Zinc and ORS - Recommendation of Zinc in Diarrhea Treatment

4th Pediatric Infectious Diseases Conference

ISSN 0973 - 0958

Gastrointestinal Disorders in Children

Zinc and ORS

Gastrointestinal Disorders in Children

Zinc and ORS

Acute Diarrhea in Children

Inflammatory Bowel Disease/IBD

Acute Childhood Diarrhea: Review of Recent Advances in Standard Management

Zinc For The Prevention Of Diarrhea

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Vomiting and Diarrhea in Children

Upper Gastrointestinal bleed

ORS - Which one to use?

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Malabsorption syndromes

Prevention of Diarrhea

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Results

ZINC AND ORS

Related topics

Introduction

New Reduced Osmolarity ORS

Composition Of Reduced Osmolarity ORS

Zinc as Adjuvant in Rehabilitation of Patients with Diarrhea

Santosh Singh
Medical Sciences Department, Pediatric Oncall, Mumbai

Address for Correspondence:

Dr Santosh Singh, Medical Sciences Department, Pediatric Oncall, 1/B Saguna, 271/B St. Francis Road, Vile Parle (W), Mumbai 400056.

Recommendations of the IAP National Task Force for use of Zinc in Diarrhea, August 18-19, 2003

Based on studies in India and other developing countries there is sufficient evidence to recommend zinc in the treatment of acute diarrhea as adjunct to oral rehydration.However, ORS remains

the mainstay of therapy during acute diarrhea and zinc has an additional modest benefit in the reduction of stool volume and duration of diarrhea as an adjunct to ORS. Under all circumstances, oral rehydration therapy must remain the main stay of treatment.

Treatment of acute diarrhea with zinc may have benefits on morbidity and mortality from other childhood infections and these should be further investigated.

A uniform dose of 20 mg of elemental zinc should be given during the period of diarrhea and for 7 days after cessation of diarrhea to children older than 3 months. Recommendations for below 3 months must await further research.

Based on all the studies the group proposed that zinc salts e.g., sulphate, gluconate or acetate may be recommended. The industry should be encouraged to prepare a zinc formulation, which contains only zinc. Until these are available, the group proposed that formulations providing vitamins together with zinc may be used provided doses of former are within 1 RDA .Iron containing formulations should not be used with zinc as iron interferes with zinc absorption. ¹⁰

Conclusion

Thus, there is abundant evidence to justify the widespread inclusion of zinc supplements for diarrhea treatment. The world must face the challenges to enable this to happen. The changes in the programme are simple and incorporating these into diarrhea control programs will have a lasting impact on child health. National and local level health decision makers are needed to contribute local knowledge to successfully design programs that will ensure the highest coverage possible. The world cannot afford to ignore that revitalizing diarrhea control programs to include zinc supplementation and reinforcement of the importance of ORS use is a child health goal. Urgent action is needed from governments, international aid agencies, and donors to accept this challenge and decrease childhood diarrhea deaths.

See Expertise Views On "Zinc"

