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<div class="Section1">
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS ゴシック"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
ロタウイルス感染症</span><span lang="EN-US" style=
"FONT-SIZE: 10pt; mso-fareast-font-family: "MS ゴシック""><br></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 10.5pt; mso-para-margin-left: 1.0gd"><span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
概念</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">:</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
乳児期に流行性に発生する嘔吐下痢症</span><span lang="EN-US"
style="FONT-SIZE: 10pt"><font face="Century">.</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
主に冬季にみられる</span><span lang="EN-US" style=
"FONT-SIZE: 10pt"><font face="Century">.<br></font></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 10pt; TEXT-INDENT: -10pt; mso-char-indent-count: -1.0">
<span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS ゴシック"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
病因・疫学</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">:</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
病因はロタウイルス</span> <span lang="EN-US" style=
"FONT-SIZE: 10pt"><font face="Century">(</font></span><span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">レオウイルス科</span><span lang="EN-US"
style="FONT-SIZE: 10pt"><font face="Century">2</font></span><span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">本鎖</span><span lang="EN-US"
style="FONT-SIZE: 10pt"><font face="Century">RNA</font></span><span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">ウイルス</span><span lang="EN-US"
style="FONT-SIZE: 10pt"><font face="Century">).</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
エンベロープなし</span><span lang="EN-US" style=
"FONT-SIZE: 10pt"><font face="Century">.</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
罹患年齢は乳幼児に多い</span><span lang="EN-US" style=
"FONT-SIZE: 10pt"><font face="Century">.</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
家族内</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
施設内感染が高率に起こる</span><span lang="EN-US" style=
"FONT-SIZE: 10pt"><font face="Century">.</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
成人も罹患</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">.</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
冬季にピーク</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">.</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
感染経路は便中のウイルスによる経口感染</span><span lang=
"EN-US" style="FONT-SIZE: 10pt"><font face="Century">.</font></span>
<span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
同様のウイルス感染はロタウイルスの他に</span><span lang=
"EN-US" style="FONT-SIZE: 10pt"><font face="Century">,</font></span>
<span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
ノーウォークウイルス</span><span lang="EN-US" style=
"FONT-SIZE: 10pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
カリシウイルス</span><span lang="EN-US" style=
"FONT-SIZE: 10pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
腸性アデノウイルスなどによって起こる</span><span lang="EN-US"
style="FONT-SIZE: 10pt"><font face="Century">.<br></font></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 10pt; TEXT-INDENT: -10pt; TEXT-ALIGN: right; mso-char-indent-count: -1.0"
align="right"><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">[</font></span><span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">写真は</span><span lang="EN-US"
style="FONT-SIZE: 10pt"><font face="Century">Wikipedia]<br></font></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 10.5pt; TEXT-INDENT: -10.5pt; mso-char-indent-count: -1.0">
<span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS ゴシック"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
症状</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">:</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
潜伏期</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">2-3</font></span><span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">日</span><span lang="EN-US"
style="FONT-SIZE: 10pt"><font face="Century">.</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
初発症状は頻回の嘔吐</span><span lang="EN-US" style=
"FONT-SIZE: 10pt"><font face="Century">.</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
発熱や鼻汁などの感冒症状を伴う</span><span lang="EN-US" style=
"FONT-SIZE: 10pt"><font face="Century">.</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
下痢は水様性</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
約</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">30%</font></span><span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">に米とぎ汁様の白色便が見られる</span><span lang="EN-US"
style="FONT-SIZE: 10pt"><font face="Century">.</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
下痢回数は</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">10</font></span><span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">回</span><span lang="EN-US"
style="FONT-SIZE: 10pt"><font face="Century">/</font></span><span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">日におよび</span><span lang="EN-US"
