Nigerian Journal of Paediatrics

8Are we losing the gains of the Oral Rehydration Therapy Strategy An illustrative case

Niger J Paediatr 2016; 43 (2):102 – 103

LETTER TO THE EDITOR

DOI:http://dx.doi.org/10.4314/njp.v43i2.8

Accepted: 16th March 2016

Are we losing the gains of the Oral

Ekanem EE (

)

Akinwunmi F

Rehydration Therapy Strategy? An

Department of Paediatrics,

illustrative case

University of Calabar, Calabar,

Nigeria.

Community Health Department,

Shell Petroleum Development

Company of Nigeria

Email: emmanuel.ekanem@shell.

Dear Editor,

tube. PCV dropped to 21% by the sixth day and child

was transfused. Infant regained consciousness after

Incidence and deaths from diarrhoea in childhood have

seven days but with evidence of cortical damage- in-

declined remarkably in the last decade. Much of this

creased tone in all limbs and cortical blindness.

could be attributed to the Oral Rehydration Therapy

strategy introduced by the WHO . In Nigeria, this was

It would appear we are beginning to lose some of the

adapted into standard guidelines with salutary effects .

gains made by the ORT strategy. In this illustrative case,

The strategy hinges on hygienic practices, non-use of

the mother, from a sub-urban area, was using feeding

feeding bottles, use of appropriate oral fluids for the

bottle to feed the infant. The ORS was improperly

prevention and correction of dehydration from diar-

mixed and may explain the hypernatraemia and subse-

rhoea, selective use of antimicrobials, continued feeding

quent convulsions and coma. Several branded drugs

during episodes of diarrhoea, avoidance of anti-emetics

containing promethiazine, chlorpheneramine, hyoscine

and anti-motility drugs . A recent study has demon-

bromide, pseudoephedrine, kaolin, some of which may

strated inappropriate use and abuse of anti-microbials,

have contributed to the child’s seizures and coma, were

anti-emetics and anti-motility drugs at all levels of the

given. In addition, several anti-microbials were given.

health system in Nigeria . At a Community Cottage

The sedation, which interfered with feeding, contributed

Hospital in the Niger Delta supported by Shell Petro-

to the severe hypoglycaemia. The use and abuse of vari-

leum Development Company, children are often seen

ous oral dehydration salt solutions and drugs for diar-

with multiple drugs for diarrhoea prescribed in patent

rhoea by patent medicine dealers in Nigeria have been

reported by several authors.

5,6

medicine dealers shop, health centres and clinics, with

serious consequences. We describe here an illustrative

case.

Dear Editor, it is our contention that the intense cam-

paigns on diarrhoea prevention and management in

Infant BTO was admitted at eight months of age into the

childhood that were once mounted in Nigeria should be

Obio Cottage Hospital Oginigba, Port Harcourt, with

revisited. We may be beginning to lose the gains made.

history of diarrhoea, vomiting and fever for five days

and convulsions on the day of presentation. Child was

Thanks.

initially managed by patent medicine dealers with sev-

eral drugs as tabulated below Table 1 (see also fig 1).

Fig 1: 8 months old infant with feeding bottle and some of the

Standard ORS dissolved in 750ml of water was also

drugs given in the same episode of diarrhoea.

given. Child had fever (40.7 C), evidence of severe de-

hydration and seizures. Diagnoses of diarrhoea with

severe dehydration, hypovolaemic and septic shock,

bronchopneumonia (? aspiration pneumonia) and severe

malaria were made. PCV was 26%, sodium level

151mmol/l and random blood sugar 0.8mmol/l. Infant

was rehydrated with normal saline 20m/kg/hr repeated a

total of three times, seizures controlled with intravenous

diazepam. Intravenous ceftreaxone, and after urine pro-

duction, genticin were given. Hypoglycaemia was cor-

rected with ten percent glucose. After initial anti-shock

therapy, infant was given 75ml/kg of Ringer’s lactate

over six hours and then moved to ORS by naso-gastric

103

Table 1: Drugs used/ abused in the index infant

Drug used/Abused

Usefulness in Diarrhoea

Adverse effects

Trade name

Active Substance

Anti-microbials

Emgyl

Metronidazole

Useful only in proven E. histo-

Diverts attention from ORS.

lytica and Gardia lamblia, both

Nausea

rare in infants

Chloraphin

Chloramphenicol

Nil against common diarrhoea

Can cause bone marrow failure

organisms

Fleming

Amoxicillin + clavunalic acid

Not effective against most diar-

Can worsen diarrhoea

rhoea organisms. Useful in dysen-

tery (blood in stool)

Emmox

Amoxicillin

Not effective against most diar-

Can worsen diarrhoea

rhoea organisms. Useful in dysen-

tery (blood in stool)

Anti- Diarrhoeal’s/ Anti -Motility Drugs

Diastop

kaolin

No proven use

Diverts attention from ORS.

Gives false impression of im-

Deshalom

kaolin

No proven use

provement by thickening stools.

Rophelgan

Promethiazine

No proven use

Drowsiness, sedation, extra-

pyramidal crisis which resembles

convulsions.

Poor appetite, child difficult to

assess accurately

Cof”N” cold

Chlorpheniramide

No proven use

Drowsiness, sedation, extra-

pyramidal crisis, dizziness, head-

Babyrex

Chlorpheniramine

No proven use

ache, constipation,

blurring of vision, dry nose,

mouth and throat, irritability,

confusion, hallucination

Panda cold

Paracetamol

Pseudoephidrine can cause nau-

Chlorpheniramide

sea, vomiting, dizziness, head-

pseudoephidrine

ache, difficulty sleeping.

Colipan

Hyoscine bromide

Nil

Paralyses the intestine.

Abdominal distension which may

embarrass breathing

Maxiquine

Chloroquin +

No proven use in diarrhoea.

Promethiazine effect,

Paracetamol + Promethiazine

Chloroquine not recommended

see above. Chloroquin no longer

for malaria

effective for malaria. Recently

banned by NAFDAC

Amodiaquin

Not recommended alone for

malaria. No use in diarrhoea

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