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Boresi , Richard J. Boresi, Richard J. Advanced Mechanics of Materials and Elasticity. Boresi, et al. Resources: Course notes and Mechanics of Materials, 3rd Ed. Course Objectives:. Boresi, R. Schmidt, and O. Sidebottom , Advanced Mechanics of.
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Book download link provided by Notesvarsity. Boresi and Richard J Advanced Mechanics of Materials and Applied In children with severe malnutrition, it is often impossible to reliably distinguish between moderate and severe dehydration. A severely malnourished child who has signs of severe dehydration but who does not have a history of watery diarrhea should be treated for septic shock.
WHO recommends 10 milliliters of ReSoMal per kilogram body weight for each of the first two hours for example, a 9-kilogram child should be given 90 ml of ReSoMal over the course of the first hour, and another 90 ml for the second hour and then continuing at this same rate or slower based on the child's thirst and ongoing stool losses, keeping in mind that a severely dehydrated child may be lethargic. If the child drinks poorly, a nasogastric tube should be used.
The IV route should not be used for rehydration except in cases of shock and then only with care, infusing slowly to avoid flooding the circulation and overloading the heart. For an initial cereal diet before a child regains his or her full appetite, WHO recommends combining 25 grams skimmed milk powder, 20 grams vegetable oil, 60 grams sugar, and 60 grams rice powder or other cereal into 1, milliliters water and boiling gently for five minutes.
Give ml per kilogram of body weight during per 24 hours. A child who cannot or will not eat this minimum amount should be given the diet by nasogastric tube divided into six equal feedings. Later on, the child should be given cereal made with a greater amount of skimmed milk product and vegetable oil and slightly less sugar.
As appetite fully returns, the child should be eating ml per kilogram of body weight per day. Zinc, potassium, vitamin A, and other vitamins and minerals should be added to both recommended cereal products, or to the oral rehydration solution itself.
Children who are breastfed should continue breastfeeding. In addition, hospitalized children should be checked daily for other specific infections. A healthy individual secretes — milligrams of sodium per day into the intestinal lumen.
Nearly all of this is reabsorbed so that sodium levels in the body remain constant. In a diarrheal illness, sodium-rich intestinal secretions are lost before they can be reabsorbed. This can lead to life-threatening dehydration or electrolyte imbalances within hours when fluid loss is severe. The objective of therapy is the replenishment of sodium and water losses by ORT or intravenous infusion.
The first is via intestinal epithelial cells enterocytes. Sodium passes into these cells by co-transport with glucose, via the SGLT1 protein.
From the intestinal epithelial cells, sodium is pumped by active transport via the sodium-potassium pump through the basolateral cell membrane into the extracellular space.
This creates a "downhill" sodium gradient within the cell. SGLT proteins use energy from this downhill sodium gradient to transport glucose across the apical membrane of the cell against the glucose gradient. The co-transporters are examples of secondary active transport. The GLUT uniporters then transport glucose across the basolateral membrane.
The co-transport of glucose into epithelial cells via the SGLT1 protein requires sodium. Two sodium ions and one molecule of glucose or galactose are transported together across the cell membrane via the SGLT1 protein.
Without glucose, intestinal sodium is not absorbed. This is why oral rehydration salts include both sodium and glucose. For each cycle of the transport, hundreds of water molecules move into the epithelial cell to maintain osmotic equilibrium. The resultant absorption of sodium and water can achieve rehydration even while diarrhea continues.
In , the definition changed to encompass recommended home-made solutions, because the official preparation was not always readily available.
The definition was again amended in to include continued feeding as an appropriate associated therapy. In , the definition became, "an increase in administered hydrational fluids " and in , "an increase in administered fluids and continued feeding". Until , ORT was not known in the West. Dehydration was a major cause of death during the cholera pandemic in Russia and Western Europe.
In , William Brooke O'Shaughnessy noted the loss of water and salt in the stool of people with cholera and prescribed intravenous fluid therapy IV fluids. The prescribing of hypertonic IV therapy decreased the mortality rate of cholera from 70 to 40 percent.
In the West, IV therapy became the "gold standard" for the treatment of moderate and severe dehydration. Robert A. Phillips attempted to create an effective ORT solution based on his discovery that, in the presence of glucose, sodium and chloride could be absorbed in patients with cholera.
However, Phillips' efforts failed because the solution he used was excessively hypertonic.
Crane described the sodium - glucose co-transport mechanism and its role in intestinal glucose absorption. This supported the notion that oral rehydration might be possible even during severe diarrhea due to cholera.