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Reduced osmolarity oral rehydration solution for treating dehydration caused by acute diarrhoea in children

Children with diarrhoea lose body water and sometimes become dehydrated. A solution of sugar and salt dissolved in water is widely used to treat dehydration caused by diarrhoea. This reviews shows that a solution of lower osmolarity than the current international standard means fewer children subsequently require an intravenous drip.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Children with dehydration due to gastroenteritis need to be rehydrated, and this review did not show any important differences between giving fluids orally or intravenously

Dehydration is when body water content is reduced causing dry skin, headaches, sunken eyes, dizziness, confusion, and sometimes death. Children with dehydration due to gastroenteritis need rehydrating either by liquids given by mouth or a tube through the nose, or intravenously. The review of 17 trials (some funded by drug companies) found that the trials were not of high quality; however the evidence suggested that there are no clinically important differences between giving fluids orally or intravenously. For every 25 children treated with fluids given orally, one child would fail and require intravenous rehydration. Further, the results for low osmolarity solutions, the currently recommended treatment by the World Health Organization, showed a lower failure rate for oral rehydration that was not significantly different from that of intravenous rehydration. Oral rehydration should be the first line of treatment in children with mild to moderate dehydration with intravenous therapy being used if the oral route fails. The evidence showed that there may be a higher risk of paralytic ileus with oral rehydration while intravenous therapy carries the risk of phlebitis (ie inflammation of the veins).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Clinical symptoms, signs and tests for identification of impending and current water‐loss dehydration in older people

Water‐loss dehydration results from drinking too little fluid. It is common in older people and associated with increased risk of many health problems. We wanted to find out whether simple tests (like skin turgor, dry mouth, urine colour and bioelectrical impedance) can usefully tell us whether an older person (aged at least 65 years) is drinking enough. Within the review we assessed 67 different tests, but no tests were consistently useful in telling us whether older people are drinking enough, or are dehydrated. Some tests did appear useful in some studies, and these promising tests should be re‐checked to see whether they are useful in specific older populations. There was sufficient evidence to suggest that some tests should not be used to indicate dehydration. Tests that should not be used include dry mouth, feeling thirsty, heart rate, urine colour, and urine volume.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Restricted versus liberal water intake for preventing morbidity and mortality in preterm infants

Most babies born before 37 weeks of pregnancy (preterm babies) are not developed enough to take all the water and nutrients they need by mouth. As a result, they are unable to regulate their intake of water. Inadequate water intake can cause the baby to become dehydrated. Excessive water intake can cause heart and lung problems or intestinal damage. Systematic review of trials related to this issue leads to the conclusion that careful restriction of water for preterm babies, to amounts that meet their physical needs without causing dehydration, reduces the risk of certain complications. More research on this topic is needed.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Oral rehydration salt solutions for treating cholera: lower salt content versus higher salt content solutions

Cholera is caused by pathogenic bacteria ingested with contaminated food or water and is commonly found where sanitation measures are poor. It causes severe diarrhoea and vomiting, which can lead to profound dehydration and potentially death. Oral rehydration solution (ORS) is an effective treatment for diarrhoea, and ORS with a salt concentration of ≤ 270 mOsm/L, which has a lower electrolyte content than the earlier ORS ≥ 310 mOsm/L, is safe and more effective in people with non‐cholera diarrhoea. This review found that ORS ≤ 270 mOsm/L appears to be as effective as ORS ≥ 310 mOsm/L at rehydrating people with cholera, but may lead to low blood salt levels. More research is needed to better understand these potential safety issues.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Black cohosh (Cimicifuga spp.) for menopausal symptoms

Menopause is the period of time in a woman's life when menstruation ceases. These changes in menstruation are often accompanied by troublesome symptoms, including hot flushes, vaginal dryness and night sweats. Interventions that decrease the severity and frequency of these menopausal symptoms are likely to improve a person's well‐being and quality of life. The herb black cohosh was traditionally used by Native Americans to treat menstrual irregularity, with many experimental studies indicating a possible use for black cohosh in menopause. This review set out to evaluate the effectiveness of black cohosh for controlling the symptoms of menopause. The review of 16 studies (involving 2027 women) found insufficient evidence to support the use of black cohosh for menopausal symptoms. Given the uncertain quality of most studies included in the review, further research investigating the effectiveness of black cohosh for menopausal symptoms is warranted. Such trials need to give greater consideration to the use of other important outcomes (such as quality of life, bone health, night sweats and cost‐effectiveness), stringent study design and the quality reporting of study methods.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Advising patients to increase fluid intake for treating acute respiratory infections

Doctors commonly recommend that people with acute respiratory infections drink extra fluids. Acute infections include colds, acute sinusitis, tonsillitis, laryngitis, bronchitis, pneumonia and influenza. This review intended to find out the benefit or harm from this recommendation. Potential benefits of fluids are replacing fluid lost because of fever or rapid breathing, treating dehydration and reducing the viscosity of mucus. In infections of the lower part of the respiratory tract, possible harmful effects of fluids might be a dilution of the blood sodium concentration, leading to headache, confusion and seizures. This review found no evidence for or against the use of increased fluids in acute respiratory infections. No randomised controlled trials have been conducted to determine the benefit or harm from extra fluids. It is important that further studies be done in order to determine the true effect of this very common medical advice.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Medically assisted hydration to assist palliative care patients

It is common for palliative care patients to have reduced fluid intake during their illness. Management of this condition includes discussion with the patient, family and staff involved, and may include the provision of fluids with medical assistance. This can be performed using a small plastic tube inserted into a vein or under the skin, or via a tube inserted into the stomach. It is unknown whether this treatment helps people to feel better or live longer.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Polymer‐based oral rehydration solution (ORS) ORS for acute diarrhoea

