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CPS Statements > GI and Nutrition > Flashcards

GI and Nutrition Flashcards

1
Q

What is the difference btwn a probiotic and prebiotic? Give an example of a probiotic.

A

Probiotic = live micro-organism which can survive in digestive tract and confer health effect when consumed in adequate amounts (e.g. lactobacilli, bifidobacteria)

Prebiotic = nonviable food component that can confer a health benefit

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2
Q

What factors affect the development/composition of gut microflora? (5)

A 
type of delivery
infant diet (breastfed vs formula)
environment
gestational age
antibiotics
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3
Q

How do probiotics work?

A

modify gut microflora by lowering colonic pH through production of short-chain fatty acids

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4
Q

What is the role of the gut microflora?

A
  • contributes to gut’s barrier function (decreases gut permeability)
  • modulates guts immune function
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5
Q

For what conditions is there definite evidence for benefit to using probiotics? What conditions might have evidence? No conclusive evidence?

A

Have evidence for probiotic use in:

  • antibiotic-associated diarrhea
  • acute infectious viral diarrhea
  • preventing NEC

May be evidence for:

  • colic
  • IBS
  • preventing relapse in pts with recurrent C diff infections

No conclusive evidence:

  • atopic disease
  • travellers diarrhea
  • preventing food allergies
  • treating allergic colitis
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6
Q

Define antibiotic-associated diarrhea.

A

> 3 loose stools/day for at least 2 days occurring up to 2 weeks after initiation of antibiotics

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7
Q

What effect do probiotics have in acute viral diarrhea?

A

-decreased duration of diarrhea (btw 17-30 hrs less) and there is greater benefit if initiated early (

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8
Q

In which premature babies could you consider probiotics?

A

-preterm babies>1kg at risk for NEC

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9
Q

True or false: Lower counts of lactobacilli and bifidobacteria are found in children with atopic dermatitis compared with healthy controls.

A

True

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10
Q

True or false; We should recommend adding probiotics to infant feeds to prevent allergic disease or food hypersensitivity.

A

False. There is insufficient evidence to make this recommendation.

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11
Q

What are side effects of probiotics?

A

-can cause systemic or local infections in critically ill or immunocompromised patients

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12
Q

True or false: Effect of probiotics is strain and disease specific.

A

True

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13
Q

What are the benefits of breastfeeding for baby? (7)

A

Decreased incidence of:

  • bacterial meningitis
  • bacteremia
  • AOM
  • UTI
  • resp infections
  • decrease in SIDS
  • enhanced performance on neurocognitive testing

For each month of exclusive breastfeeding this may reduce hospital admissions secondary to infection by 30%.

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14
Q

What are benefits of breastfeeding for mums? (4)

A
  • decreased incidence of breast and ovarian cancer
  • delay in return of ovulation
  • greater postpartum weight loss
  • economical
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15
Q

What does CPS recommend for breastfeeding?

A

Exclusive breastfeeding for the first 6 months of life and continued breastfeeding with appropriate complementary foods for up to 2 yrs and beyond

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16
Q

What are the 10 steps to successful breastfeeding? (as per WHO and UNICEF)

A
  1. Have written BF policy routinely communicated to all staff.
  2. Train all staff in skills necessary to implement BF policy
  3. Inform all pregnant women about the benefits and management of breastfeeding
  4. Help mothers initiate BF within half an hour of birth
  5. Show mums how to BF and maintain lactation even when separated from their infants
  6. Give newborns no food or drink other than breastmilk, unless medically indicated
  7. Practice rooming-in, allow mums and babes to stay together 24 h a day
  8. Encourage BF on demand
  9. Give no artificial soothers to BF infants
  10. Foster the establishment of BF support groups and refer mothers to them at d/c from hospital or clinic
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17
Q

What does it take to be considered a Baby-Friendly institution?

A

follow each of the 10 steps of successful BF for at least 80% of all women and babies

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18
Q

Discuss some of the features of the international code of marketing breast-milk substitutes.

