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Intensive therapy emergency states in acute intestinal infections
in children
Makhfuza MADUMAROVA
1
, Yuriy AZIZOV
2
, Abdug‘ofur QODIROV
3
,
Albina BAZAROVA
4
, Ra’noxon YAKUBOVA
5
Andijan State Medical Institute
ARTICLE INFO
ABSTRACT
Article history:
Received May 2021
Received in revised form
20 May 2021
Accepted 15 June 2021
Available online
15 July 2021
Despite the successes achieved in the fight against many
infectious diseases, the problem of diarrheal diseases in
Uzbekistan, as well as throughout the world, continues to be
relevant. The medical and social significance of the problem is de
– termined not only by the significant spread of diseases, but also
by the high fre – 150 quency of severe complicated forms of the
disease, especially among young children. In addition, diarrheal
diseases indirectly contribute to an increase in the incidence of
other infections, as they lead to depletion and, as a result, to a
decrease in the div’s resistance. Despite the sufficiency of
literature data on the study of diarrheal diseases and their
treatment, many clinical and organizational aspects of the
problem of acute intestinal infections, especially in young
children, remain unresolved. Treatment of an emergency in
acute intestinal infections (ACI) often reduces only to the
elimination of various degrees of exsiccosis using oral and
intravenous rehydration.
2181-1415/© 2021 in Science LLC.
This is an open access article under the Attribution 4.0 International
(CC BY 4.0) license (https://creativecommons.org/licenses/by/4.0/deed.ru)
Keywords:
diarrhea,
infectious diseases,
acute intestinal infections,
rehydration.
1
Senior lecturer of the Departament of Pathological Physiology, Andijan State Medical Institute, Andijan, Uzbekistan.
2
Head of Departament of phtysiatriya and pulmonology, microbiology, immunology and virusology, Andijan State
Medical Institute, Andijan, Uzbekistan.
3
Dotsent of the department Normal physiology, Andijan State Medical Institute, Andijan, Uzbekistan.
4
Assistant of the department normal physiology, Andijan State Medical Institute, Andijan, Uzbekistan.
5
Assistant of the department infectious diseases, Andijan State Medical Institute, Andijan, Uzbekistan.
Жамият ва инновациялар – Общество и инновации – Society and innovations
Special Issue – 6 (2021) / ISSN 2181-1415
163
Bolalardagi o‘tkir ichak infektsiyalarida intensiv terapiya
shoshilinch holatlari
ANNOTATSIYA
Kalit so‘zlar:
diareya,
yuqumli kasalliklar,
o‘tkir ichak infeksiyalari,
regidratatsiya.
Ko‘pgina yuqumli kasalliklarga qarshi kurashda erishilgan
yutuqlarga qaramay, O‘zbekistonda, shuningdek butun dunyoda
diareya kasalliklari muammosi dolzarb bo‘lib qolmoqda.
Muammoning tibbiy va ijtimoiy ahamiyati nafaqat kasallik-
larning sezilarli darajada tarqalishi, balki yuqori darajadagi
yuqumli kasalliklar bilan ham belgilanadi. Kasallikning og‘ir
murakkab shakllari, ayniqsa yosh bolalar orasida kuzatilmoqda.
Bundan tashqari, diareya kasalliklari bilvosita boshqa infeksiya-
larning paydo bo‘lishining kuchayishiga yordam beradi, chunki
ular tükenmeye olib keladi va natijada tanadagi qarshilikning
pasayishiga olib keladi. Diareya kasalliklarini o‘rganish va ularni
davolash bo‘yicha adabiyotlar ma’lumotlarining etarlicha
bo‘lishiga qaramay, o‘tkir ichak infektsiyalari, ayniqsa yosh
bolalarda, ko‘plab klinik va tashkiliy jihatlar hal qilinmagan.
O‘tkir ichak infektsiyasida (O‘II) favqulodda vaziyatni davolash
ko‘pincha og‘iz va tomir ichiga regidratatsiya yordamida turli
darajadagi ekssikozni bartaraf etishgacha kamayadi.
Экстренные состояния интенсивной терапии при острых
кишечных инфекциях у детей
АННОТАЦИЯ
Ключевые слова:
диарея,
инфекционные
заболевания,
острые кишечные
инфекции,
регидратация.
Несмотря на успехи, достигнутые в борьбе со многими
инфекционными заболеваниями, проблема диареи в
Узбекистане, как и во всем мире, остается актуальным.
Медико-социальная значимость проблемы определяется не
только значительной распространенностью заболевания,
но и высокой распространенностью инфекционных
заболеваний. Выявляются тяжелые сложные формы
заболевания, особенно у детей раннего возраста. Кроме
того, диарейные заболевания косвенно способствуют
возникновению других инфекций, так как приводят к
истощению и, как следствие, снижению сопротивляемости
организма. Несмотря на наличие данных из литературы по
изучению и лечению диареи, острых клинических
инфекций, особенно у детей раннего возраста, многие
клинические и организационные аспекты остаются
нерешенными. При острой кишечной инфекции (ОКИ)
неотложное лечение часто сводится к устранению
высыхания различной степени с помощью пероральной и
внутривенной регидратации.
Жамият ва инновациялар – Общество и инновации – Society and innovations
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GOAL
He will study the pathological conditions that occur with acute intestinal infec- tions
and other pathological conditions that require intensive therapeutic measures. Research
material and methods An analysis of 350 patients who were treated in the intensive care
unit for acute respiratory infections for 5 years (2005–2010).
Patients treated in the intensive care unit amounted to 12.5 %, of all children with
acute respiratory infections admitted to the hospital, most of them (89 %) were infants.