Acute diarrhoea is a common cause of death and illness in developing countries. Oral rehydration solutions (ORS) have had a massive impact worldwide in reducing the number of deaths related to diarrhoea.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Drugs that aim to reduce the loss of water from red blood cells in people with sickle cell disease

We reviewed the evidence to assess the relative risks and benefits of drugs to rehydrate sickled red blood cells.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Infectious diarrhea: Traveler's diarrhea

When people travel to faraway countries, their stomach and bowel often have to get used to new foods and new ways of preparing food. Diarrhea is quite common during travels to distant countries. Traveler's diarrhea typically only lasts a few days and usually doesn't need to be treated. There are certain things you can do to try to avoid getting it.The risk is higher in the tropics and subtropics. There are a number of reasons for this. For instance, your stomach and bowel might have a hard time coping with unfamiliar foods such as very spicy dishes and exotic ingredients. Poor hygiene, high temperatures and inadequate cooling of foods make it easier for bacteria to thrive in foods or water. Traveler's diarrhea is most often caused by bacteria. But viruses can also be transmitted through foods or water.If diarrhea is severe or lasts a long time, it is particularly important to replace the lost fluids and salts. You should see a doctor if the symptoms don't improve or if you develop severe diarrhea within a few days or weeks of returning from travels to a distant country.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: May 4, 2016

Infectious diarrhea: Overview

Diarrhea is very common. It is usually caused by viruses and goes away on its own after a few days. But more severe or longer lasting diarrhea needs to be treated because it can lead to the loss of dangerously high levels of fluid and salt, especially in young children and older people.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: June 30, 2016

Kidney stones: Overview

Kidney stones are very common, especially in people between the ages of 20 and 40. These small, hard deposits form in the renal pelvis and can enter a ureter. Larger stones can be painful and often have to be surgically removed. There are several options for treatment and prevention.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: February 25, 2016

Antibiotics for treating cholera

Cochrane Collaboration researchers conducted a review of the effects of antibiotics for treating people with cholera. After searching for relevant trials, they included 39 randomized controlled trials enrolling 4623 people with cholera.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Benzodiazepines for extreme movement problems (catatonia) in people with schizophrenia and other serious mental illnesses.

Some people who have schizophrenia or other serious mental illnesses develop catatonia, which consists of extreme lack of movement or constant repetitive movement over which they seem to have very little control.  Whilst in a catatonic state these people are unable to interact with their environment and may go on to acquire secondary problems such as pneumonia, blood clotting problems (thrombosis), malnutrition or dehydration.  Current treatments for this are either drugs, which are given by injection, or electric shock treatment (electroconvulsive therapy).  The aim of this review is to look at how effective benzodiazepines are compared to placebo or other drug treatments in treating this problem.  However, while some clinical trials that seemed relevant were identified, no usable data could be extracted from them. There is no good trial‐derived data on this subject.  However, there are five trials on which more information needs to be collected.  In the longer term, to make sure people with catatonia receive the most effective treatment, this is an area that would benefit from good research and well planned and reported trials.  Also, since the condition is rare, there should be good communication between those involved in researching it.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Botulinum toxin for swallowing disorders

Many people have problems swallowing because of an impairment of the upper oesophageal sphincter (UOS), a high pressure zone within the tube that carries food from the mouth to the stomach. Many people with neurological conditions such as stroke, traumatic brain injury, Parkinson's disease or multiple sclerosis can have UOS impairment. This results in difficulty swallowing food and liquids, resulting in choking and food entering into the lungs (aspiration). This has serious consequences for the patient and can cause dehydration, malnutrition and aspiration pneumonia. The person's quality of life can be affected as they are unable to have food or liquids safely by mouth. Tube feeding and hospitalisation is often required.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Impact of morphine, fentanyl, oxycodone or codeine on patient consciousness, appetite and thirst when used to treat cancer pain

Care pathways are packages of care designed to ensure that patients have appropriate and effective care in particular situations. Such pathways are commonly used, and often produce good results, but they can also be used as a tick box solution that acts as a barrier to good care. Care pathways have been used to ensure appropriate care for people who are dying in hospice settings.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Interventions for drooling in children with cerebral palsy

Many children with CP have difficulty controlling saliva. Drooling varies in severity and can be distressing for the children, families and caregivers. Excessive drooling can cause constant damp soiled clothing, unpleasant odour, irritated, chapped or sore skin around the mouth and chin, skin and mouth infections, dehydration, difficulties chewing, interference with speech, damage to books, communication aids, computer and audio equipment. There is also risk of social rejection and social isolation for these children.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Infectious diarrhea: Can probiotics help against diarrhea?

Probiotics can make diarrhea go away about one day faster. Generally speaking, probiotic products – which mostly contain certain lactic acid bacteria – are well tolerated.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: May 4, 2016

Electric fans for reducing the health effects of heatwaves

Heatwaves are set to become more common and their effects can be devastating. For example, up to 30,000 people may have died because of the heatwave that occurred in Europe during August 2003. One way to try to get relief from the heat is to use an electric fan, but whether this will do more good or harm is uncertain. A fan might help to increase heat loss if the temperature is below 35 °C and the fan is not directly aimed at the person, but, when temperatures are above 35 °C, the fan might actually contribute to heat gain. Excess sweating can also lead to dehydration and other health problems. It is important, therefore, to know about the potential benefits and harms of electric fans when choosing whether to use one. This applies if the decision is about your own use of a fan, but it is also relevant to broader public health decisions, such as whether to give electric fans to groups of people during a heatwave. This is particularly important for people who are considered more vulnerable to the effects of heat, such as older adults who are less able to cool down through sweating or increasing the flow of blood to their skin.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

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