Elevation of the serum sodium concentration has been recognized as a frequent phenomenon in the fluid and electrolyte imbalances accompanying infant diarrhea.* Its importance is indicated by the fact that the mortality rate in such cases is five times that of patients with normal or low sodium concentration.2 Recognition of the disturbance is more difficult than the diarrheal imbalances in which salt depletion is prominent.Marked disturbances of the central nervous system occur. Fluid and electrolyte management during repair is difficult.Our experience with patients with diarrhea and hypernatremia has led us to con-clude that two mechanisms, singly or together, are the causes of the disturbance. These are (a) profound water depletion with hyperosmolarity of which the hypernatremia is a part and (b) sodium administration in excess of the excretory capacity of the kidney.This report will present the clinical problem as manifested in a number of patients, and discuss the pathogenesis and repair of the disturbance.Submitted for publication May 20, 1956; accepted May 23, 1956. Trainee, National Institute of Arthritis and Metabolic Diseases, 1954Diseases, -1955 (Table 2)
ObjectivesThis review aimed to provide an overview of the prevalence of undernutrition in children under 5 years old in refugee camps according to the different indicators. In addition, we aimed to evaluate the quality and quantity of relevant epidemiological data available.DesignWe used a systematic review of prevalence study design to achieve the above aims. We sought eligible observational studies through database searching of OVID Medline, CAB Global Health, Scopus and PubMed; citation chasing; and grey literature searching.SettingThe setting of interest was refugee camps across the globe.ParticipantsParticipants in the studies included in the review were children under 5 years old.Primary and secondary outcome measuresOutcome measures of interest were the prevalence of wasting, global acute malnutrition, stunting and underweight.ResultsThe review included 33 cross-sectional studies in 86 sites and a total of 36 750 participants. Overall, the quality of the studies was moderate to high, but some reports lacked clarity around data collection or outcome definitions. The results showed a wide variation in prevalence estimates across the different indicators and between different refugee camps. The median prevalence estimates of global acute malnutrition based on weight-for-height z-score, stunting and underweight were 7.1%, 23.8% and 16.7%, respectively. Using weight-for-height z-score identified a higher prevalence of acute malnutrition than using mid-upper arm circumference in the majority of studies.ConclusionsAcute malnutrition remains a public health problem in many refugee camps, but chronic malnutrition has a high prevalence in more locations. Research and policy must, therefore, focus not only on nutrition but also on the wider determinants of both acute and chronic undernutrition. The difference in prevalence of global acute malnutrition depending on the measure used has implications for screening and diagnosis.
An international ship crew presented for medical care in Saint John, New Brunswick, following rapid onset of gastrointestinal and in some cases neurological and cardiac symptoms after a common fish meal. Ciguatera poisoning was identified as the cause of illness. This report describes the public health investigation and management of this incident, including collaboration between the implicated provincial and federal authorities.
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