INTRACTABLE DIARRHEA OF INFANCY AND ITS MANAGEMENT - MODIFIED COST-EFFECTIVE TREATMENT

One-hundred-twenty infants under 1 year of age suffering from intracta ble diarrhoea were studied. They had received prior treatment in the f orm of antimicrobials (100 per cent), stool binding substance (50 per cent), antimotility agents (50 per tent), and intravenous (IV) fluids (33 per cent). One-third of them had been hospitalised in peripheral h ospitals. All of them had diarrhoea of more than 2 weeks' duration, pr otein energy malnutrition and were very ill. In addition vomiting, deh ydration, fever, paralytic ileus, perianal excoriation and rectal prol apse were present in 44, 23, 33, 9, 47, and 3 per cent of the infants, respectively. Anaemia, multiple vitamin deficiencies, and pedal oedem a were seen in 70, 10, and 3 per cent of infants, respectively. The in fections documented were septicaemia (22 per cent), bronchopneumonia ( 6 per cent), meningitis (4 per cent), urinary tract infection (3 per c ent) and acute supporative otitis media in 2 per cent of infants. Fift y-three per cent of infants had secondary lactose intolerance. Intoler ance to milk protein, milk protein and soyabean and milk protein, as w ell as soyabean and chicken was seen in 4, 2, and 1 per cent cases, re spectively. Aetiological agents isolated from stool culture were E. co li, (18 per cent), Klebsiella species (9 per cent), Shigella species ( 6 per cent), Salmonella typhimurium (2 per cent), Cholera mitschikom ( 1 per cent), Giardia lamblia (6 per cent), cryptosporidium (1 per cent ), and E. histolytica (1 per cent). Candida albicans was grown in 18 p er cent of infants. Pseudomembranous colitis was documented in 2 per c ent cases. All the infants were managed with locally made rice gruel. Very sick and dehydrated patients received IV fluids. Thirteen infants (11 per cent) received modified parenteral nutrition through IV cannu la in the peripheral vein. After initial stabilization cereal diets we re instituted. The septicaemia was responsible for 5 per cent mortalit y. The remainder improved and showed weight gain. The enteral and modi fied parenteral nutrition are very effective in the management of intr actable diarrhoea in developing countries.