كتاب  Fallibility of faecal consistency as a criterion of success in the evaluation of oral fluid therapy for calf diarrhoeaكتب الطب

كتاب Fallibility of faecal consistency as a criterion of success in the evaluation of oral fluid therapy for calf diarrhoea

Fallibility of faecal consistency as a criterion of success in the evaluation of oral fluid therapy for calf diarrhoea من كتب طب بيطرى The primary object of oral rehydration therapy (ORT) in the treatment of diar- rhoea is to correct the fluid and electrolyte depletion and the acid-base disturb- ances, allowing the patient's natural defences to overcome the cause of the diar- rhoea and to restore optimal conditions for the normal gut flora (Michell, 1983, 1994). Specifically, the aim is to treat the patient rather than the faeces (Ludan, 76 BRITISH VETERINARY.JOURaN.AL, 152, 1 1988; Avery & Snyder, 1990). The most important single objective is to restore plasma volume and reduce the danger of circulatory shock. In human medicine, from the earliest days of ORT, there have been problems with resistance from patients (or their mothers) if the faeces failed to improve, or if faecal loss even increased, in the early stages of therapy (Carpenter, 1987; Naylor, 1990; Ribeiro & Lifshitz, 1991). Indeed, rehydration may increase the patient's ability to produce fluid faeces as well as restoring circulating volume. It required persistent education by health workers to persuade mothers that this did not matter provided the child's condition was improving. Naturally, it implies that utilization of the oral rehydration solution (ORS) is less than perfect, but the per- fect ORS is yet to emerge in either human or veterinary medicine. In veterinary medicine, the analogous problem is obviously important: faced with a tardy improvement in faecal appearance, the farmer oz" the veterinarian may well conclude that they should t o , something different. Worse, the European Commission (EC) sets particular store by clinical criteria, notably improvement of faecal consistency (as reflected in faecal score (FS)), in judging the suitably of new oral rehydration products for registration (EC, 1999). Yet we have shown that clinical criteria, including faecal consistency, are hopelessly insensitive as a basis for comparing the efficacy of different ORSs (Michell et al., 1999). We therefore thought it important to examine the particular question 'Does improvement of faecal appearance, offer even a crude guide to the effectiveness of an ORS in restoring plasma volume?'. We thought it important to use mainstrealn, conven- tional ORT rather than novel solutions to answer it, hence our choice of the two most widely used veterinary oral rehydration products in the UK for our treat- ment. The focus of the study, however, is not the effectiveness of the products but the prognostic value of faecal improvement in gauging the success of oral rehy- dration therapy. METHODS General Our methods have been published in detail (Michell et aL, 199
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وصف الكتاب : Fallibility of faecal consistency as a criterion of success in the evaluation of oral fluid therapy for calf diarrhoea من كتب طب بيطرى


The
primary
object
of
oral
rehydration
therapy
(ORT)
in
the
treatment
of
diar-
rhoea
is
to
correct
the
fluid
and
electrolyte
depletion
and
the
acid-base
disturb-
ances,
allowing
the
patient's
natural
defences
to
overcome
the
cause
of
the
diar-
rhoea
and
to
restore optimal
conditions
for the
normal
gut
flora
(Michell,
1983,
1994).
Specifically,
the
aim
is
to
treat
the
patient
rather
than
the
faeces
(Ludan,

76
BRITISH
VETERINARY.JOURaN.AL,
152,
1
1988;
Avery
&
Snyder,
1990).
The
most
important
single
objective
is
to
restore
plasma
volume
and
reduce
the
danger
of
circulatory
shock.
In
human
medicine,
from
the
earliest
days
of
ORT,
there
have
been
problems
with
resistance
from
patients
(or
their
mothers)
if
the
faeces
failed
to
improve,
or
if
faecal
loss
even
increased,
in
the
early
stages
of
therapy
(Carpenter,
1987;
Naylor,
1990;
Ribeiro
&
Lifshitz,
1991).
Indeed,
rehydration
may
increase
the
patient's
ability
to
produce
fluid
faeces
as
well
as
restoring
circulating
volume.
It
required
persistent
education
by
health
workers
to
persuade
mothers
that
this
did
not
matter
provided
the
child's
condition
was
improving.
Naturally,
it
implies
that
utilization
of
the
oral
rehydration
solution
(ORS)
is
less
than
perfect,
but
the
per-
fect
ORS
is
yet
to
emerge
in
either
human
or
veterinary
medicine.
In
veterinary
medicine,
the
analogous
problem
is
obviously
important:
faced
with
a
tardy
improvement
in
faecal
appearance,
the
farmer
oz"
the
veterinarian
may
well
conclude
that
they
should
t
o
,
something
different.
Worse,
the
European
Commission
(EC)
sets
particular
store
by
clinical
criteria,
notably
improvement
of
faecal
consistency
(as
reflected
in
faecal
score
(FS)),
in
judging
the
suitably
of
new
oral
rehydration
products
for
registration
(EC,
1999).
Yet
we
have
shown
that
clinical
criteria,
including
faecal
consistency,
are
hopelessly
insensitive
as
a
basis
for
comparing
the
efficacy
of
different
ORSs
(Michell
et
al.,
1999).
We
therefore
thought
it
important
to
examine
the
particular
question
'Does
improvement
of
faecal
appearance,
offer
even
a
crude
guide
to
the
effectiveness
of
an
ORS
in
restoring
plasma
volume?'.
We
thought
it
important
to
use
mainstrealn,
conven-
tional
ORT
rather
than
novel
solutions
to
answer
it,
hence
our
choice
of
the
two
most
widely
used
veterinary
oral
rehydration
products
in
the
UK
for
our
treat-
ment.
The
focus
of
the
study,
however,
is
not
the
effectiveness
of
the
products
but
the
prognostic
value
of
faecal
improvement
in
gauging
the
success
of
oral
rehy-
dration
therapy.
METHODS
General
Our
methods
have
been
published
in
detail
(Michell
et
aL,
199

