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Archivos de Pediatría del Uruguay

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PREGO, JAVIER; BELLO, OSVALDO; PROTASIO, LAURA  and  IRIARTE, ROSARIO. Diarrea grave en la emergencia. Arch. Pediatr. Urug. [online]. 2001, vol.72, n.1, pp. 18-28. ISSN 0004-0584.

The decrease in mortality of infant acute diarrhea can lead to the false belief that it is a solved problem. However, the morbimortality is high and morbidity has not decreasead to the same extent as mortality. The severe infant acute diarrhea in the small child presents multiple problems to the emergency pediatrician who has to emphasize in the detection of complications and an adequate treatment. The goals of the following work were to determine and analyze in a population of small children with severe infant acute diarrhea, assisted in a pediatric Emergency Department, the following elements: 1) clinical presentation and paraclinical characteristics; 2) performed treatment and procedures; 3) evolution and complications. A retrospective study was carried out in the Reanimation Unit of the Pediatric Emergency Department of teh Pereira Rossell Hospital Center, during the period January 1, 1997 to December 12, 1998, in patients less than 24 months old, whose main symptoms were diarrhea, vomiting and dehydration, in conjunction with complications that risk life that determined their entrance to the Reanimation Unit. The complications included were: cardiorespiratory arrest, shock, severe dehydration, electrolitic disorders, ionic disorders (hyponatremia, hypernatremia, hypokaliemia, hyperkaliemia, hypocalcemia, metabolic acidosis, renal failure, hypoglicemia, hyperglicemia, abdominal distension, intestinal ileus, presumption of sepsis, complications due to procedures and complications in the Reanimation Unit. The vascular acces performed, the need of orotracheal intubation and mechanical ventilation, the use of inotropics, hydroelectrolytic solutions used, correction of ionic disturbs, use of hemoderivatives, use of antibiotics, final evolution and destiny, was analized. One hundred and eighteen (118) cases were studied, with an average age of 5 months, having higher frequency during the warmer months. There was a predominant population of children with a good nutritional status. The complications were multiple, detecting a significant incidence of hypovolemic shock and cardio-respiratory arrest with mortality of 5%. It is concluded that the problems associated to infant acute diarrhea are multiple, severe and very frequent and challenge the emergency pediatrician. The epidemiology and the approach of this group of problems from the perspective of an emergency area have little consideration in the literature in the last years.

Keywords : diarrea; deshidratación; disturbios hidroelectroliticos; "shock"; reposición; solución polielectrolítica 90; sueros.

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