style="FONT-SIZE: 10pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
多くは脱水症状をともなう</span><span lang="EN-US" style=
"FONT-SIZE: 10pt"><font face="Century">.</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
下痢は</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">7-8</font></span><span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">日で治癒</span><span lang="EN-US"
style="FONT-SIZE: 10pt"><font face="Century">.</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
ときに痙攣や腸重積を合併</span><span lang="EN-US" style=
"FONT-SIZE: 10pt"><font face="Century">.<br></font></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 10pt; TEXT-INDENT: -10pt; mso-char-indent-count: -1.0">
<span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS ゴシック"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
診断</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">:</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
季節と臨床症状から診断できる</span><span lang="EN-US" style=
"FONT-SIZE: 10pt"><font face="Century">.</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
ただし細菌性下痢を見逃さないことが大切で</span><span lang=
"EN-US" style="FONT-SIZE: 10pt"><font face="Century">,</font></span>
<span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
診察医が観便を行うことが誤診防止につながる</span><span lang="EN-US"
style="FONT-SIZE: 10pt"><font face="Century">.</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
細菌培養は必須</span><span lang="EN-US" style=
"FONT-SIZE: 10pt"><font face="Century">.<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS ゴシック"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
治療</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">:</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
対症療法</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">.</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
補液・食事療法</span><span lang="EN-US" style=
"FONT-SIZE: 10pt"><font face="Century">.<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt; TEXT-ALIGN: right" align=
"right"><span lang="EN-US" style="FONT-SIZE: 8pt"><font face=
"Century">[</font></span><span style=
"FONT-SIZE: 8pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">阿部</span><span lang="EN-US"
style="FONT-SIZE: 8pt"><font face="Century">:</font></span> <span style=
"FONT-SIZE: 8pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
小児科学新生児学テキスト</span><span lang="EN-US" style=
"FONT-SIZE: 8pt"><font face="Century">]<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt; TEXT-ALIGN: right" align=
"right"><span lang="EN-US" style="FONT-SIZE: 8pt"><font face=
"Century">[</font></span><span style=
"FONT-SIZE: 8pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">横田</span><span lang="EN-US"
style="FONT-SIZE: 8pt"><font face="Century">:</font></span> <span style=
"FONT-SIZE: 8pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
小児の薬の使い方・選び方</span><span lang="EN-US" style=
"FONT-SIZE: 8pt"><font face="Century">]<br></font></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 10.5pt; TEXT-INDENT: -10.5pt; mso-char-indent-count: -1.05">
<span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS ゴシック"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
予防</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face="Century">:
In a report issued February 3rd, 2006, the U.S. FDA approved a live, oral
vaccine (RotaTeq") for use in children. The Advisory Committee on Immunization
Practices voted to recommend a newly licensed vaccine to protect against
rotavirus. <span style=
"mso-spacerun: yes"> </span>[CDC]<br></font></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 10.5pt; TEXT-INDENT: -10.5pt; mso-char-indent-count: -1.05">
</p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><b style=
"mso-bidi-font-weight: normal"><span lang="EN-US" style=
"FONT-SIZE: 10pt"><font face="Century">QUESTIONS<br></font></span></b></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"></p>
</div>
<span lang="EN-US" style=
"FONT-SIZE: 10pt; FONT-FAMILY: Century; mso-fareast-font-family: "MS 明朝"; mso-bidi-font-family: "Times New Roman"; mso-font-kerning: 1.0pt; mso-ansi-language: EN-US; mso-fareast-language: JA; mso-bidi-language: AR-SA"><br style="PAGE-BREAK-BEFORE: auto; mso-break-type: section-break"
clear="all"></span>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><font face="Century"><b style=
"mso-bidi-font-weight: normal"><span lang="EN-US" style=
"FONT-SIZE: 10pt">9</span></b> <span lang="EN-US" style="FONT-SIZE: 10pt">Since
JPs moderately dehydrated, the following schedule is
recommended:<br></span></font></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 10pt"><font face="Century">a. Rehydration phase with ORS: Pedialyte
1450 mL (100 mL/kg based on wt before diarrhea) within 4-6
hr<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 10pt"><font face="Century">b. Maintenance phase with ORS: Pedialyte
145 mL (10 mL/kg) for each diarrheal stool (not to exceed 150