A
  • no free samples/gifts to mums or HC workers
  • no promotion of products in HC facilities
  • no words or pictures idealizing artificial feeding
  • all info on artificial feeding should be factual and explain the benefits of BF
  • complementary foods are not to be marketed in ways that undermine exclusive and sustained BF
  • financial assistance from the infant feeding industry may interfere with professionals’ unequivocal support for BF
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19
Q

How should we approach breastfeeding in NICU babies?

A

If not medically feasible to do rooming-in and BF then if not enough of mum’s own milk then use PHDM.

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20
Q

Discuss the timing of pacifier introduction in breastfed babies.

A

Prudent to delay intro of pacifiers until after BF is established.

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21
Q

What is kangaroo care and when should it be done?

A

skin-to-skin contact

within 30 mins of birth

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22
Q

What are the contraindications to breastfeeding? (4)

A

HIV-positive
cytotoxic chemo
radioactive isotopes/radiation therapy
classic galactosemia

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23
Q

Can you breastfeed if mum smokes, drinks or baby has PKU?

A

Smoking – BF may mitigate some of the negative effects of smoking on the health of baby so keep BF
Alcohol - limit this as freely passes into breastmilk
PKU – continue breastfeeding to supplement a low-phenylalanine formula along with strict monitoring of phenylalanine levels

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24
Q

What are phytoestrogens?

A

Plant-derived substances found in soy that have estrogenic activity. Are isoflavone class and are weak estrogens.

Present in large amounts in soy-formula. 94% in soy formula are biologically inactive. Are activated once ingested but only 3% in the plasma are biologically active.

Infants do not accumulate phytoestrogens in the plasma.

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25
Q

What medical condition is affected by phytoestrogens in soy formula and what is the mechanism?

A

Congenital hypothyroidism

Phytoestrogens can inhibit thyroid peroxidase which potentially lowers free thyroxine concentration which can lead to abnormal thyroid function. Need to monitor free T4 levels.

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26
Q

True or False: Animal and human models have shown consuming phytoestrogens alters sex organ development, brain maturation, immune system function and stimulate cancer development.

A

False. This is only true in animal models and cannot be directly extrapolated.

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27
Q

In what population should soy-based formulas be avoided?

A

premature babies

congenital hypothyroidism

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28
Q

What are the effects of soy formula on growth?

A

None. Supports normal growth and nutritional status in the first year of life.

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29
Q

What is the incidence of CMPA?

A

2.5%

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30
Q

In CMPA, when is it ok to use soy-based formula?

A

Soy formula is contraindicated in NON-IgE mediated CMPA. (due to high coincident soy allergies in these pts)

Is ok in IgE-mediated CMPA but ideally should recommend hydrolyzed formula b/c is difficult to clinically differentiate non-IgE from IgE-mediated CMPA.

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31
Q

What do the AAP and ESPGHAN say about soy formulas in kids

A

recommend extensively hydrolyzed protein (or amino acid-based formulas if hydrolyzed formulas not tolerated) for the treatment of infants with CMPA

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32
Q

What is the gold standard for diagnosing CMPA?

A

double-blind, placebo-controlled food challenge

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33
Q

What is the ‘classic’ presentation of non-IgE mediated CMPA versus IgE-mediated?

A

non-IgE mediated - blood in stool, GI symptoms; Delayed (late) reactions manifest up to 48 hours or even 1 week following ingestion. Usually gastrointestinal or cutaneous.

IgE-mediated - urticaria, angioedema, resp and GI features; Immediate (early) reactions minutes up to 2 hours after allergen ingestion. Reactions can be mild to acute life-threatening anaphylaxis

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34
Q

What are the limitations of the 2004 CDC (american) growth charts?

A

these charts are growth references and not necessarily representative of what optimal growth should be

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35
Q

When did the WHO make new international growth charts and how did they make them? (birth to 5 yrs)

A

2006
sample of kids from 6 diff countries who did exclusive breastfeeding for 4-6 months and also had good recommended nutrition

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36
Q

Who should be plotted on the WHO birth to 5 yrs chart?

A

all full-term babies (whether or not are breastfed) and preschoolers

kids and teens (age 5-19 yrs) should be on the 2007 WHO reference for growth

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37
Q

Until what age do you do head circumference? recumbent length?

