Research Paper Example on the Management of Acute Viral Gastroenteritis

In the 20th century (during the 1970s), the management of acute gastroenteritis involved the use of oral rehydration therapy (ORT). Today, the management of this condition has become multifaceted, and it is dynamic. There are new treatment and management strategies that are being proposed, some of which are regarded as being controversial. One of the new approaches that are being proposed in the management of gastroenteritis is rapid rehydration through the use of intravenous fluids (Alam, Raqib and Ashraf, 2011). Other approaches are becoming increasingly popular as alternative therapeutic approaches for this condition such as the use of anti-emetic drugs and antidiarrheal drugs; even though there are still many uncertainties regarding the efficacy and safety of these agents.

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It has long been established that there is variation regarding clinical practice in the management and treatment of gastroenteritis. For instance, different hospitals use different guidelines and therefore there will be some disparity in the advice that different parents will be given in regards to the types of oral fluids that their children should be given (Alam, Raqib and Ashraf, 2011). Also, there is some clinical variance regarding the use of oral versus intravenous fluids for rehydration purposes. In some hospital settings, they advocate for the use of nasogastric tubes for rehydration purposes, while in others they avoid this practice. In this paper, it focuses on different treatment methods that are used in the management of children with rotavirus gastroenteritis in different parts of the world.

The onset symptoms of Acute Viral Gastroenteritis, if not effectively managed, will lead to dehydration, which is considered to be a potentially life-threatening condition. Therefore, it is prudent to use the most effective rehydration therapy for the treatment of the dehydration that is as a result of acute viral gastroenteritis. In a study that was conducted in Bangladesh that involved 285 cases and 728 controls, to assess the effectiveness of oral fluids for rehydration purposes and treatment of gastroenteritis (Black, Cousens and Johnson, 2010). The study measured the effectiveness of continued breastfeeding and the use of ORS solution as management strategies to prevent dehydration.

The results of the survey indicated that the risk of dehydration was five times higher for infants whose mother stopped breastfeeding them at the onset of diarrhea, in comparison to the mothers who continued breastfeeding their children (Black, Cousens and Johnson, 2010). In the study, it was also revealed that children who did not receive any dose of the ORT solution at home were 1.5 times more likely to become dehydrated as compared to children who had received huge doses (>250ml) of ORT while they were at home. In addition to that; children who received small amounts of ORT solution (<250ml) before they were admitted to the hospital, had an 18% higher chance of being dehydrated as compared to children who had received more than 250ml of ORT (Brandt, de Castro Antunes and da Silva, 2015).

Therefore, based on the results of this study it was found out that; it is important to continue the breastfeeding process to reduce the risk of the child becoming dehydrated. The study also indicated that one of the most effective methods of ensuring that the child does not become dehydrated is by providing him or her with huge quantities of oral fluid supplementation at home once the parent notes incidences of constant vomiting and diarrhea (Costa and Silva, 2011). As has been indicated by the evidence that has been provided, as a researcher on this issue, one can assume that fluid supplementation is an effective method regarding preventing dehydration.

Various studies were conducted in different regions (six trials in the USA, and one each in Canada, Australia, and Finland) to compare the efficacy and safety of both the ORT and IVT therapies in the treatment of dehydration. The study used a sample size of 1811 people and assessed different things such as; the risk of rehydration failure, duration of stay at the hospital, risk of developing complications, and other assessments such as the mean duration of diarrhea, weight gain and even the total fluid intake of the children who had been treated with ORT as compared to those treated with IVT (Costa and Silva, 2011).

The primary focus of the study was to assess which method was more effective regarding rehydrating the patients. Evidence from the study indicated that children who had been treated using the ORT method had a 4% higher risk of failing to rehydrate using any definition of rehydration as compared to those who had used the IVT treatment method (Costa and Silva, 2011). However, when a homogenous definition of rehydration was used, only 2% of the children who used ORT had a high risk of failing to rehydrate. An important observation that was made was the difference in the length of stay for the children who used different methods of treatment for rehydration (Costa and Silva, 2011). Children who were treated with ORT had a shorter stay in hospital (on average 1.2 days), in comparison with the ones who were treated with IVT.

The other focus of the study was assessing the risk of developing complications when different methods of therapy were used in the treatment of dehydration. The children who used the IVT treatment method had an increased chance of developing phlebitis (2% higher chance than for the children who used ORT) (Costa and Silva, 2011). On the other hand, more children who used the ORT treatment method developed paralytic ileus although the evidence from the study indicated that the statistical difference was minor. The evidence from the research showed that the children who had been treated using the ORT and IVT methods had equal chances of developing hypernatraemia, paralytic ileus, seizures and abdominal distension. There were no statistically significant differences in the measurement of other outcomes such as weight gain during the period of discharge, total fluid intake at 6-24 hours, the mean duration period of diarrhea, and the incidences of hyponatremia or hypernatraemia.