mL/kg/day)<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 10pt"><font face="Century">c. Start feeding and advance as
tolerated as described in the SOA<span style=
"BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 0mm; BORDER-TOP: windowtext 1pt solid; PADDING-LEFT: 0mm; PADDING-BOTTOM: 0mm; BORDER-LEFT: windowtext 1pt solid; PADDING-TOP: 0mm; BORDER-BOTTOM: windowtext 1pt solid; mso-border-alt: solid windowtext .5pt">P</span>
report;<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><font face="Century"><b style=
"mso-bidi-font-weight: normal"><span lang="EN-US" style=
"BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 0mm; BORDER-TOP: windowtext 1pt solid; PADDING-LEFT: 0mm; FONT-SIZE: 10pt; PADDING-BOTTOM: 0mm; BORDER-LEFT: windowtext 1pt solid; PADDING-TOP: 0mm; BORDER-BOTTOM: windowtext 1pt solid; mso-border-alt: solid windowtext .5pt">
P</span></b><b style="mso-bidi-font-weight: normal"><span lang="EN-US" style=
"FONT-SIZE: 10pt">: Problem 1: Viral Gastroenteritis<br></span></b></font></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
・</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face="Century">Oral
rehydration solution with Pedialyte<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
・</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">Monitor <u>frequency of stools</u><br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
・</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">Monitor <u>weight</u><br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
・</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">Monitor <u>Na<sup>+</sup>, K<sup>+</sup>, HCO<sub>3</sub>, and
glucose</u><br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
・</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face="Century">Start
feedings initially with easily digested foods such as <u>bananas, applesauce,
and cereal, and advance as tolerated</u><br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
・</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">Subsequent foods can include <u>complex carbohydrates (potatoes,
bread), lean meats</u>, <u>yogurt, vegetables, and fresh
fruits</u><br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
・</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face="Century">Avoid
<u style="text-underline: wave">free water, caffeine, carbonated soft drinks,
hyperosmolar fruit juices</u> (i.e., specifically apple juice since this is
what JP has been consuming), and <u style="text-underline: wave">foods high in
simple sugars and fats</u><br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><b style=
"mso-bidi-font-weight: normal"><span lang="EN-US" style=
"FONT-SIZE: 10pt"><font face="Century">Problem 2:
Dehydration<br></font></span></b></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
・</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">Supportive care as outlined above<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
・</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">Counsel parents on how to monitor for JP's condition (i.e., keep
records of stool counts, oral intake, and JP's mental
alertness)<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
・</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">Recommend that parents bring JP back to clinic if he continues to
produce frequent large-volume, watery stools<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><font face="Century"><b style=
"mso-bidi-font-weight: normal"><span lang="EN-US" style=
"FONT-SIZE: 9pt">Pedialyte</span></b><sup><span lang="EN-US" style=
"FONT-SIZE: 9pt">
<div class="Section1">
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS ゴシック"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
ロタウイルス感染症</span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
<font face="Arial">概念</font></span><span lang="EN-US" style=
"FONT-SIZE: 10pt"><font face="Century">:</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
乳児期に流行性に発生する嘔吐下痢症</span><span lang="EN-US"
style="FONT-SIZE: 10pt"><font face="Century">.</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
主に冬季にみられる</span><span lang="EN-US" style=
"FONT-SIZE: 10pt"><font face="Century">.<br></font></span><span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS ゴシック"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">病因・疫学</span><span lang="EN-US"
style="FONT-SIZE: 10pt"><font face="Century">:</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
病因はロタウイルス</span> <span lang="EN-US" style=
"FONT-SIZE: 10pt"><font face="Century">(</font></span><span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">レオウイルス科</span><span lang="EN-US"
style="FONT-SIZE: 10pt"><font face="Century">2</font></span><span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">本鎖</span><span lang="EN-US"
style="FONT-SIZE: 10pt"><font face="Century">RNA</font></span><span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">ウイルス</span><span lang="EN-US"
