Successful therapy for congenital sodium diarrhea by enteral management: A case report.

BACKGROUND: Congenital sodium diarrhea (CSD) is a rare disorder causing electrolyte imbalances due to excessive diarrhea. In pediatric literature, common practice for treating CSD includes parenteral nutrition (PN) for fluid, nutrient, and electrolyte support through the first year of the patient's life. The aim of this study was to report a neonate who showed common symptoms of CSD, including a distended abdomen, large amounts of clear, yellow fluid draining from the rectum, dehydration, and electrolyte abnormalities. CASE SUMMARY: A diagnostic gene panel was completed and confirmed heterozygous variant GUCY2C gene associated with autosomal dominant CSD. The infant was initially treated with PN to maintain fluid, nutrient, and electrolyte status, but was subsequently transitioned to full enteral feeds, showing improvement in symptoms. Frequent therapy adjustments were required to maintain appropriate electrolyte levels during the duration of the hospital stay. At discharge, the infant followed an enteral fluid maintenance plan that provided symptomatic control through the first year of life. CONCLUSION: This case demonstrated the ability to maintain electrolyte levels in a patient through enteral means while avoiding long-term use of intravenous access.

Multidisciplinary views toward pharmacist-delivered medication therapy management services in dialysis facilities.

OBJECTIVE: To determine views of staff of dialysis centers toward pharmacist-delivered medication therapy management (MTM) services. DESIGN: Focus group study. SETTING: Three private, nonprofit, outpatient dialysis facilities. PARTICIPANTS: Multidisciplinary dialysis staff. INTERVENTION: Two focus group sessions were conducted using a semistructured interview guide. MAIN OUTCOME MEASURES: Views of staff toward MTM services at a dialysis center. RESULTS: A total of 13 staff members of dialysis centers participated in the study. Participants included nurses, patient care technicians, a social worker, dietitian, and administrative personnel. Key themes included: the need for access to MTM services in dialysis facilities exists; services should include medication reconciliation and patient education; services should be proactive, consistent, individualized, and covered by insurance; and that pharmacists are uniquely suited to provide MTM services. CONCLUSION: Dialysis staff support the integration of MTM services in facilities. Further research is needed to identify barriers and opportunities in the implementation process, including patient perspectives.