Clinical and laboratory parameters in dapsone acute intoxication.

OBJECTIVE: To determine the severity of dapsone (DDS) acute intoxication - an uncommon medical event - using clinical and laboratory parameters. METHODS: Two hundred and seventy four patients with acute DDS intoxication, aged 1 month to 50 years old, were studied and classified into four age groups. Clinical evaluation was assessed through a protocol and correlated with laboratory parameters. Spectrophotometric methods were used to analyze methemoglobinemia (MHbp) and dapsonemia (DDSp). RESULTS: The most prevalent clinical sign of intoxication was cyanosis, seen in 65.7% of the patients and in 100% of children less than 5 years of age. According to laboratory criteria, MHbp-related severe clinical intoxication was seen in 56.2% and DDSp-related occurred in 58% of the patients. Regarding DDSp, intoxication was considered severe when 20 tablets (100 mg each) were ingested, a median of 29 microg/ml. Regarding MHbp, intoxication was severe when 7.5 tablets were ingested, a median of 38% of the total Hb. The correlation between MHbp and DDSp was statistically significant (n=144, r=0.32, p<0.05). Negative correlation was observed between MHbp and the time elapsed since DDS intake (n=124, r=-0.34, p<0.001). There was also a negative correlation between DDSp and the time elapsed since DDS intake (n=63, r=-0.35, p<0.0001). CONCLUSIONS: Longitudinal analysis showed a significant association between methemoglobinemia and the time elapsed after the intake (t), according to the equation: Dapsonemia = 12.9256 - 0.0682t + 0.234 methemoglobinemia

The effects of glutamine-supplemented diet on the intestinal mucosa of the malnourished growing rat.

UNLABELLED: Glutamine is the most abundant amino acid in the blood and plays a key role in the response of the small intestine to systemic injuries. Mucosal atrophy is an important phenomenon that occurs in some types of clinical injury, such as states of severe undernutrition. Glutamine has been shown to exert powerful trophic effects on the gastrointestinal mucosa after small bowel resection or transplant, radiation injury, surgical trauma, ischemic injury and administration of cytotoxic drugs. Since no study has been performed on the malnourished animal, we examined whether glutamine exerts a trophic effect on the intestinal mucosa of the malnourished growing rat. Thirty-five growing female rats (aged 21 days) were divided into 4 groups: control - chow diet; malnutrition diet; malnutrition+chow diet; and malnutrition+glutamine-enriched chow diet (2%). For the first 15 days of the experiment, animals in the test groups received a malnutrition diet, which was a lactose-enriched diet designed to induce diarrhea and malnutrition. For the next 15 days, these animals received either the lactose-enriched diet, a regular chow diet or a glutamine-enriched chow diet. After 30 days, the animals were weighed, sacrificed, and a section of the jejunum was taken and prepared for histological examination. All the animals had similar weights on day 1 of experiment, and feeding with the lactose-enriched diet promoted a significant decrease in body weight in comparison to the control group. Feeding with both experimental chow-based diets promoted significant body weight gains, although the glutamine-enriched diet was more effective. RESULTS: The morphological and morphometric analyses demonstrated that small intestinal villous height was significantly decreased in the malnourished group, and this change was partially corrected by the two types of chow-based diet. Crypt depth was significantly increased by malnutrition, and this parameter was partially corrected by the two types of chow-based diet. The glutamine-enriched diet resulted in the greatest reduction of crypt depth, and this reduction was also statistically significant when compared with control animals. CONCLUSIONS: Enteral glutamine has some positive effects on body weight gain and trophism of the jejunal mucosa in the malnourished growing rat.

Nutritional follow-up of critically ill infants receiving short term parenteral nutrition.