A

HC = 2 yrs

recumbent lengeth = 2-3 yrs

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38
Q

When do you stop plotting a kid corrected?

A

24-36 months

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39
Q

For what ages do we use BMI? If not using BMI what do we use?

A

BMI for kids >2yrs

For kids

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40
Q

Why is important to adopt the WHO Growth charts?

A

Gold standard for an individual child

important to be unified for population health surveillance

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41
Q

According to the WHO growth charts for kids 5-19 yrs what BMI is overweight and what BMI is obese?

A 
overweight = BMI >85 %ile
obese = BMI >97 %ile (UTD says >95 %ile)
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42
Q

Why is the BMI cut-off different for younger kids compared to kids >5 yrs?

A

due to growth and lack of data on functional significance of upper cut-offs and to avoid the risks of putting young kids on diets

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43
Q

What are the benefits of human breast-milk for preterm babies?

A
  • fewer severe infections
  • less NEC (medical and surgical)
  • reduction in colonization with pathogenic organisms
  • decreased length hospital stay
  • improved neurodevelopment outcomes
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44
Q

When did the first human milk bank open in the world?

A

1909 in Austria

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45
Q

How many milk banks are there in Canada and where are they?

A

Only one in Vancouver

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46
Q

Who should get human donor breast milk?

A 
preterm babies
babies undergoing GI sx as newborn
malabsorption
feeding intolerance
immunodeficiency
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47
Q

What are the barriers to a premature baby getting mum’s breastmilk?

A
  • transportation to a hospital away from mum

- inadequate maternal milk supply due to illness or stress

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48
Q

What are exclusions to a mother donating breastmilk for PHDM?

A
  • if not doing it for altruistic reasons
  • any positive serology (Hep B, C, HIV, human T cell leukemia virus)
  • if taking medications
  • if they smoke or drink
  • temporarily excluded while taking over the counter meds
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49
Q

How does a mother donate her milk?

A
  • must be screened with an interview, medical approval and serology
  • expresses one or multiple feeds a day, freezes it and transports it to the milk bank
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50
Q

What happens to the donated milk once it reaches the milk bank?

A
  • batched from up to 4 mums
  • thawed
  • bacterial cx taken
  • pasteurized (62.5 degrees C x 30 mins)
  • recultured
  • frozen
  • milk that is culture positive is discarded
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51
Q

How does a preterm baby get PHDM?

A
  • must be prescribed

- must have written parental consent

52
Q

What does the pasteurization do to bacterial and viral contaminants? nutritional components? antibodies?

A
  • viral and bacterial contaminants (incl CMV) are inactivated
  • proteins and some water-soluble vitamins are degraded
  • carbs, fats and salts are Unchanged
  • IgA and IgG are reduced
  • IgM is completely removed
53
Q

Is PHDM cost effective?

A
  • no economic evaluation published
  • processing cost of PHDM is modest when compared to managing one case of NEC or short gut secondary to NEC
  • helps decrease length of stay, sepsis and NEC
54
Q

What is the CPS’ position on unprocessed human milk?

A

it should not be shared

55
Q

What is dental fluorosis and what causes it? Who is at risk for it?

A
  • abnormal enamel development due to ingestion of too much fluoride. Ranges from minimal changes, to mottling and pitting of teeth to snow-capped cusps and chalky-white teeth.
  • Occurs mainly in kids
56
Q

What is the benefit of fluoride and what is its mechanism of action?

A
  • prevents caries by its TOPICAL effect
  • decreases enamel solubility
  • inhibits plaque
  • inhibits demineralization of teeth
  • enhances remineralization of enamel
57
Q

How much fluoride is in a pea-sized portion of toothpaste?

A
  • not all toothpaste has fluoride
  • pea sized amount has 0.4mg of fluoride
  • should not swallow toothpaste b/c amount of fluoride could be excessive and ingested fluoride contributes to fluorosis without benefits of carie protection
58
Q

What are effective delivery methods for fluoride?

A
  • fluoridated toothpaste

- fluoridated water

59
Q

What are the recommendations for fluoride for toothpaste and drinking water?

