Spectrum of complications in intestinal infections
The severity of diarrheal syndrome (especially in shigellosis caused by Shigella flexneri or Shigella sonnei) is largely due to the development of severe systemic reactions. The leading factor determining the high risk of mortality is exicosis (dehydration). Its severity is closely associated with profound disorders of systemic hemodynamics, as well as disturbances in water-electrolyte and protein balance.
In addition to fluid loss, the clinical picture may be aggravated by the following pathologies:
- Infectious-toxic shock (ITS) — an extremely severe complication most characteristic of S. flexneri infection.
- Intestinal bleeding — occurs against the background of pronounced hemorrhagic syndrome.
- Pneumonia — the most frequent respiratory system pathology in Flexner dysentery. It tends to a severe progressive course and can result in acute cardiopulmonary failure.
- Internal organ damage — toxic impact can cause myocarditis, toxic hepatitis, nephritis, and polyarthritis.
- Post-dysenteric colitis — the outcome of past inflammation. It manifests as mucosal atrophy of the intestine and the formation of inflammatory polyps (this condition is not a true chronization of the infectious process).
Basic tactics for dehydration
The main tool for correcting first- and second-degree exicosis is oral rehydration. This method is strictly indicated for all patients with hyperosmolar and secretory diarrhea. Often, adequate fluid replenishment becomes the main element of pathogenetic treatment and leads to full recovery without additional methods.
In rotavirus infection in infants, starting treatment is necessarily based on the use of low-osmolarity oral solutions. This therapy is strictly combined with the administration of probiotics and enterosorbents. In diagnosed shigellosis, fluid intake is recommended for absolutely all patients, while tactics are built taking into account body weight, age, and current degree of dehydration.
Rules for performing oral rehydration
Special attention is required for fluid replenishment in children under three years of age. The main rule is that glucose-salt solutions must be alternated with salt-free liquids (water, tea, rice or rosehip decoction). It is strictly forbidden to mix them in the same container!
The choice of proportion between salt and salt-free solutions directly depends on how the body loses fluid:
| Ratio (salt : salt-free) | Nature of pathological losses |
|---|---|
| 1:1 | Pronounced watery diarrhea (isotonic losses) |
| 2:1 | Preponderance of vomiting over diarrhea (active chloride loss) |
| 1:2 | Preponderance of perspiration (moderate diarrhea against the background of high fever) |
Efficacy criteria and indications for infusions
The success of the therapy can be assessed by objective signs. The patient should show a reduction or disappearance of dehydration symptoms, restoration of initial body weight, and normalization of diuresis. In parallel, the volume of losses through vomiting and stool significantly decreases or completely stops.
If oral rehydration is ineffective, or adequate fluid intake is impossible (due to indomitable vomiting, severe intoxication syndrome, or complete refusal to drink), emergency hospitalization and transition to intravenous infusions are indicated. The goals of such treatment are restoration of circulating blood volume, detoxification, and correction of electrolyte balance.
When prescribing infusions, it is extremely critical to control the rate of solution administration. This is especially vital in the hypertonic type of dehydration. Too rapid a decrease in blood plasma osmolarity provokes the development of a fatal complication — cerebral edema. Water deficit in such cases is replenished smoothly and gradually.
To memorize the fluid proportions (salt : salt-free): with vomiting we lose salts (chlorides) — give more salt solutions (2:1). With fever, pure water evaporates — give more salt-free solutions (1:2). With watery diarrhea, losses are uniform — 1:1.
Class and exam questions
In which cases is it necessary to switch to intravenous rehydration?
Infusion therapy is indicated for the ineffectiveness of oral rehydration, severe degrees of exicosis, indomitable vomiting, and severe intoxication syndrome.
How to properly rehydrate children under 3 years old?
It is necessary to strictly alternate glucose-salt and salt-free solutions. Mixing them in a single container is strictly prohibited.
Which extraintestinal complication is most typical for Flexner dysentery?
The most frequent complication is pneumonia. It can progress and lead to the development of acute cardiopulmonary failure.
What else to study on this topic
- Pathogenesis of infectious-toxic shock in shigellosis
- Mechanisms of formation of secretory and hyperosmolar diarrhea
- Clinical picture of rotavirus infection in infants
- Assessment of degrees of exicosis and calculation of body weight deficit
- Differential diagnosis of types of dehydration (hypertonic, isotonic, hypotonic)
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