Few studies have tried to characterize the efficacy of parenteral support of critically ill infants during short period of intensive care. We studied seventeen infants during five days of total parenteral hyperalimentation. Subsequently, according to the clinical conditions, the patients received nutritional support by parenteral, enteral route or both up to the 10th day. Evaluations were performed on the 1st, 5th, and 10th days. These included: clinical data (food intake and anthropometric measurements), haematological data (lymphocyte count), biochemical tests (albumin, transferrin, fibronectin, prealbumin, retinol-binding protein) and hormone assays (cortisol, insulin, glucagon). Anthropometric measurements revealed no significant difference between the first and second evaluations. Serum albumin and transferrin did not change significantly, but mean values of fibronectin (8.9 to 16 mg/dL), prealbumin (7.7 to 18 mg/dL), and retinol-binding protein (2.4 to 3. 7 mg/dL) increased significantly (p < 0.05) from the 1st to the 10th day. The hormonal study showed no difference for insulin, glucagon, and cortisol when the three evaluations were compared. The mean value of the glucose/insulin ratio was of 25.7 in the 1st day and 15. 5 in the 5th day, revealing a transitory supression of this hormone. Cortisol showed values above normal in the beginning of the study. We conclude that the anthropometric parameters were not useful due to the short time of the study; serum proteins, fibronectin, prealbumin, and retinol-binding protein were very sensitive indicators of nutritional status, and an elevated glucose/insulin ratio, associated with a slight tendency for increased cortisol levels suggest hypercatabolic state. The critically ill patient can benefit from an early metabolic support.

Contribution of villous atrophy to reduced intestinal maltase in infants with malnutrition.

BACKGROUND: It has been known for many years that small intestinal maltase activities are reduced in malnourished infants and in other patients with villous atrophy. The recent availability of human maltase-glucoamylase cDNA provides the opportunity to test the hypothesis that villous atrophy accounts for the reduced maltase enzyme activity in malnourished infants. METHODS: Mucosal biopsy specimens obtained for clinical evaluation of malnourished infants with poor responses to refeeding were examined by quantitative methods for enzyme activity and mRNA levels. RESULTS: Maltase activity and maltase-glucoamylase mRNA were reduced (approximately 45% of normal). When maltase-glucoamylase message was normalized to villin message, a structural protein expressed only in enterocytes, a preservation of maltase messages in surviving enterocytes was documented. The luminal glucose transporter-villin message was also preserved. CONCLUSIONS: The loss of maltase-glucoamylase message paralleled the reduction in villin message and degree of villous atrophy. The reduced maltase-glucoamylase message also paralleled sucrase-isomaltase message, previously found to be decreased in proportion to villous atrophy of malnourished infants. The data directly demonstrate, for the first time, that the terminal steps of starch 1-4 starch digestion and sucrase-isomaltase 1-6 starch digestion are decreased in malnourished infants, secondary to villous atrophy. These data in prior and present reports suggest that mechanisms underlying the chronic villous atrophy of malnutrition should be a priority for investigations in malnourished infants with slower than expected weight gain during refeeding.

[Magnesium metabolism in chronic primary hypomagnesemia] / Metabolismo do magnésio na hipomagnesemia primária crônica.

OBJECTIVES: To report three cases of primary hypomagnesemia (PH) with secondary hypocalcemia in symptomatic infants, born to consanguineous parents, and to present Mg metabolic studies.METHODS: Classic metabolic balances of Mg were performed during three consecutive days, using carmin as fecal marker, with and without Mg supplementation.RESULTS: The patients (one male) presented, between 15 and 28 days old, with convulsions and persistent hypocalcemias, which could not be controlled with anticonvulsivants and/or intravenous calcium gluconate. After diagnostic was established the above symptoms and hypomagnesemia were controlled with Mg supplementation. Without supplements, mean daily balances were negative or below daily needs, showing final magnesemias lesser than 0.7 mEq/L and hypocalcemias about 3 mEq/L. The renal conservation test performed for six days after Mg repletion showed at the beginning of the study normal magnesemias (1.4 to 1.5 mEq/L) decreasing to 0.7 or 0.8 mEq/L in the first 24 hours, indicating absence of response from the body stores. Mg total renal excretion was smaller than 1 mEq, during six consecutive days, indicating adequate renal Mg reabsorption. Intestinal absorption of Mg varied from 6 to 15% of intake. With Mg supplementation, daily balances were positive, correcting progressively the serum Ca and Mg. The intestinal absorption was greater than 22% of intake in this situation.In pacient LPCJ, urinary excretion was 35% of the administered dosis, confirming Mg depletion.CONCLUSIONS: Besides confirming specific intestinal malabsorption of Mg, adequate renal conservation and an homeostatic extracellular defect of Mg were observed, probably caused by an incapacity of mobilization of Mg from tissue reserves.

[Basis of nutritional support in pediatrics] / Princípios do suporte nutricional em pediatria.

