Studies on infant diarrhea. II. Absorption of glucose and net fluxes of water and sodium chloride in a segment of the jejunum.

Torres-Pinedo, Ramón; Rivera, Cynthia; Fernández, Sergio Tomé

doi:10.1172/jci105496

Cited by 57 publications

(11 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The fluid loss in other types of diarrheal disorders may be produced by secretory processes similar to those in cholera. In this respect, the study of cholera, both in man and the animal models, may help in understanding the diarrhea associated with Escherichia coli (30), staphylococci (31), or other toxin-producing microorganisms. …”

Section: Discussionmentioning

confidence: 99%

Intestinal fluid and electrolyte transport in human cholera

Banwell¹,

Pierce²,

Mitra³

et al. 1970

J. Clin. Invest.

139

View full text Add to dashboard Cite

A B S T R A C T The site, nature, magnitude, and duration of fluid and electrolyte loss into the small intestine during the acute and recovery phase of human cholera was defined in 27 Indian patients. 11 subjects without cholera served as controls. The marker perfusion technique employed was shown, in preliminary experiments, to measure accurately jejunal and ileal fluid and electrolyte transmucosal transport rates under conditions of cholera diarrhea. Fluid loss into the lumen occurred from jejunal and ileal mucosa. The fluid was isotonic in both regions. Bicarbonate concentration was significantly higher in ileal than jejunal fluid during all phases of the disease. Bicarbonate concentration in both regions was significantly higher in acute cholera than during convalescence. Fluid loss into the intestinal lumen ranged from 0.07 to 10.9 ml/hr per cm. Losses were significantly greater from jejunum than ileum. Net ileal absorption was recorded in five of 10 acute cholera studies. During the acute phase of the disease, net jejunal fluid transport showed a positive correlation with fasting intestinal flow rate and stool output. Stool output was also positively correlated with jejunal fasting intestinal flow rates. Recovery of normal fluid and electrolyte absorptive function was usually complete in both jejunum and ileum by the sixth day after admission.These findings in human cholera validate the animal models of choleraic diarrhea and suggest that similar measurements of small intestinal secretory function in other nonspecific diarrheal diseases using the marker perfusion technique may be rewarding.A preliminary report of this study has already been presented (1).

show abstract

Section: Discussionmentioning

confidence: 99%

Intestinal fluid and electrolyte transport in human cholera

Banwell¹,

Pierce²,

Mitra³

et al. 1970

J. Clin. Invest.

139

View full text Add to dashboard Cite

show abstract

“…Torres-Pinedo, Rivera, Fernandez, and Maldonado (25), using a similar perfusion technique demonstrated that glucose absorption was impaired in the proximal jejunum of infants with enteropathogenic E. coli diarrhea. In the presence of a perfused glucose load the defect in glucose absorption resulted in a reduction in net absorption of fluid and electrolytes from the small intestine and an accumulation of osmotically active products in the lumen which induced fluid secretion.…”

Section: Intestinal Biopsiesmentioning

confidence: 90%

Acute undifferentiated human diarrhea in the tropics

Banwell¹,

Gorbach²,

Pierce³

et al. 1971

J. Clin. Invest.

View full text Add to dashboard Cite

A B S T R A C T The nature and magnitude of fluid and electrolyte loss into the small intestine were defined by the marker perfusion technique in patients with acute undifferentiated diarrhea (AUD) in the tropics. The patients were divided into two groups according to their small bowel bacteriologic findings, namely those with a predominant Esche'richia coli flora and those with a mixed flora. 11 normal subjects served as controls. Net jejunal fluid secretion occurred into the lumen in four of seven patients with E. coli flora and three of seven with a mixed flora. The magnitude of secretion in the jejunum was greater in the E. coli flora patients than in those with a mixed flora. Four E. coli patients and one mixed flora patient had net fluid secretion in the ileum, although the magnitude of secretion in this area was less than in the jejunum. Intestinal fluid had higher bicarbonate concentration in the ileum than in the jejunum but was isotonic in both regions. It resembled in composition fluid from the same region of intestine in normal individuals. Recovery of normal fluid and electrolyte absorptive function was usually complete in both jejunum and ileum by 6-8 days after onset of the disease. Increase in unidirectional flux rates for H30 and 'Na occurred in acute E. coli flora diarrhea and returned to normal levels in recovery: increase in Je (plasma to lumen flux) primarily accounted for the increase in fluid loss. Intestinal biopsy revealed no alterations in villous architecture.A relationship between small bowel fluid production and the presence of toxigenic strains of E. coli within the small bowel has been found for E. coli flora patients. In many respects this disease resembles acute cholera.The mixed flora group represents a less defined entity which requires further study.

show abstract

“…This reinforced Ingelfinger’s emphasis on the conjoint need for both sodium and glucose to facilitate absorption. John Banwell told me that my studies on malnutrition and gastroenteritis, together with those of Torres-Pinedo [9] in Puerto Rico (whom I visited during my studies), had justified him and his colleagues in Dhaka, Bangladesh to advocate the use of glucose/saline for children in the community with gastroenteritis as well as for their patients with cholera [10]. This has already saved 93% of deaths in clinical settings and probably many further millions in the community [11].…”

Section: Stimulating the Use Of Sugar/saline Treatment For Childhood mentioning

confidence: 99%

From Treating Childhood Malnutrition to Public Health Nutrition

James¹

2018

Ann Nutr Metab

View full text Add to dashboard Cite

Background: This analysis sets out an overview of an IUNS presentation of a European clinician’s assessment of the challenges of coping with immediate critical clinical problems and how to use metabolic and a mechanistic understanding of disease when developing nutritional policies. Summary: Critically ill malnourished children prove very sensitive to both mineral and general nutritional overload, but after careful metabolic control they can cope with a high-quality, energy-rich diet provided their initial lactase deficiency and intestinal atrophy are taken into account. Detailed intestinal perfusion studies also showed that gastroenteritis can be combatted by multiple frequent glucose/saline feeds, which has saved millions of lives. However, persisting pancreatic islet cell damage may explain our findings of pandemic rates of adult diabetes in Asia, the Middle East and Mexico and perhaps elsewhere including Africa and Latin America. These handicaps together with the magnitude of epigenetic changes emphasized the importance of a whole life course approach to nutritional policy making. Whole body calorimetric analyses of energy requirements allowed a complete revision of estimates for world food needs and detailed clinical experience showed the value of redefining stunting and wasting in childhood and the value of BMI for classifying appropriate adult weights, underweight and obesity. Lithium tracer studies of dietary salt sources should also dictate priorities in population salt-reduction strategies. Metabolic and clinical studies combined with meticulous measures of population dietary intakes now suggest the need for far more radical steps to lower the dietary goals for both free sugars and total dietary fat unencumbered by flawed cohort studies that neglect not only dietary errors but also the intrinsic inter-individual differences in metabolic responses to most nutrients. Key Messages: Detailed clinical and metabolic analyses of physiological responses combined with rigorous dietary and preferably biomarker of mechanistic pathways should underpin a new approach not only to clinical care but also to the development of more radical nutritional policies.

show abstract

Studies on infant diarrhea. II. Absorption of glucose and net fluxes of water and sodium chloride in a segment of the jejunum.

Cited by 57 publications

References 17 publications

Intestinal fluid and electrolyte transport in human cholera

Intestinal fluid and electrolyte transport in human cholera

Acute undifferentiated human diarrhea in the tropics

From Treating Childhood Malnutrition to Public Health Nutrition

Contact Info

Product

Resources

About