhea and mild dehydration were rehydrated successfully with Amylyte ORS and the diarrhea ceased within 48 hours. None developed clinical features of carbohydrate intolerance. In study 2, an open-label clinical case study, children with acute diarrhea given Amylyte ORS had significantly less stool output than children given the WHO ORS. CONCLUSIONS: Amylyte ORS has the advantages of a higher caloric density than the WHO ORS and shares a simple preparation of appropriate osmolality and electrolyte composition. It can safely and effectively rehydrate children with acute diarrhea and dehydration.
Asunto(s)
Diarrea Infantil/terapia , Diarrea/terapia , Glucanos/normas , Oryza , Soluciones para Rehidratación/normas , Enfermedad Aguda , Amilasas/metabolismo , Amilopectina/metabolismo , Preescolar , Cloruros/análisis , Deshidratación/epidemiología , Deshidratación/metabolismo , Deshidratación/terapia , Diarrea/epidemiología , Diarrea/metabolismo , Diarrea Infantil/epidemiología , Diarrea Infantil/metabolismo , Glucanos/uso terapéutico , Humanos , Indonesia/epidemiología , Lactante , Japón/epidemiología , Masculino , Concentración Osmolar , Potasio/análisis , Soluciones para Rehidratación/química , Soluciones para Rehidratación/uso terapéutico , Sodio/análisis , Tailandia/epidemiología , Estados Unidos/epidemiología , Organización Mundial de la SaludRESUMEN
OBJECTIVE: To compare the efficacy of an oral rehydration solution (ORS) containing short polymers of glucose derived from rice (Amylyte-ORS) and five times the caloric density of current ORS to the standard glucose-ORS (World Health Organization [WHO] = ORS) in the treatment of acute diarrhea in children. METHODS: The rice ORS (Amylyte-ORS) was obtained by adding thermophilic amylase (252,500 MW units) and salts (1.5 g NaCl, 600 mg KCl, and 150 mg CaCl2) to 100 g rice and boiling for 10 minutes in 500 mL water. This yields 250 mL Amylyte-ORS, which contains 92% to 96% short-chain glucose polymers, three to nine molecules in length, and provides 425 kcal/L, compared to 80 kcal/L for the WHO-ORS. One hundred forty-four male children, 4 months to 3 years of age, presenting with acute diarrhea and mild, moderate, or severe dehydration, were assigned by random allocation to receive either WHO-ORS or Amylyte-ORS. Data from 127 children were analyzed (57 received the WHO-ORS and 70 the Amylyte-ORS). Two children given Amylyte-ORS and 15 given the WHO-ORS were not included in the analysis because of improperly collected data or lost urine or fecal specimens. None were given antibiotics during the study. Free water and feeding were allowed after the children were rehydrated. RESULTS: The clinical characteristics of the children in the two treatment groups were comparable. Five children who received the WHO-ORS and three children given Amylyte-ORS were treatment failures. Amylyte-ORS reduced diarrhea duration by 15% (41.4 +/- 2.5 vs 34.7 +/- 1.8 hours; P < .03) compared to the WHO-ORS, regardless of the severity of dehydration. In the Amylyte-treated group, ORS requirements were significantly less (234 +/- 15.2 vs 295 +/- 17.6 mL/kg; P < .01) and weight gain was significantly more (367.7 +/- 45.1 vs 199.2 +/- 38.2 g; P < .01) than in those given the WHO-ORS. The net intestinal fluid balance and total body fluid balance were similar in the two groups. CONCLUSIONS: Amylyte-ORS effectively rehydrates children with acute diarrhea, reduces diarrhea duration, decreases ORS requirements, and improves weight gain compared to the WHO-ORS.