OBJECTIVE: To present an update and systematic review of the basis of nutritional support in pediatrics, emphasizing the importance of nutrition in critically ill patient. METHODS: Relevant studies were selected from databases (Medline, Scielo, Lilacs, etc.). Textbooks and theses were analyzed, and the authors personal experience was also considered. RESULTS: Nutritional therapy is part of the treatment. In order to reach the objective, it is important to determine specific nutritional requirements of water, calories, proteins, macro and micronutrients. So, nutritional evaluation should consist of clinical, anthropometric, and laboratory assessment, so that the best nutritional therapy (parenteral and/or enteral) is chosen. Patient monitoring is also indicated in order to prevent complications. CONCLUSION: Nutritional therapy is essential for the treatment. When well indicated and well monitored, it helps in the patient s recovery, and in the decrease of morbidity and mortality.

Effects of malnutrition on expression and activity of lactase in children.

BACKGROUND & AIMS: Many malnourished infants have reduced lactase specific activity in the small intestine. The aim of this study was to test the hypothesis that the hypolactasia of malnourished infants results from transcriptional suppression of lactase expression. METHODS: Biopsy specimens were studied from two groups of infants: 29 with malnutrition and 10 normally nourished controls with normal morphology and lactase activity. RESULTS: In malnourished infants, lactase messenger RNA (mRNA) was reduced to 32% and sucrase to 61% of normal. Lactase and sucrase enzyme proteins and activities were lower in malnourished infants, and partial villus atrophy was present. The genotype of adult hypolactasia was not present. CONCLUSIONS: Because the hypolactasia of malnourished children was associated with much lower lactase than sucrase mRNA abundance and because the epigenetic suppression, which accounted for the reduction of sucrase mRNA, was inadequate to explain the greater reduction of lactase mRNA, this study concludes that malnutrition suppresses lactase gene transcription or mRNA stability in infants. The reductions of lactase mRNA, distinct from those found in adults with genetic hypolactasia, explain the low lactase activities commonly found in malnourished infants.

Evaluation of a rapid screening assay for bacterial identification (Dot-ELISA) in fecal samples from children.

With the objective of standardizing a Dot Enzyme-Linked Immunosorbent Assay (Dot-ELISA) to detect antigens of fecal bacterial enteropathogens, 250 children, aged under 36 months and of both sexes, were studied; of which 162 had acute gastroenteritis. The efficacy of a rapid screening assay for bacterial enteropathogens (enteropathogenic Escherichia coli "EPEC", enteroinvasive Escherichia coli "EIEC", Salmonella spp. and Shigella spp.) was evaluated. The fecal samples were also submitted to a traditional method of stool culture for comparison. The concordance index between the two techniques, calculated using the Kappa (k) index for the above mentioned bacterial strains was 0.8859, 0.9055, 0.7932 and 0.7829 respectively. These values express an almost perfect degree of concordance for the first two and substantial concordance for the latter two, thus enabling this technique to be applied in the early diagnosis of diarrhea in infants. With a view to increasing the sensitivity and specificity of this immunological test, a study was made of the antigenic preparations obtained from two types of treatment: 1) deproteinization by heating; 2) precipitation and concentration of the lipopolysaccharide antigen (LPS) using an ethanol-acetone solution, which was then heated in the presence of sodium EDTA.

[Nutritional evaluation of children with cholestatic diseases]. / Caracterização nutricional de crianças com colestase crônica.

OBJECTIVE: To characterize the type of malnutrition and to determine the usefulness of anthropometric indices in children with chronic liver disease (CLD). METHODS: 11 children (aged 5 - 105 mo) with CLD underwent anthropometric evaluation when they were clinically stable. The nutritional evaluation was made by the determination of Weight/Age (W/A), Height/Age (H/A) and Weight/Height (W/E) Z scores. The nutritional evaluation by Waterlow's method was also made. The fat and protein body deposits were estimated by triceps skinfold and midarm muscular circumference measurements. The analysis of the 24-hour recall was used to evaluate the quality and pattern of the feeding. RESULTS: The mean weight / age (W/A = -1.18) and height / age (H/A = - 1.26) Z scores were depressed under 1 SD, whereas mean weight / height (W/H) Z score was normal. The interpretation of the nutritional evaluation by Waterlow's method shows normal mean of the weight and almost normal mean of the height. Only three patients had normal triceps skinfold thickness (TSF) Z score, and the same occurred with five of them with the midarm muscular circumference. The quality and pattern of the feeding was adequate in only 4 patients. CONCLUSIONS: We conclude that chronic malnutrition is common in childhood CLD and that weight/height values underestimate the degree of acute malnutrition compared with TSF thickness, most likely because of the inflated patient weight caused by organomegaly. The reduction of the triceps skinfold thickness best reflected the nutritional impairment of the patients. The quality of feeding of the patients was mostly inadequate.