A

-should add fluoride to municipal water where natural concentrations are

60
Q

When should supplemental fluoride be administered?

A
  • after age 6 months and only if:
  • concentration of fluoride in drinking water is less than 0.3ppm
  • child does not brush their teeth bid
  • if a dentist or other feels that the child is susceptible to high caries activity (FHx, pattern in community, etc)
61
Q 
If additional fluoride is being given, how should it be given and how much?
0-6 months
6 mo - 3 yrs
3-6 yrs
>6 yrs
A

give as mouthwashe or lozenge

0-6 months - none
6 mo - 3 yrs - 0.25 mg/day
3-6 yrs - 0.5 mg/day
>6 yrs - 1 mg/day

62
Q

What are the benefits of breastfeeding?

A
  • enhanced cognitive development
  • protection against GI infections
  • protection against AOM
  • protection against resp tract infections
  • protection against SIDS
63
Q

What are the recommendations around feeding for kids birth to 6 months?

A
  • exclusive breastfeeding from birth to 6 months
  • implement the policies and practices of the baby-friend initiative for hospitals
  • vit d 400 IU daily
  • first complementary foods should be iron-rich (meat, meat alternatives, iron-fortified)
64
Q

What are the benefits of nutritional rehabilitation in neurologically impaired children?

A
  • improved overall health
  • improved peripheral circulation
  • healing of decubitus ulcers
  • decreased spasticity
  • decreased irritability
  • improved gastroesophageal reflux
65
Q

What are some causes of malnutrition in neurologically impaired children?

A

INADEQUATE INTAKE

  • lack hand-mouth coordination
  • eat more slowly (need more time than is allotted)
  • unable to communicate hunger/satiety
  • dependent on caregiver

INCREASED LOSSES

  • frequent emesis and regurgitation
  • reflux esophagitis (so food refusal)

ALTERED METABOLISM

  • lower resting expenditure in some kids
  • increased metabolism in some kids with increased muscle tone or athetoid CP

OROMOTOR DYSFUNCTION

66
Q

What are signs of promoter dysfunction?

A
  • drooling
  • persistent extrusion reflex
  • spilling
  • delayed swallowing
  • aspiration/choking/coughing
67
Q

What are some additional measurements in children with deformities or in a wheelchair that might be helpful?

A
  • lower leg length
  • upper arm length
  • triceps skinfold thickness
68
Q

How do you diagnose superior mesenteric artery syndrome?

A
  • UGI

- more common in kids with scoliosis or rapid weight loss

69
Q

What are some imaging modalities that can be used in neurologically impaired kids and what are they used for?

A
  • Swallowing study - efficacy and safety of swallowing, position for feeds, texture restrictions
  • UGI - SMA syndrome
  • 24h esophageal pH probe - to determine if aspiration is secondary to GER
  • Gastric emptying - to show delayed gastric emptying and possibly pulmonary aspiration of gastric content
70
Q

What are the treatment options for neurologically impaired kids with gastroesophageal reflux?

A
  • treat aggressively
  • PPI
  • H2 blockers
  • Prokinetics helpful in some
  • surgical antireflux procedure
71
Q

What are the risk factors for osteopenia and osteoporosis in neurologically impaired kids?

A
  • reduced ambulation and weight bearing
  • malnutrition
  • limited sun exposure
  • use of anticonvulsants which can alter vitamin D metabolism
72
Q

How do you determine energy needs in neurologically impaired kids?

A

-different methods, some related to decreased of tone, activity, growth, height etc

73
Q

What are ways to improve oral intake in neurologically impaired kids?

A
  • adequate positioning
  • adjust food consistency
  • increase density of calories (fortify)
74
Q

What are options for enteral nutrition and when would you consider them in neurologically impaired kids? What are their side effects?

A
  • when PO intake is unsafe, insufficient or too time consuming
  • NG - minimally invasive, used for short term nutrition ( 3 months, more invasive
75
Q

Should all kids getting a g-tube get an antireflux surgical procedure at the same time?

A

Nope - no role for prophylactic anti-reflux procedure

76
Q

When do we use GJ or NJ feeds in neurologically impaired kids?