Asunto(s)
Deshidratación/terapia , Diarrea Infantil/terapia , Diarrea/terapia , Fluidoterapia , Glucosa , Oryza , Soluciones para Rehidratación/uso terapéutico , Enfermedad Aguda , Amilasas , Bicarbonatos/química , Bicarbonatos/uso terapéutico , Preescolar , Glucosa/química , Glucosa/uso terapéutico , Humanos , Lactante , Masculino , Cloruro de Potasio/química , Cloruro de Potasio/uso terapéutico , Soluciones para Rehidratación/química , Cloruro de Sodio/química , Cloruro de Sodio/uso terapéutico , Factores de Tiempo , Resultado del Tratamiento , Equilibrio Hidroelectrolítico , Aumento de PesoRESUMEN
In this study, we have compared the effects of the World Health Organization oral rehydration solution (WHO ORS) and an ORS containing short polymers of glucose (Amylyte ORS) at a high caloric density (five times) and comparable osmolality, on stool output, duration of diarrhea, weight gain and fluid and electrolyte balance, in randomized, open-labeled, controlled clinical trials in five centers. A total of 198 male children (4 months to 10 years) with acute diarrhea ( <72 h after onset) were assigned by random allocation to either WHO ORS or Amylyte ORS at five centers in Asia. Children were stratified according to grade of dehydration (mild, moderate or severe) and the initial purging rates during the first 6 h (low ( < 2 ml/kg/h), moderate (2-5 ml/kg/h) and high ( > 5 ml/kg/h) purgers). The clinical characteristics of the children in the two treatment groups were comparable. Amylyte ORS reduced stool volumes significantly in children with severe dehydration (285.4 +/- 74.2 versus 75.5 +/- 20.0 ml/kg; p < 0.05) and in children with a high initial purging rate (200.3 +/- 42.8 versus 130.5 +/- 9.1 ml/kg; p < 0.05). This was accompanied by a significant (276.4 +/- 14.6 versus 227.6 +/- 11.8 ml/kg; p < 0.01) reduction in ORS requirements in the Amylyte ORS treated group, the effect being greatest in children with severe dehydration (491.5 +/- 108.5 versus 155.7 +/- 27.3 ml/kg; p < 0.01) or high initial purging rates (394.2 +/- 66.2 versus 316.8 +/- 34.8 ml/kg; p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Deshidratación/terapia , Diarrea/complicaciones , Ingestión de Energía , Glucosa/uso terapéutico , Oryza , Soluciones para Rehidratación/uso terapéutico , Enfermedad Aguda , Amilasas/uso terapéutico , Niño , Preescolar , Factores de Confusión Epidemiológicos , Deshidratación/etiología , Humanos , Lactante , Masculino , Concentración Osmolar , Polímeros/uso terapéutico , Soluciones para Rehidratación/química , Índice de Severidad de la EnfermedadRESUMEN
The colonic mucosa may be especially vulnerable during starvation and malnutrition, as luminal nutrients make the greatest contribution to its energy production. To investigate possible metabolic changes in the colonic mucosa during nutrient restriction, we studied substrate utilization by colonocytes isolated from three groups of 6-wk-old rats: control, fasted (72 h), and chronically malnourished animals. Isolated colonocytes were incubated with nonlabeled and 14C-labeled substrates (glucose, glutamine, n-butyrate, or beta-hydroxybutyrate). Substrate oxidation and net increase of intermediary metabolites were reduced in fasted and malnourished animals. The effect of fasting on substrate oxidation was greater than that of chronic malnutrition for all substrates tested except n-butyrate. The total ketone body concentrations and beta-hydroxybutyrate to acetoacetate ratios were higher in the fasted and malnourished groups than in controls. The findings suggest that the colonic mucosa responds to nutrient deprivation by a general reduction of oxidative metabolism that is associated with an altered redox state.
Asunto(s)
Colon/metabolismo , Trastornos Nutricionales/metabolismo , Ácido 3-Hidroxibutírico , Acetoacetatos/metabolismo , Animales , Butiratos/metabolismo , Ácido Butírico , Metabolismo Energético , Ayuno , Femenino , Glucosa/metabolismo , Glutamina/metabolismo , Hidroxibutiratos/metabolismo , Mucosa Intestinal/metabolismo , Cuerpos Cetónicos/metabolismo , Oxidación-Reducción , Ratas , Ratas EndogámicasRESUMEN
Six-week-old rats subjected to prenatal and postnatal dietary restriction (maternal and weanling intake = 50% that of controls) were studied. Compared with controls, malnourished rats not only had reduced body (78 +/- 12 vs 187 +/- 21 g) and organ weights (small intestine: 4.51 +/- 0.46 vs 9.89 +/- 0.61 g; colon: 0.75 +/- 0.08 vs 1.77 +/- 0.18 g; liver: 2.75 +/- 0.34 vs 9.13 +/- 1.33 g; pancreas: 0.78 +/- 0.14 vs 1.67 +/- 0.49 g) but also decreased body weight-length ratios (6.5 +/- 0.3 vs 10.8 +/- 1.4 g/cm) and serum albumin levels. The small intestinal mucosa was hypotrophic (protein-DNA ratio: 5.02 +/- 1.43 vs 8.82 +/- 0.68, malnourished vs controls, respectively) with reduced mucosal thickness, villus height, and crypt depth. Specific activities of lactase, maltase, and sucrase were diminished (53%, 66%, 54% of control values, respectively). Colonic mucosa was hypoplastic with decreased mucosal thickness and crypt depth. Liver and pancreas were both hypotrophic and hypoplastic. The findings suggest that, in contrast to colonic mucosa, pancreas, and liver, the small intestinal mucosa maintained cell number during prolonged prenatal and postnatal malnutrition.