style="FONT-SIZE: 10pt"><font face="Century">).</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
エンベロープなし</span><span lang="EN-US" style=
"FONT-SIZE: 10pt"><font face="Century">.</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
罹患年齢は乳幼児に多い</span><span lang="EN-US" style=
"FONT-SIZE: 10pt"><font face="Century">.</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
家族内</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
施設内感染が高率に起こる</span><span lang="EN-US" style=
"FONT-SIZE: 10pt"><font face="Century">.</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
成人も罹患</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">.</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
冬季にピーク</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">.</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
感染経路は便中のウイルスによる経口感染</span><span lang=
"EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">.</font></span><span style="FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">同様のウイルス感染はロタウイルスの他に</span><span lang="EN-US"
style="FONT-SIZE: 10pt"><font face="Century">,</font></span><span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">ノーウォークウイルス</span><span lang="EN-US"
style="FONT-SIZE: 10pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
カリシウイルス</span><span lang="EN-US" style=
"FONT-SIZE: 10pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
腸性アデノウイルスなどによって起こる</span><span lang="EN-US"
style="FONT-SIZE: 10pt"><font face="Century">.<br></font></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 10pt; TEXT-INDENT: -10pt; TEXT-ALIGN: right; mso-char-indent-count: -1.0"
align="right"><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">[</font></span><span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">写真は</span><span lang="EN-US"
style="FONT-SIZE: 10pt"><font face="Century">Wikipedia]<br></font></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 10.5pt; TEXT-INDENT: -10.5pt; mso-char-indent-count: -1.0">
<span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS ゴシック"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
症状</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">:</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
潜伏期</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">2-3</font></span><span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">日</span><span lang="EN-US"
style="FONT-SIZE: 10pt"><font face="Century">.</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
初発症状は頻回の嘔吐</span><span lang="EN-US" style=
"FONT-SIZE: 10pt"><font face="Century">.</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
発熱や鼻汁などの感冒症状を伴う</span><span lang="EN-US" style=
"FONT-SIZE: 10pt"><font face="Century">.</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
下痢は水様性</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
約</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">30%</font></span><span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">に米とぎ汁様の白色便が見られる</span><span lang="EN-US"
style="FONT-SIZE: 10pt"><font face="Century">.</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
下痢回数は</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">10</font></span><span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">回</span><span lang="EN-US"
style="FONT-SIZE: 10pt"><font face="Century">/</font></span><span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">日におよび</span><span lang="EN-US"
style="FONT-SIZE: 10pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
多くは脱水症状をともなう</span><span lang="EN-US" style=
"FONT-SIZE: 10pt"><font face="Century">.</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
下痢は</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">7-8</font></span><span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">日で治癒</span><span lang="EN-US"
style="FONT-SIZE: 10pt"><font face="Century">.</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
ときに痙攣や腸重積を合併</span><span lang="EN-US" style=
"FONT-SIZE: 10pt"><font face="Century">.<br></font></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 10pt; TEXT-INDENT: -10pt; mso-char-indent-count: -1.0">
<span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS ゴシック"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
診断</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">:</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
季節と臨床症状から診断できる</span><span lang="EN-US" style=
"FONT-SIZE: 10pt"><font face="Century">.</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
ただし細菌性下痢を見逃さないことが大切で</span><span lang=
"EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">,</font></span><span style="FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">診察医が観便を行うことが誤診防止につながる</span><span lang="EN-US"
style="FONT-SIZE: 10pt"><font face="Century">.</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
細菌培養は必須</span><span lang="EN-US" style=
"FONT-SIZE: 10pt"><font face="Century">.<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS ゴシック"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