References

Bryce J, Boschi-Pinto C, Shibuya K, Black RE. WHO estimates of the causes of death in children. Lancet 2005;365:1147-52.
Gebhord RI, Karonani R, Priggle WF, McClain CJ: Effect of severe zinc deficiency on activity of intestinal disaccharidases and 3-OH-3-methyl glutaryl coenzyme A reductase in the rat. J Nutr 113:855-859, 1983.
Golden BE, Golden MHN: Zinc, sodium and potassium losses in the diarrheas of malnutrition and zinc deficiency. In Mills CF, Brenner I, Chesters JF (eds): "Trace Elements in Man and Animals-TEMA 5." Aberdeen, UK: Rowett Research Institute, pp228-232, 1985.
Bhan MK, Bhandari N: The role of zinc and vitamin A in persistent diarrhea among infants and young children. J Pediar Gastro Nutr 26:446-453, 1998
Sazawal S, Black RE, Bhan MK, Bhandari N, Sinha A, Jalla S:Zinc supplementation in young children with acute diarrhea in India. New Engl J Med 1995; 333:839-844, 1995.
Roy SK, Tomkins AM, Mahalanabis D, Akramuzzaman SM,Haider R, Behrens RH, Fuchs G: Impact of zinc supplementation on persistent diarrhea in malnourished Bangladeshi children. Acta Paediatr 1998;87:1235-1239,
Penny ME, Peerson JM, Marin RM, Duran A, Lanara CF, Lonnerdal B, Black RE, Brown RH: Randomized, community-based trial of the effect of zinc supplementation, with and without other micronutrients, on the duration of persistent childhood diarrhea in Lima, Peru. J Pediatr 1999;135:208-217,
Roberto Berni Canani and Serena Ruotolo. The Dawning of the "Zinc Era" in the Treatment of Pediatric Acute Gastroenteritis Worldwide Editorial. Journal of Pediatric Gastroenterology and Nutrition 42:253-255
Bern C, Martines J, de Zoysa I, Glass RI. The magnitude of the global problem of diarrhoeal disease: a ten-year update. BullWHO. 1992;70:705-714.
Wapnir RA. Zinc deficiency, malnutrition and the gastrointestinal tract. J Nutr. 2000;130: 1388-1392
Implementing the new recommendations on the clinical management of diarrhea: guidelines for policy makers and programme managers. World Health Organization, 2006 , chapter 2 , Page 4
Shinjini Bhatnagar,Nita Bhandari,U.C. Mouli,M.K. Bhan .Consensus Statement of IAP National Task Force: Status Report on Management of Acute Diarrhea.. Indian Pediatrics. April 2004;41:335-348
Gracey M. Diarrhea and malnutrition: a challenge for pediatricians. J Pediatr Gastro Nutr. 1996;22:6-16.,
Ahmed T, Ali M, Ullah MM, Choudhury IA, Haque ME, Salam MA, Rabbani GH, Suskind RM, Fuchs GJ. Mortality in severely malnourished children with diarrhea and use of a standardized management protocol. Lancet. 1999;353:1919-1922.
Roy SK, Behrens RH, Haider R, Akramuzzaman SM,Mahalanabis D, Wahed MA, Tomkins AM. Impact of zinc supplementation on intestinal permeability in Bangladeshi children with acute diarrhea and persistent diarrhea syndrome. JPediatr Gastro Nutr. 1992;15:289-296.
Alam AN, Sarker SA, Wahed MA, Khatun M, Rahaman MM. Enteric protein loss and intestinal permeability changes in children during acute shigellosis and after recovery: effect of zinc supplementation. Gut. 1994;35:1707-1711
Bhutta ZA, Nizami SQ, Isani Z. Zinc supplementation in malnourished children with persistent diarrhea in Pakistan. Pediatr.1999;103:e42.
Bhutta ZA, Black RE, Brown KH, Gardner JM, Gore S, Hidayat A, Khatun F, Martorell R, Ninh NX, Penny ME, Rosado JL, Roy, SK, Ruel M, Sazawal S, Shankar A. Prevention of diarrhea and pneumonia by zinc supplementation in children of developing countries: pooled analysis of randomized controlled trials. Zinc Investigators' Collaborative Group. J Pediatr. 1999;135:689-697.
Cui L, Takagi Y, Wasa M, Liboshi Y, Khan J, Nezu R, Okada A. Induction of nitric oxide synthase in rat intestine by interleukin-1a may explain diarrhea associated with zinc deficiency. J Nutr.1997;127:1729-1736.
Blanchard PK, Cousins RJ. Upregulation of rat intestinal uroguanylin mRNA by dietary zinc restriction. Am J Physiol. 1997; 272: G972-G978.
Wingertzahn MA, Rehman K, Wapnir RA. Nitric oxide (NO) scavenging in vitro by zinc (Zn) chelates. FASEB J.1999;13:A570
Sachdev HP, Mittal NK, Mittal SK, et al. A controlled trial on utility of oral zinc supplementation in acute dehydrating diarrhea in infants. J Pediatr Gastroenterol Nutr 1988;7:877Y81.
Strand TA, Chandyo RK, Bahl R, et al. Effectiveness and efficacy of zinc for the treatment of acute diarrhea in young children. Pediatrics 2002;109:898-903.
Roy SK, Tomkins AM, Akramuzzaman SM, et al. Randomized controlled trial of zinc supplementation in malnourished Bangladeshi children with acute diarrhea. Arch Dis Child 1997;77:196Y200.
Baqui AH, Black RE, El Arifeen S, et al. Effect of zinc supplementation started during diarrhea on morbidity and mortality in Bangladeshi children: community randomized trial. BMJ 2002; 325:1059.
Patel AB, Dhande LA, Rawat MS. Economic evaluation of zinc and copper use in treating acute diarrhea in children: a randomized controlled trial. Cost Eff Resour Alloc 2003;29:7.
WHO/UNICEF, WHO/UNICEF Joint Statement: Clinical Management of Acute Diarrhea. New York, NY, and Geneva, Switzerland: The United Nations Children's Fund/World Health Organization;2004:1Y8..
Zinc Investigators' Collaborative Group. Therapeutic effects of oral zinc in acute and persistent diarrhea in children in developing countries: pooled analysis of randomized controlled trials. AJCN 2000;72:1516-22
Zinc Investigators' Collaborative Group. Effect of zinc supplementation on clinical course of acute diarrhea. J Health Popul Nutr 2001;19(4):338-46.
Zinc Investigators' Collaborative Group. Prevention of diarrhea and pneumonia by zinc supplementation in children in developing countries: pooled analysis of randomized controlled trials. J Pediatr 1999;135:689-97.