A
  • short term enteral nutrition in pts with GER or gastric dysmotility
  • long term only in kids with reflux who are poor candidates for anti-reflux procedures (fundo)
  • risk of intussusception with GJ tube
77
Q

What formulas should be used to feed kids >12 months?

A
  • 1 kcal/mL is preferred
  • use 1.5 kcal/mL if needed with careful monitoring of hydration status
  • avoid adult formulas b/c the calorie-to-nutrient ratio is inadequate for kids
78
Q

Which kids benefit from continuous feeds?

A
  • poor tolerance to gastric feeds
  • kids with dumping syndrome
  • kids with GJ tube
79
Q

What are the ideal weights for nutritionally impaired kids?

A

-kids

80
Q

What are trans fats?

A
  • partially hydrogenated unsaturated fats which increase low-density lipoprotein cholesterol and decreased HDL cholesterol
  • can be monounsaturated or polyunsaturated
  • benefit of hydrogenation is to extend shelf life and increases fat’s melting point to make it more suitable to frying
81
Q

What are the benefits of trans fats?

A

NONE. They increase LDL and decrease HDL which increases risk for cardiovascular disease

  • no benefits to human health
  • no such thing as a safe level of dietary trans fats
82
Q

What does it take for a food to be labelled as ‘trans fat free’? ‘low in saturated fat’?

A

trans fat free-less than 0.2g of trans fat per reference amount and per serving
-low in saturated fat -

83
Q

According to the WHO, what % of our total daily intake should be trans fat?

A
84
Q

What were the recommendations of the Canadian Trans Fat Task Force?

A
  • limit trans fat of vegetable oil and soft margarines to 2% of total fat content
  • limit trans fat content of all other foods to 5% of total fat content
85
Q

How should complementary foods be introduced?

A
  • gradually increase the # of times a day that complementary foods are offered while continuing to breastfeed
  • recommend iron-rich meat, meat alternatives and iron-fortified cereals as the first complementary foods
  • ensure lumpy textures are offered no later than 9 months
  • delay introduction of cow’s milk until 9-12 months of age (limit to no more than 750 ml/day or 24 oz)
  • promote offering finger foods to encourage self-feeding
  • encourage the use of an open cup, initially with help
  • no honey before age 1 year
  • regular meals and snacks
  • use all 4 food groups
86
Q

What are the recommendations around formulas/drinking after 12 months?

A
  • commercial formal should not be used for healthy kids beyond 1 year of age
  • homogenized milk starting age 9-12 months
  • soy, rice or plant-based beverages are NOT appropriate alternatives to cow’s milk in the first 2 years
  • avoid prolonged bottle feeding and giving bottles at night
87
Q

What % of toddlers are described as picky eaters by their parents?

A

25-35%

-most of these kids are eating and growing normally

88
Q

How much growth (weight and length) should a kid grow during the 1st year? 2nd year? ages 2-5 years?

A

First year - 7kg and 21 cm
Second year - 2.3 kg and 12 cm
2-5 years - 1-2kg and 6-8cm

89
Q

What is the normal appetite progression in a preschooler?

A
  • grow less age 2-5 years so the appetite decreases which is normal
  • appetite is very variable during the day but they keep a fairly constant total daily energy content
90
Q

What are factors that contribute to a toddler eating less at a meal?

A
  • if pressured or forced they may resist
  • are neophobic (don’t like new foods) so there is a perception they are picky but do accept them with time
  • excessive milk, juice, etc
  • grazing
  • food refusal as attention seeking
  • poor role modelling by parents
91
Q

What information should be gathered by parents ahead of time before coming to an appointment for being a picky eater?

A
  • 3-7 day dietary diary

- include portion sizes, time taken to finish a meal, mealtime atmosphere

92
Q

What features would suggest organic aetiology as opposed to physiologic?

A
  • abrupt decrease in appetite that pertains to all foods

- poor growth

93
Q

What are the things you can tell parents to help deal with a picky eater?