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Fallibility of faecal consistency as a criterion of success in the evaluation of oral fluid therapy for calf diarrhoea من كتب طب بيطرى

The 
primary 
object 
of 
oral 
rehydration 
therapy 
(ORT) 
in 
the 
treatment 
of 
diar- 
rhoea 
is 
to 
correct 
the 
fluid 
and 
electrolyte 
depletion 
and 
the 
acid-base 
disturb- 
ances, 
allowing 
the 
patient's 
natural 
defences 
to 
overcome 
the 
cause 
of 
the 
diar- 
rhoea 
and 
to 
restore  optimal 
conditions 
for  the 
normal 
gut 
flora 
(Michell, 
1983, 
1994). 
Specifically, 
the 
aim 
is 
to 
treat 
the 
patient 
rather 
than 
the 
faeces 
(Ludan, 

76 
BRITISH 
VETERINARY.JOURaN.AL, 
152, 

1988; 
Avery 

Snyder, 
1990). 
The 
most 
important 
single 
objective 
is 
to 
restore 
plasma 
volume 
and 
reduce 
the 
danger 
of 
circulatory 
shock. 
In 
human 
medicine, 
from 
the 
earliest 
days 
of 
ORT, 
there 
have 
been 
problems 
with 
resistance 
from 
patients 
(or 
their 
mothers) 
if 
the 
faeces 
failed 
to 
improve, 
or 
if 
faecal 
loss 
even 
increased, 
in 
the 
early 
stages 
of 
therapy 
(Carpenter, 
1987; 
Naylor, 
1990; 
Ribeiro 

Lifshitz, 
1991). 
Indeed, 
rehydration 
may 
increase 
the 
patient's 
ability 
to 
produce 
fluid 
faeces 
as 
well 
as 
restoring 
circulating 
volume. 
It 
required 
persistent 
education 
by 
health 
workers 
to 
persuade 
mothers 
that 
this 
did 
not 
matter 
provided 
the 
child's 
condition 
was 
improving. 
Naturally, 
it 
implies 
that 
utilization 
of 
the 
oral 
rehydration 
solution 
(ORS) 
is 
less 
than 
perfect, 
but 
the 
per- 
fect 
ORS 
is 
yet 
to 
emerge 
in 
either 
human 
or 
veterinary 
medicine. 
In 
veterinary 
medicine, 
the 
analogous 
problem 
is 
obviously 
important: 
faced 
with 

tardy 
improvement 
in 
faecal 
appearance, 
the 
farmer 
oz" 
the 
veterinarian 
may 
well 
conclude 
that 
they 
should 



something 
different. 
Worse, 
the 
European 
Commission 
(EC) 
sets 
particular 
store 
by 
clinical 
criteria, 
notably 
improvement 
of 
faecal 
consistency 
(as 
reflected 
in 
faecal 
score 
(FS)), 
in 
judging 
the 
suitably 
of 
new 
oral 
rehydration 
products 
for 
registration 
(EC, 
1999). 
Yet 
we 
have 
shown 
that 
clinical 
criteria, 
including 
faecal 
consistency, 
are 
hopelessly 
insensitive 
as 

basis 
for 
comparing 
the 
efficacy 
of 
different 
ORSs 
(Michell 
et 
al., 
1999). 
We 
therefore 
thought 
it 
important 
to 
examine 
the 
particular 
question 
'Does 
improvement 
of 
faecal 
appearance, 
offer 
even 

crude 
guide 
to 
the 
effectiveness 
of 
an 
ORS 
in 
restoring 
plasma 
volume?'. 
We 
thought 
it 
important 
to 
use 
mainstrealn, 
conven- 
tional 
ORT 
rather 
than 
novel 
solutions 
to 
answer 
it, 
hence 
our 
choice 
of 
the 
two 
most 
widely 
used 
veterinary 
oral 
rehydration 
products 
in 
the 
UK 
for 
our 
treat- 
ment. 
The 
focus 
of 
the 
study, 
however, 
is 
not 
the 
effectiveness 
of 
the 
products 
but 
the 
prognostic 
value 
of 
faecal 
improvement 
in 
gauging 
the 
success 
of 
oral 
rehy- 
dration 
therapy. 
METHODS 
General 
Our 
methods 
have 
been 
published 
in 
detail 
(Michell 
et 
aL, 
199

 



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