Determining the indications for hospitalization in the intensive care unit, the following
emergency conditions were distinguished in children with acute intestinal infections and,
accordingly, differentiated therapeutic measures were carried out. 1. Intestinal toxicosis
with exsiccosis II-III degree. This condition is common, in 42 % of cases, usually with acute
respiratory infections, accompanied by watery diarrhea and repeated vomiting, that is,
with escherichiosis, foodborne toxic infections. However, in infants, it can develop with a
severe form of acute intestinal in – fections of any etiology. The main link in the disorders
should be considered exico – sis with a loss of 5 to 15 % fluid with the development of
hypokalemia and hypopro- teinemia. The latter are often detected after correction of
exsiccosis and elimination of hemoconcentration. In patients up to a year of age, exicosis
is mainly isotonic, a decrease in sodium is rare. Disturbances from the central nervous
system, micro circulation and acid-base state are secondary. The basis of therapy in this
condition is timely and adequate correction of water-electrolyte balance and
hypoproteinemia with the help of infusion therapy, both on the first day of the patient’s
admission and for the entire period of continuing losses. To assess the adequacy of the
treat- ment, a constant clinic laboratory monitoring is necessary. Informative laboratory
indicators are the level of hematocrit and the concentration of electrolytes in plas- ma,
primarily K + and Na +, as well as the level of total protein. As infusion agents, we used an
isosmotic glucose-polyionic solution (contains 86 mmol / I sodium). Of the colloidal
solutions in the acute phase, reopoliglukin is most suitable. Albumin so- lutions were used
after dehydration was eliminated; their use as a starting solution is undesirable. The
volume of infusion therapy depends on a number of factors: the age of the child. the degree
of exicosis, the volume of ongoing losses with stool and vomiting, digestion, write and
drink, etc. But the preparation of corrective programs and the use of standard solutions
allows the doctor to quickly make the necessary calculations. Cocarboxylase, ATP, and
drugs to improve microcirculation (trental, curangil) are also added to the infusion media.
More than half of the children in this group can be treated without antibiotics, or receive
them only by mouth. 2. Generalized forms of intestinal infections, septicemia, occurring
with severe intoxication phenomena. Patients with these forms accounted for 33 % of all
pa- tients in the intensive care unit, these conditions are most often observed with sal-
monellosis, yersiniosis, and klebsiellosis. They are characterized by the presence of two or
more lesions, of which pneumonia and acute otitis media are most common, pyelonephritis
is rare and rarely – myocardit is. The severity of the condition of patients is explained
mainly by bacterial intoxication; lethargy, refusal to eat and drink, fever, infrequent
vomiting, enlargement of the liver and spleen, and intestinal paresis are noted. Sub
compensated metabolic acidosis, hypokalemia, hypoproteinemia, changes in the blood
formula, leukocyte index increased within 3-8units, intoxication are de- tected in the
laboratory. For patients of this group, a quick etiological diagnosis with the help of a sero
logical reaction and the correct selection of antibacterial drugs, a bacteriological study of
the discharge from the nose, ears, urine and feces, with a determination of the sensitivity
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of the allocated flora to antibiotics, are important. Such patient’s car- ry out disintegration
Dication-correcting infusion therapy with elements of paren- teral nutrition. The total
calorie volume should be 100-110 kcal KG / CUT. Accord- ing to indications, immune
globulin (intravenously), native (or frozen) plasma was used, heparin therapy was carried
out at the rate of 150-250 units. heparin per kg of div weight; proteolysis inhibitors
(contracal, gordox) were also used. Neurotoxi-cosis in our observations was observed in
7 % of patients. It manifests itself as a generalized reaction with hyperthermia,
tachycardia, shortness of breath, anxiety, and clinically tonic convulsions are often noted.
This condition was more often ob-served in severe forms of dysentery, with a combination
of the development of viral (ARVI) and bacterial (intestinal) infection. It was also observed
at a time when, against the background of a leaking intestinal infection, the child developed
compli- cations in the form of acute otitis media, pneumonia, etc. Exicosis in such patients
was usually not very pronounced, tissue turgor remained normal, a large fontanel was
performed or swollen. Laboratory leukocytosis, an increase in leukocyte index
intoxication, metabolic acidosis and compensatory hypocapnia were usually detected in
the blood, a violation in the blood coagulation system was noted. Such conditions require
the most urgent measures: they were the removal of seizures by intravenous
administration of seduxen (0.5 mg / kg) and pipolfen (1-2 mg / kg). In severe cases, this
was achieved by lowering the div temperature by physical and medical meth- ods. During
seizures, lumbar puncture was done for medical and diagnostic purpos-es (therapeutic
effect due to a decrease in cerebrospinal fluid pressure). Therapeutic measures were
aimed at normalizing hemodynamics, preventing cere-braledema with the help of ganglion
blockers, neuroplegic drugs, and corticosteroid hormones. With severe tachycardia, beta-
blockers (obzidan) were used. The introduc-tion of this drug was carried out slowly, under
the control of heart rate and even ECG. At the first stage of treatment, infusion media
containing sodium were strictly limited. After eliminating the phenomena of
neurotoxicosis, infusion therapy was carried out (if necessary) according to generally
accepted principles of correction. Conclusions In addition to toxicosis and exicosis in
severe acute intestinal infections in children, it is also necessary to bear in mind the
development of shock, acute renal failure and the onset of atoxico-dystrophic state. Thus,
a differentiated approach to the assessment of emergency conditions in children with
acute renal failure and their adequate therapy can reduce mortality among resuscitation
patients who re-ceivedacute intestinal infections.
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