A
  • decrease in appetite is normal btwn age 2-5 years
  • parents are responsible for which foods the kid is offered, the kid decides how much
  • be flexible and allow food preferences within reason
  • start with relatively small portions of each food
  • snacks are best mid way between meals and should not be offered if interferes with next meal
  • do not offer juice as part of snacks
  • eating should be enjoyable and should not be coerced or coaxed to eat
  • limit table time to 20 mins
  • remove food when mealtime is over and only offer food again at next snack or meal
  • exercise and play are important
  • no tv or distractions at the table
  • do not make meals a time to focus on discipline of table manners
94
Q

What is the rough guideline for portion sizes?

A

one tablespoon of food for each year of child’s age

95
Q

When should an appetite stimulant like cyproheptadine be considered?

A

-Almost never. Not indicated for isolated food refusal and should never be considered solely to alleviate parental anxiety.

96
Q

Which growth charts should be used for kids age birth to 5 years and why?

A

WHO.
Using the CDC charts 30% of normal kids can cross one major %ile and 23% crossed 2 whereas on WHO charts crossing 2 major %iles would be considered abnormal.

97
Q

After what age is it no longer ok to cross growth %iles?

A

age 3 years (before that you adjust for your genetic potential)

98
Q

What are differences in growth for breastfed versus formula fed infants in the first year of life?

A
  • breastfed babies grow faster than formula fed babies in the first 6 months
  • formula fed babies grow faster than breastfed babies after 6 months
99
Q

What is the pattern that children with constitutional growth show?

A

-growth delay starts in the first 3 years of life and then they track along their own %ile after that

100
Q

What are the big overarching categories of poor growth?

A
  • inadequate nutrition (tends to affect weight first then height later)
  • chronic disease
  • endocrinopathy (tends to affect height more than weight)
101
Q

How do you calculate mid-parental height?

A

(mother’s ht + dad’s ht +/- 13) div 2

add 13cm if a boy, subtract 13 cm if a girl

102
Q

What is the major differential for growth failure?

A
  • eating poorly
  • anorexia associated with chronic disease
  • oromotor dysfunction
  • emesis
  • pancreatic disease (CF, scwachman-diamond)
  • cholestatic liver disease
  • intestinal disease (celiac, crown’s)
  • chronic/recurrent infections
  • hypothyroidism
  • GH deficiency
  • diencephalic tumour
  • renal tubular acidosis
103
Q

What are the first line investigations for growth failure in toddlers? What are second line?

A

1st line:

  • cbc, ESR, CRP
  • lytes, gas, glucose
  • BUN, Cr
  • protein, albumin
  • iron, TIBC, ferritin
  • Ca, PO4, ALK P
  • liver enzymes (AST, ALT, GGT)
  • serum immunoglobulins
  • TTG (with IgA)
  • TSH
  • UA

2nd line:

  • sweat chloride
  • vitamin levels
  • fecal elastase
  • bone age
104
Q

How do you calculate caloric needs?

A

caloric needs (cal/kg/day) = caloric needs for weight age (cal/kg/day) x ideal weight for height (kg)/actual weight (kg)

105
Q

What is cyproheptadine and what are its side effects?

A
  • antihistamine sometimes used as an appetite stimulant

- transient drowsiness, need to cycle its use as tolerance develops over time

106
Q

When should tube feeds we used in kids with poor growth?

A
  • as a last resort when the child is not growing
  • when underlying disease is worsened by poor nutritional status
  • when oral intake is unsafe
107
Q

What are psychosocial factors to consider with a child falling off the growth curve?

A
  • parental anxiety usually high and find it stressful, feel helpless,
  • focus interventions on reducing parental anxiety, returning control of feeding to the child and making mealtimes more positive experiences for the family
  • sometimes need psychologist, OT or SLP
108
Q

What are the Rome III criteria for infantile colic?

A

-infants

109
Q

What are the recommendations regarding hypoallergenic diets for mums who have babies with colic?

A
  • some studies demonstrated a small reduction in colic.
  • for severe colic can consider a time-limited (2 week) trial of a maternal hypoallergenic diet
  • can consider eliminating cow’s milk from the maternal diet but if no definite benefit after 2 weeks then lift the restrictions
110
Q

Which formulas are considered hypoallergenic?