In vivo study of colonic fermentation of carbohydrate in infants.

Dietary carbohydrate in the colon is fermented and converted into short-chain fatty acids. We studied the fate of carbohydrate that arrives in the colon under circumstances similar to those that occur during an episode of diarrhea and determined whether a quantitative correlation exists among certain indicators of colonic fermentation of carbohydrate arriving in the large bowel. A stable-isotope method was used to estimate carbon scavenging by the colon. Fourteen infants with severe malnutrition and history of watery stools and/or increased numbers of stools in the preceding 20 days were studied. Infants underwent nasocecal intubation and a 60-min infusion of 0.5 g/kg glucose containing 5 mg/kg of 13C-glucose. Stools were assessed for carbohydrate-fermenting bacteria, acetate, glucose, and 13C abundance; blood was assessed for acetate; and breath was assessed for hydrogen. Some of the infants eliminated the infusate per anus within 30 min of the infusion (group I; n = 5), while others did so 120 min or more after the infusion (Group II; n = 9). The volume of fecal output after the intracecal infusion differed significantly between group I and group II (57 +/- 13 vs. 24 +/- 4 ml; p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Mosaic expression of brush-border enzymes in infants with chronic diarrhea and malnutrition.

The chronic diarrhea observed in young malnourished infants that is sensitive to dietary glucose and other carbohydrates is associated with variable degrees of patchy mucosal villous atrophy. To explore intrinsic mucosal function in the pathogenesis of this alimentary intolerance, we have conducted an immunohistologic investigation of brush-border enzyme proteins of clinically obtained, mucosal biopsy samples. We used a group of monoclonal antibodies against human brush-border aminopeptidase, sucrase/isomaltase (SI), maltase, and lactase enzyme proteins. SI was strongly and uniformly expressed in crypts and villi of 11 of the 14 subjects; in 3 subjects, however, SI was expressed in a mosaic pattern. Maltase and lactase were occasionally absent, but more commonly were expressed in a mosaic distribution. The mosaic expression of brush-border enzyme proteins has been reported in congenital enzyme deficiencies associated with normal intestinal histology. We report the mosaic expression of brush-border enzyme proteins as a functional alteration associated with a pathological lesion of the mucosa in infants with chronic diarrhea. Our observation challenges the existing concept of ontogenic regulation of brush-border enzyme activity.

Balanço de energia durante a hospitalizaçäo de lactentes desnutridos com diarréia / Energy balance in the malnourished infants with diarrhea during the hospitalization

Lactentes desnutridos com diarréia apresentam balanço energético negativo nos primeiros dias de internaçäo. A estimativa da energia ingerida, da energia fecal e do gasto energético de repouso tornam-se extremamente úteis no planejamento do fornecimento calórico diário para essas crianças. Estudaram-se 13 lactentes(10 do sexo masculino) com idades inferiores a 12 meses, desnutridos com diarréia, em 3 ocasiöes durante a internaçäo: no período inicial (PI), na recuperaçäo (PR) e no período de alta (PA). As ingestöes e perdas, diárias de energia foram calculadas a partir dos conteúdos energéticos de leite, urina e fezes que foram determinadas por bomba calorimétrica. O gasto energético de repouso (GER) foi medido por calorimetria indireta. No PI a ingestäo diária correspondeu à metade do PA (59,7 ñ 12,2 vs. 132,9 ñ 27,9 Kcal/Kg, -p (menor que) 0,05). O GER aumentou no PR significativamente (71,1 ñ 11.4 vs. 58,3 ñ 10,9 Kcal/kg, p (menor que) 0.05). Os balanços médicos de energia foram significativamente diferentes nos 3 períodos: PI= -21 ñ 20; pr= 29 ñ 22; PA 29ñ 22; PA= 52 ñ 21 Kcal/Kg/dia, p (menor que) 0,01. Em conclusäo pode-se afirmar que o balanço negativo de energia no PI foi consequente a menor ingestäo e a maior perda fecal (proporcionalmente ao ingerido) de energia. Os balanços efetuados durante a recuperaçäo hospitalar desses pacientes foram úteis como fonte de informaçöes para um adequado tratamento nutricional