Asunto(s)
Animales Recién Nacidos/crecimiento & desarrollo , Sistema Digestivo/metabolismo , Trastornos Nutricionales/metabolismo , Efectos Tardíos de la Exposición Prenatal , Animales , Colon/metabolismo , Colon/patología , ADN/análisis , Sistema Digestivo/patología , Femenino , Mucosa Intestinal/enzimología , Intestino Delgado/metabolismo , Intestino Delgado/patología , Hígado/metabolismo , Hígado/patología , Trastornos Nutricionales/patología , Tamaño de los Órganos , Páncreas/metabolismo , Páncreas/patología , Embarazo , Proteínas/análisis , Ratas , Ratas Endogámicas , Sacarasa/metabolismo , alfa-Glucosidasas/metabolismo , beta-Galactosidasa/metabolismoRESUMEN
Parameters of nutritional and small intestinal status were studied in 3 groups of rats which had been subjected to malnutrition during different periods (pre- and postnatal, postweaning and adulthood). Malnutrition was induced by restriction of feeds (50% of controls). Compared with controls, malnourished rats from all 3 groups had reduced body weight and length, thoracic diameters, small intestinal weight, length and diameters, small intestinal mucosal weight, total mucosal DNA and protein/DNA ratios. However, there was no difference in DNA contents between malnourished rats and corresponding controls, indicating no changes in cell number (hypotrophic). Prenatally malnourished rats had reduced specific activities of lactase, sucrase and maltase. But in other malnourished groups, the activities of these enzymes were higher compared with corresponding controls. Prenatally malnourished rats had the lowest percentage of control values in all parameters measured compared with the other malnourished rats.
Asunto(s)
Intestino Delgado/crecimiento & desarrollo , Trastornos Nutricionales/fisiopatología , Enfermedades Placentarias/fisiopatología , Insuficiencia Placentaria/fisiopatología , Factores de Edad , Animales , ADN/análisis , Femenino , Mucosa Intestinal/análisis , Mucosa Intestinal/enzimología , Mucosa Intestinal/ultraestructura , Masculino , Microvellosidades/enzimología , Embarazo , Proteínas/análisis , Ratas , Ratas Endogámicas , Sacarasa/metabolismo , alfa-Glucosidasas/metabolismo , beta-Galactosidasa/metabolismoRESUMEN
Vasoactive intestinal peptide (VIP) or 12-O-tetradecanoylphorbol-13-acetate (TPA) individually stimulated amylase release in dispersed rat pancreatic acini. Pretreatment of acini with TPA (10(-6) M) for 5 min at 37 degrees C potentiated their subsequent response to stimulation by VIP at a dose range of 10(-8)-10(-6) M in that the treated pancreatic acini released more amylase than could be accounted for by the additive effects of VIP or TPA acting individually. This potentiation effect of TPA was still evident when isobutyl methylxanthine was given together with VIP. Further, the maximal' dose-response curve to VIP shifted 2 log units to the left (3 x 10(-9) versus 3 x 10(-7) M). The TPA preincubation was found also to potentiate VIP-stimulated net increases in intracellular cyclic AMP (cAMP) levels. A close correlation existed between the net releases of amylase and the net increases in intracellular cAMP levels (r = 0.97). This suggested that TPA potentiated the response of rat pancreatic acini to VIP by modulating the cAMP system. The TPA as a potent activator of protein kinase C may act as a modulator of the adenylate cylase-cAMP system in rat pancreatic acini.