A
  • extensively hydrolyzed protein formulas

- partially hyldrolyzed formulas ARE NOT hypoallergenic

111
Q

How often should dietary changes be made for colic?

A
  • very rarely
  • the vast majority of colic does not respond to interventions
  • can consider in the cases where cow’s milk protein allergy is suspected
112
Q

When should hypoallergenic formulas be considered for colic?

A
  • only in a small number of bottle-fed infants in whom you suspect cow’s milk protein allergy
  • try extensively hydrolyzed protein formulas
113
Q

What is the role of soy, lactase and pre and probiotics in infant colic?

A
  • no role for soy based formulas - they should be limited to kids with galactosemia
  • no evidence to support using lactase (congenital lactase deficiency is ++ rare)
  • insufficient evidence to recommend for or against pre and pro biotics
114
Q

What are the benefits of ORT?

A
  • safe
  • practical
  • inexpensive
  • highly effective
  • easier to administer
  • less traumatic
  • can be administered at home
115
Q

How does ORT work?

A
  • based on the cotransport of glucose and sodium
  • Na-K-ATP pump on basolateral membrane of enterocyte provides the gradient that drives the process
  • cotransport remains relatively intact in infective diarrhea
  • glucose enhances Na and secondarily water absorption
116
Q

What is the ideal composition of ORS?

A

-controversial, different based on WHO, AAP, etc

Pedialyte is osmolarity 250 mOsm/L, Carbs 25 g/L, Na 45, K 20, cl 35, base 30

117
Q

What is the role of zinc in gastroenteritis?

A
  • zinc-fortified ORS reduces the duration and severity of diarrhea
  • WHO recommends daily zinc 20 mg for 10-14 days for kids with acute diarrhea
  • zinc-fortified ORS is ++more expensive so premixed zinc-fortified ORS is not routinely recommended
118
Q

Which of the following has evidence that when added to ORS for gastroenteritis is effective?

a) -glycine
b) -alanine
c) -zinc
d) -glutamine

A

zinc

119
Q

What are the key components of fluid therapy in kids with gastroenteritis?

A
  • rehydration
  • replacement of ongoing losses
  • maintenance
120
Q

How should rehydrate a kid with gastro who is hypernatremic?

A
  • normalize slowly over 48-72 hours to avoid cerebral deem

- reduce maintenance by 25% b/c these pts have higher antidiuretic hormone levels

121
Q

What degree of dehydration constitutes milld, moderate and severe? How do you rehydrate them for each of these?

A

MILD (5%)
-ORS 50 ml/kg over 4 hrs

MODERATE (5-10%)
-ORS 100 mL/kg over 4 hrs

SEVERE (>10%)
-IV bolus with NS or RL over one hour

for all the above also replace ongoing losses with ORS and give age appropriate diet after rehydration

122
Q

How do you approach a child with gastro who is ‘not tolerating’ ORS?

A
  • small amounts at frequent intervals
  • try a syringe
  • try flavoured or a popscicle
  • NG before IV
123
Q

What type of ORS do we recommend and why that as opposed to fruit juice or water?

A

Premixed as opposed to powder or homemade.

Carbonated and fruit juices have high carb content, low electrolyte content and high osmolarity so can cause osmotic diarrhea.

Water can cause hypoNa and hypoglycaemia. Need to specifically tell parents not to use water only.

124
Q

What is the most effective way to rehydrate a moderately dehydrated child?

A

-ORT is as effective as, if not better than IV

125
Q

What are contraindications to the use of ORT?

A
  • protracted vomiting despite small, frequent feeding
  • severe dehydration with a shock-like state
  • impaired consciousness
  • paralytic ileus
  • monosaccharide malabsorption
126
Q

Why do we recommend early referring after gastroenteritis?

A
  • induce digestive enzymes
  • improve absorption of nutrients
  • enhance enterocyte regeneration
  • promote recovery of disaccharidases
  • reduce duration of diarrhea
  • maintain growth
  • improve nutritional outcomes
127
Q

How do you counsel mum’s who are breastfeeding when their baby has gastroenteritis?

A

-continue breastfeeding throughout including the initial rehydration phases

CPS Statements (14 decks)

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