Gasto energetico evolutivo durante a recuperacao nutricional de lactentes desnutridos graves com infeccoes associadas / Evolutional energetics expenditures during the nutrition rehabilitation of severe undernourished infants with associated infections

Determinaram-se o gasto de energia em repouso (GER) e o quociente respiratorio (QR) de 8 lactentes desnutridos e infectados, apos a admissao hospitalar (Adm) e durante a recuperacao (Rec), que durou em media 37 dias. As idades variam de 3 a 12 meses e apresentavam um deficit medio de peso para a idade superior a 35%. Utilizou-se a tecnica de calorimetria indireta, empregando-se um calorimetro de circuito fechado. As determinacoes de VO2 e VCO2 foram efetuadas por cromatografia gasosa. A atividade fisica foi avaliada pelo score de Scopes e Ahmed. Os dados pareados mostraram que o GER, calculado pelo peso real foi semelhante entre a Adm = 70,4+/-17,4kcal/kg/dia e Rec = 79,4+/-14,7 kcal/kg/dia. Quando o GER foi calculado pelo peso/altura houve diferenca significativa entre Adm = 44,5+/-7,3 kcal/kg/dia e Rec = 55,3+/-9,5 (p<0,05).O aumento da atividade fisica na Adm como na Rec proporcionou aumento semelhante (20%) e significativo (p<0,05) do GE (tanto por peso real como por peso/altura). O QR sa Adm=0,76+/-0,09 foi significativamente menor do que na Rec = 0,83+/-0,16 p<0,05).Os AA especulam que a admissao, o GER diminuido (calculado pelo peso/altura) traduz a menor massa celular ativa dos lactentes desnutridos infectados. Conclui-se que o QR e um bom parametro para avaliar a normalizacao da atividade metabolica desses desnutridos em recuperacao nutricional .

Effect of formula carbohydrate concentration on tolerance and macronutrient absorption in infants with severe, chronic diarrhea.

To determine how the carbohydrate (CHO) content of "semielemental" formulas affects tolerance and macronutrient absorption, we enrolled 12 infants with severe diarrhea in two successive metabolic balance studies. The infants received, in random order, one of two isocaloric formulas that differed mainly in their CHO and fat concentrations. No significant differences were found between the two feeding periods for peak breath hydrogen levels and fecal osmolality. The low-CHO formula was tolerated better than the high-CHO formula, as indicated by a significantly lower stool output (mean +/- SD 387 +/- 230 vs 764 +/- 443 gm, respectively; p less than 0.05), and higher fecal pH (5.9 +/- 0.7 vs 4.9 +/- 0.5; p less than 0.05). Macronutrient absorption was greater during the ingestion of the low-CHO formula, as indicated by a significantly higher coefficient of fat absorption (p less than 0.005) and lower total fecal energy (mean +/- SD for high- vs low-CHO formula, 372 +/- 205 vs 207 +/- 102 kcal; p less than 0.05), which resulted from a lower CHO excretion (p less than 0.05). A correlation coefficient between the energy derived from CHO in feces and the total stool output was significant for both the high-CHO formula (r = 0.83; p less than 0.001) and the low-CHO formula (r = 0.7; p = 0.01). The CHO concentration of the special infant formula that we tested had an overriding effect on stool output and on fat and energy absorption.

Dietary origin of retained H+ in infants with acquired monosaccharide intolerance.

Net external acid balance was studied in 12 malnourished infants with chronic diarrhea (some of whom had acquired monosaccharide intolerance). When the infants achieved an adequate energy intake from a formula that contained either glucose or glucose polymers, seven developed metabolic acidosis and five remained free of acidosis. During the study, the acidotic infants produced a significant excess of acid (3.7 +/- 2 vs. 0.5 +/- 2 mEq/kg/day, p less than 0.005). The amount they excreted in urine (2.9 +/- 2 mEq/kg/day), however, was similar to that excreted by nonacidotic infants (2.7 +/- 2 mEq/kg/day) and indicated renal inability to reduce the excess acid load. The net effect was hydrogen ion (H+) retention (+0.8 +/- 0.8 vs. -2.2 +/- 0.8 mEq/kg/day, p less than 0.001). Good correlation existed between the net acid balance and the acid-base measurement in the blood. We speculate that (a) the increased acid load was a consequence of colonic bacterial production of volatile fatty acids from carbohydrate malabsorbed from the small bowel and (b) the renal incapacity to excrete H+ probably was secondary to potassium and phosphate depletion.