治療</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">:</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
対症療法</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">.</font></span> <span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
補液・食事療法</span><span lang="EN-US" style=
"FONT-SIZE: 10pt"><font face="Century">.<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt; TEXT-ALIGN: right" align=
"right"><span lang="EN-US" style="FONT-SIZE: 8pt"><font face=
"Century">[</font></span><span style=
"FONT-SIZE: 8pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">阿部</span><span lang="EN-US"
style="FONT-SIZE: 8pt"><font face="Century">:</font></span> <span style=
"FONT-SIZE: 8pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
小児科学新生児学テキスト</span><span lang="EN-US" style=
"FONT-SIZE: 8pt"><font face="Century">]<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt; TEXT-ALIGN: right" align=
"right"><span lang="EN-US" style="FONT-SIZE: 8pt"><font face=
"Century">[</font></span><span style=
"FONT-SIZE: 8pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">横田</span><span lang="EN-US"
style="FONT-SIZE: 8pt"><font face="Century">:</font></span> <span style=
"FONT-SIZE: 8pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
小児の薬の使い方・選び方</span><span lang="EN-US" style=
"FONT-SIZE: 8pt"><font face="Century">]<br></font></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 10.5pt; TEXT-INDENT: -10.5pt; mso-char-indent-count: -1.05">
<span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS ゴシック"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
予防</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">:In a report issued February 3rd, 2006, the U.S. FDA approved a live,
oralvaccine (RotaTeq") for use in children. The Advisory Committee on
ImmunizationPractices voted to recommend a newly licensed vaccine to protect
againstrotavirus. <span style=
"mso-spacerun: yes"> </span>[CDC]<br></font></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 10.5pt; TEXT-INDENT: -10.5pt; mso-char-indent-count: -1.05">
</p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><b style=
"mso-bidi-font-weight: normal"><span lang="EN-US" style=
"FONT-SIZE: 10pt"><font face="Century">QUESTIONS<br></font></span></b></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"></p>
</div>
<span lang="EN-US" style=
"FONT-SIZE: 10pt; FONT-FAMILY: Century; mso-fareast-font-family: "MS 明朝"; mso-bidi-font-family: "Times New Roman"; mso-font-kerning: 1.0pt; mso-ansi-language: EN-US; mso-fareast-language: JA; mso-bidi-language: AR-SA"><br style="PAGE-BREAK-BEFORE: auto; mso-break-type: section-break"
clear="all"></span>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><font face="Century"><b style=
"mso-bidi-font-weight: normal"><span lang="EN-US" style=
"FONT-SIZE: 10pt">9</span></b> <span lang="EN-US" style=
"FONT-SIZE: 10pt">SinceJPs moderately dehydrated, the following schedule
isrecommended:<br></span></font></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 10pt"><font face="Century">a. Rehydration phase with ORS:
Pedialyte1450 mL (100 mL/kg based on wt before diarrhea) within
4-6hr<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 10pt"><font face="Century">b. Maintenance phase with ORS:
Pedialyte145 mL (10 mL/kg) for each diarrheal stool (not to exceed
150mL/kg/day)<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 10pt"><font face="Century">c. Start feeding and advance astolerated
as described in the SOA<span style=
"BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 0mm; BORDER-TOP: windowtext 1pt solid; PADDING-LEFT: 0mm; PADDING-BOTTOM: 0mm; BORDER-LEFT: windowtext 1pt solid; PADDING-TOP: 0mm; BORDER-BOTTOM: windowtext 1pt solid; mso-border-alt: solid windowtext .5pt">P</span>report;<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><font face="Century"><b style=
"mso-bidi-font-weight: normal"><span lang="EN-US" style=
"BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 0mm; BORDER-TOP: windowtext 1pt solid; PADDING-LEFT: 0mm; FONT-SIZE: 10pt; PADDING-BOTTOM: 0mm; BORDER-LEFT: windowtext 1pt solid; PADDING-TOP: 0mm; BORDER-BOTTOM: windowtext 1pt solid; mso-border-alt: solid windowtext .5pt">
P</span></b><b style="mso-bidi-font-weight: normal"><span lang="EN-US" style=
"FONT-SIZE: 10pt">: Problem 1: Viral Gastroenteritis<br></span></b></font></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
・</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">Oralrehydration solution with Pedialyte<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
・</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">Monitor <u>frequency of stools</u><br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
・</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">Monitor <u>weight</u><br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
・</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">Monitor <u>Na<sup>+</sup>, K<sup>+</sup>, HCO<sub>3</sub>,
