S. Bhatnagar et al., PROGNOSTIC FACTORS IN HOSPITALIZED CHILDREN WITH PERSISTENT DIARRHEA - IMPLICATIONS FOR DIET THERAPY, Journal of pediatric gastroenterology and nutrition, 23(2), 1996, pp. 151-158
A dietary algorithm for management of persistent diarrhea in developin
g countries, using locally available foods, is yet to be standardized.
We identified factors related to poor outcome among 75 malnourished h
ospitalized male patients aged 348 months with persistent diarrhea (gr
eater than or equal to 14 days) treated on soy and cereal-based diet (
Diet 1). The 28 patients with stool output >60 g/k body weight on the
sixth or the seventh treatment day were considered diarrhea treatment
failures on Diet I. In the univariate analysis, breast feeding (p < 0.
001), carbohydrate malabsorption based on low stool pH or reducing sub
stances >0.5% (p = 0.03), initial 24-h purge rate (p = 0.001), pneumon
ia (p = 0.003), or probable septicemia (p = 0.03) were associated with
diarrhea treatment failures. Although 16 of these 28 patients respond
ed to systemic antibiotics without dietary modification, all but one o
f the remaining recovered on a chicken puree, glucose, and oil formula
tion. Twenty-six children had weight loss after 7 days on Diet I as co
mpared with the postrehydration weight. These children had lower mean
age (p = 0.05), lower food intake in the first 24 h (p = 0.05) and dur
ing the initial 7 days (p < 0.01), and a higher initial excretion of e
nteroaggregative Escher?chia coil (32 vs. 8%; p = 0.01). In the logist
ic regression model, significant risk factors for diarrhea treatment f
ailures were initial purge rates, carbohydrate malabsorption, and inte
rcurrent systemic infection; only low food intake was associated with
significant risk for weight loss. The significant association of diarr
hea treatment failures with carbohydrate malabsorption suggests that i
n the initial diet itself, part of polysaccharide be substituted with
sucrose or glucose to obtain the right balance between osmolarity and
energy density. Our data suggest that prompt identification and treatm
ent of systemic infection is critical, as its eradication achieved rec
overy in more than half of the treatment failures without a dietary ch
ange.