A carbon-13 breath test to characterize glucose absorption and utilization in children.

After the administration of a 5% glucose-water solution that contained tracer amounts of the stable nonradioactive isotope 13C, breath samples were collected from five children with congenital glucose-galactose malabsorption and five with severe small bowel villous atrophy and chronic diarrhea. The 13CO2 breath test curves of the children with the congenital malabsorption and chronic diarrhea were compared with each other and with those from three healthy children and four infants with severe malnutrition but no diarrhea. The breath test curves from the children with glucose-galactose malabsorption and from those with diarrhea were significantly different from those of the other two groups, a finding consistent with impairment of glucose absorption. The [13C]glucose breath test clearly identified the children with severe glucose malabsorption. Further studies are required to determine whether less severe cases of carbohydrate malabsorption also can be identified using the parameters described in our study.

[Minerals in Latin American diets]. / Minerais em dietas Latino-Americanas.

Body minerals (macro and microminerals) are distributed in extra- and intracellular compartments as inorganic salts or organic compounds. A characteristics of mineral compounds is that when they are metabolized, the corresponding ions are liberated and reutilized by the organism, thus reducing dietary needs. This chapter includes a brief discussion of the functions, dietary sources and clinical consequences of deficiencies (or excess) of calcium, phosphorus, sodium, potassium, zinc, selenium and iodine. Based on metabolic balance studies, body composition, and dietary population surveys, their daily needs are analyzed and dietary recommendations are suggested based on regional diets. Factors that must be taken into account are emphasized, such as bioavailability, intestinal absorption and interrelations with other nutrients that interfere with absorption. Many Latin American populations have a high content of dietary fiber due to the intake of vegetables, fruits, cereals and grains. Dietary fiber may have a negative influence on the intestinal absorption of minerals. However, this effect is not clearly defined. Some population groups who eat diets with a high concentration of fiber do not show clinical signs of mineral deficits. In relation to fluorine, its supplementation is discussed, placing emphasis on its beneficial effects for the prevention of dental caries. Diet fortification with the addition of iodine, iron and fluorine are discussed elsewhere.

[Oral rehydration in pediatrics]. / Reidratação oral em pediatria.

A review of recent developments in the field of oral rehydration in pediatrics, is presented. To verify the viability of commercially available solution for oral rehydration, 4 available preparations were analysed. Small differences in electrolyte composition were observed but the preparations differed in osmolal content. These differences are explained by the different amounts of carbohydrate added to the electrolyte mixture. Due to their high osmolal content, some of the preparations are unsuitable for oral rehydration.

Treatment of diarrheal dehydration.

A regimen for the treatment of diarrheal dehydration is presented. It was devised for use in conditions found in developing countries. Application to large number of patients has been successful. One of its characteristics is the infusion at the start of treatment of a larger amount of fluid than generally recommended. The advantages of magnesium supplementation and phosphate supplementation have been studied. Fecal electrolyte composition has been studied during recovery from diarrheal dehydration. Components of acid balance and generation have been measured with the "net acid" balance technique.

PIP: A regimen for treating diarrheal dehydration is presented which was devised specifically for use in developing countries. Also reported is the author's experience when using this regimen for rehydration on a large population of people with diarrheal diseases. The fluid therapy recommended has 3 phases: reparation, maintenance, and replacement. The fluid therapy is designed to reduce the volume of the extracellular fluid compartment by reestablishing normal tissue perfusion and normal renal regulatory function. The main difference between this regimen and previously published procedures is an emphasis on correction of sodium and chloride deficit within the first 2-3 hours of therapy. To this end, the authors recommend infusion at the start of treatment of a larger amount of fluid than heretofore recommended. Also discussed are the advantages of magnesium supplementation and phosphate supplementation is some cases. Also studied was fecal electrolye composition during recovery from diarrheal dehydration as a gauge for measuring rehydration effectiveness. The net balance technique was used to measure components of acid balance and generation. Tables and graphs present data on urine and fecal component losses during diarrheal dehydration and rehydration.