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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