In taking into consideration the most effective treatment method that is likely to be used by a majority of people, it is important to take into consideration the cost of treatment between different treatment methods. In the treatment of dehydration of children, it has been established by different studies that have been highlighted in this research paper that; both the ORT and the IVT treatment methods can be used (DeCamp et al., 2008). A Cochrane review was used to assess the cost effective method between the two treatment options that are available about the risk of complications that a patient risks developing when he or she uses different treatment methods. There was also a worst case analysis that was conducted for ORT about IVT. Based on this analysis in the Cochrane review, the use of ORT was seen as the most cost-effective treatment method for children who have been found to have moderate to mild dehydration (DeCamp et al., 2008).

The different studies that were used to assess both the ORT and IVT regarding safety and efficacy showed that there were no significant clinical differences between the two treatment methods. Most of the experimental researches that have been used indicate that approximately, out of every 25 children that are treated using ORT, in most cases only one child failed to respond to this treatment method and required the use of the IVT method (DeCamp et al., 2008). These results were consistent in different experiments that were conducted in different regions i.e. in both the developed and developing countries. These results support the existing practice guideline that recommends the use of the ORT as the first option in the treatment of children who have dehydration as a result of gastroenteritis.

Different studies have also indicated that in most developed countries, the ORS therapy is underutilized, while the IV therapy is overused in these countries. According to Mackenzie and Barnes, several factors have contributed to the overuse of IV therapy in developed countries. It has been established that in most of the cases where IVT is used over ORS, the degree of dehydration is over-estimated (Farthing et al., 2013). Most of the medical practitioners believe that for children who have been diagnosed with moderate or severe dehydration that the most appropriate type of treatment is the use of the IV therapy. This is despite having existing evidence that shows that ORS is not only safe as a treatment method, but different studies have also proven it to be effective in the treatment of dehydration even in severe conditions. Also, most of the medical practitioners in the USA believe that ORS is a more labor intensive process as compared to IVT (Farthing et al., 2013).

The recommended therapy method for dealing with minimal and moderate dehydration in children is ORS. The ORS composition that has 70mEq/L Sodium is appropriate for the rehydration and also the maintenance of all the patients including those that have been diagnosed with hypo or hypernatremia. When dealing with patients who have severe watery diarrhea, the recommended ORS composition has to contain 90mEq/L. Even in cases where the children are vomiting, ORS can still be used, and be provided with small amounts frequently- about 10ml after every 2 minutes. However, during the administration of ORS, it has been recommended that the children should not be given foods that have high quantities of sugar and fat. The recommended food products are cereals, potatoes, crackers, yogurt, and bananas because they contain the salts that the child is losing through vomiting and diarrhea, and therefore they are highly recommended.

In a survey that was conducted on American and UK pediatricians, it was seen that 90% recommend the use of clear fluids such as tap water for the treatment of dehydration for children with diarrhea. However, there are no studies that have been conducted that show the effectiveness of the use of other fluids such as tap water, juices, and soup in the treatment of dehydration (Farthing et al., 2013). An important point to note is that in patients who are experiencing dehydration as a result of gastroenteritis, the components that their body requires most to reduce or even eliminate the effects of dehydration are water and electrolyte replacement, and ORS solution fluids contain appropriate amounts of these constituents.

Various components in varying constituents can be used in the composition of the ORS solution. Different organic solutes have been used in the ORS solution, and they include components such as glucose, starch, and amino acids. There are various cases whereby Sodium Chloride has been used in varying concentrations to make the ORS solution (WHO, 2005). There are also other non-essential components such as potassium, bicarbonate, and acetate that are occasionally used in the composition of the ORS solution. Various research studies have been conducted to evaluate the effectiveness and safety of the different components in different concentrations that can be used in this study.

The original composition of the WHO ORS solution is: Glucose 111, Sodium 90, Potassium 20, Chloride 80 and Bicarbonate 30, and in all the cases the appropriate measurement is in mmol/l (WHO, 2005). However, it was soon established that in developed countries although viral gastroenteritis was common in the 1970s, it did not lead to severe salt losses, and therefore the appropriate ORS solution needed to have a reduced concentration of its sodium content. The recommended ORS solution that is used today is glucose 75, sodium 75, potas...