andglucose</u><br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
・</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">Startfeedings initially with easily digested foods such as
<u>bananas, applesauce,and cereal, and advance as
tolerated</u><br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
・</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">Subsequent foods can include <u>complex carbohydrates
(potatoes,bread), lean meats</u>, <u>yogurt, vegetables, and
freshfruits</u><br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
・</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">Avoid<u style="text-underline: wave">free water, caffeine, carbonated
soft drinks,hyperosmolar fruit juices</u> (i.e., specifically apple juice since
this iswhat JP has been consuming), and <u style="text-underline: wave">foods
high insimple sugars and fats</u><br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><b style=
"mso-bidi-font-weight: normal"><span lang="EN-US" style=
"FONT-SIZE: 10pt"><font face="Century">Problem
2:Dehydration<br></font></span></b></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
・</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">Supportive care as outlined above<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
・</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">Counsel parents on how to monitor for JP's condition (i.e.,
keeprecords of stool counts, oral intake, and JP's
mentalalertness)<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span style=
"FONT-SIZE: 10pt; FONT-FAMILY: "MS 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
・</span><span lang="EN-US" style="FONT-SIZE: 10pt"><font face=
"Century">Recommend that parents bring JP back to clinic if he continues
toproduce frequent large-volume, watery stools<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><font face="Century"><b style=
"mso-bidi-font-weight: normal"><span lang="EN-US" style=
"FONT-SIZE: 9pt">Pedialyte</span></b><sup><span lang="EN-US" style=
"FONT-SIZE: 9pt">�</span></sup></font> <span lang="EN-US" style=
"FONT-SIZE: 9pt; FONT-FAMILY: Arial">Oral Electrolyte Maintenance
Solution---</span> <span lang="EN-US" style=
"FONT-SIZE: 9pt; FONT-FAMILY: Arial">InLiters, Freezer Pops, and Singles,
Pedialyte comes in multiple kid-pleasingflavors.<br></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt; TEXT-ALIGN: right" align=
"right"><font face="Century"><span lang="EN-US" style=
"FONT-SIZE: 9pt">[</span></font><span lang="EN-US" style=
"FONT-SIZE: 9pt; FONT-FAMILY: "Courier New"">http://www.pedialyte.com</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">]<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><font face="Century"><b style=
"mso-bidi-font-weight: normal"><span lang="EN-US" style=
"FONT-SIZE: 10pt">10</span></b><span lang="EN-US" style=
"FONT-SIZE: 10pt">.Instructions to JP's mom:<br></span></font></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 10pt"><font face="Century">a. Attempt to give the recommendedvolume
of ORS to JP without forcing him to drink the solution to
avoidaspiration<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 10pt"><font face="Century">b. Do not give JP any <u style=
"text-underline: wave">antidiarrheal agent</u><br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 10pt"><font face="Century">c. Avoid <u style=
"text-underline: wave">apple juice</u> until
diarrheaabates<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 10pt"><font face="Century">d. Return to clinic if JP continues
toproduce frequent large-volume, watery stools<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 10pt"><font face="Century">e. Touch his lips to see if they are
nolonger dry and rough<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><font face="Century"><b style=
"mso-bidi-font-weight: normal"><span lang="EN-US" style=
"FONT-SIZE: 10pt">11</span></b><span lang="EN-US" style=
"FONT-SIZE: 10pt">.Psychosocial factors to consider relative to JP's
outcomeinclude:<br></span></font></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 10pt"><font face="Century">a. Assure JP's mom that her child
willrespond well if he can consume adequate oral fluid intake with Pedialyte
asdescribed previously<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 10pt"><font face="Century">b. Ascertain if mom, dad, or a
caretakerfamiliar with JP can care for him during this bout of viral
gastroenteritisbecause JP will not be able to attend day
care<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 10pt"><font face="Century">c. Make sure parents are
knowledgeableabout how to monitor JP's conditions by keeping records of stool
counts, oralintake, child's mental alertness<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 10pt"><font face="Century">d. Reassure mom that she should
nothesitate to call you or the clinic if she has
anyquestions<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"></p>