Evaluation of clinical, demographic, laboratory and treatment characteristics of patients with acute gastroenteritis at Adnan Menderes University Faculty of Medicine

Acute gastroenteritis (AGE) is a major health problem worldwide, especially in developing, low and middle income countries. It is the third leading cause of mortality in children under 5 years of age worldwide. According to World Health Organization (WHO) data, approximately 1.7 billion cases of childhood diarrhea occur each year, and approximately 443,832 children under the age of five die. The aim of this study was to evaluate the demographic and clinical characteristics and laboratory data of pediatric patients admitted with the diagnosis of acute gastroenteritis and to compare the trace element levels of the patient group with the control group. In addition, to gain a new perspective in the treatment and management of acute gastroenteritis with the results obtained. In our study, 79 patients between the ages of 6 months and 5 years, who were diagnosed with AGE between August 31, 2022 and September 1, 2023 at Aydın Adnan Menderes University Faculty of Medicine, Department of Pediatric Infectious Diseases, who had no chronic disease nor continuous medication, who had not used antibiotics nor probiotics in the last month, and 40 healthy children without any complaints were included. Socio-demographic information, anthropometric measurements, number and duration of diarrhea and vomiting, fever, anorexia and abdominal pain were recorded. Patients were asked about the time of starting supplementary food, duration of breastfeeding, rotavirus vaccination status, children attending kindergarten in the same household, hygiene behaviors, average monthly income, number of toilets and presence of toilets outside the home. Clinical Dehydration Scale (CDS) and Modified Vesikari Scoring (MVS) scales were used to standardize the level of dehydration and severity of diarrhea. Complete blood count, blood gas, renal function tests, CRP level and stool tests for etiology were performed on admission. Routine serum electrolyte levels (sodium, potassium, chlorine) were checked for possible electrolyte imbalance, and trace element xiv levels (aluminum, arsenic, cadmium, cobalt, manganese, nickel, copper, molybdenum, selenium, zinc and iron) were determined by ICP-MS method. It was evaluated using an Agilent 5800 ICP-OES instrument. There was no difference between the two groups in terms of age and gender. The average income of the patient group was higher. Rotavirus vaccine was administered to a larger proportion of the patient group. The most common complaints were diarrhea, anorexia and vomiting. The mean MVS score was 8.1±3.2 and 27 (34.2%) patients had severe diarrhea. The mean CDS score was 1.9 and severe dehydration was observed in 7(8.8%) cases. Seventy (88.6%) patients had no causative agent in their stool. The most common agent was rotavirus (n=5, 6.3%). In our study, creatinine, CRP, serum aluminum and manganese levels were significantly higher in the cases compared to the control group, whereas pH and HCO3 in blood gases and serum sodium, chlorine, magnesium, copper, molybdenum and zinc levels were found to be lower. In our study, the distribution of dehydration according to the CDS and MVS scales was different from each other and this revealed the need for further studies on the scoring used in the classification of dehydration. Although the rotavirus vaccination rate in our study was lower than the rates in developed countries, it was found to be higher compared to previous Turkish studies. Rotavirus vaccination was thought to affect the distribution of the causative agent detected in the stool. In our study, zinc levels were compatible with the literature and we supported the literature with current data. Aluminum and manganese levels were found to be high in the case group. These results may be due to dehydration caused by diarrhea or high dietary intake, or they may be due to intestinal mucosal damage that develops in inflammatory bowel diseases in the literature. Copper level was found to be low in the case group, but there are results in the literature contrary to our study. This situation showed that more studies should be done in terms of the need for copper replacement in diarrhea. The low level of molybdenum in the case group is valuable in terms of the lack of studies on this subject in the literature. Molybdenum has only been used in the treatment of inflammatory bowel disease and has been shown to reduce colitis. Our study has been both a source and a light to the literature on trace elements in acute gastroenteritis. Further studies on trace element levels and their effects in acute gastroenteritis are needed.