Kukuruzovic R; Brewster DR; Gray E; Anstey NM

Author(s)

Kukuruzovic R

Brewster DR

Gray E

Anstey NM

Publication Date

2003-01

Abstract

Australian Aboriginal children hospitalized with diarrhoeal disease have severe manifestations with acidosis, hypokalaemia, osmotic diarrhoea and abnormal small bowel permeability. Nitric oxide (NO) production is increased in diarrhoeal disease, but its relationship to mucosal function and diarrhoeal complications is not known. We examined the relationship between NO production and complications of acute diarrhoea in Aboriginal and non-Aboriginal children between February 1998 and February 2000. We enrolled 318 children admitted to Royal Darwin Hospital into one of three groups: acute diarrhoea, non-diarrhoeal controls with no inflammatory illness, and non-diarrhoeal controls with inflammatory illness. Nitric oxide production was measured by urine nitrate-creatinine (NOx/Cr) excretion on a low nitrate diet. Small bowel intestinal permeability was measured by the lactulose-rhamnose (L/R) ratio on a timed blood specimen. The NOx/Cr ratios were markedly elevated in Aboriginal diarrhoeal cases (geometric mean [GM] = 1.23, 95% confidence interval [95% CI] 1.07-1.44), lowest in non-Aboriginal non-inflammatory controls (GM = 0.13, 95% CI 0.10-0.16) and intermediate in all other groups (GM = 0.35, 95% CI 0.28-0.43). Convalescent levels (day 5) in the Aboriginal diarrhoeal group (GM = 1.02, 95% CI 0.82-1.28) were slower to fall than L/R ratios. Multivariate analysis in the diarrhoeal group indicated that high NO production was associated with abnormal permeability, hypokalaemia and malnutrition, but not with the severity of diarrhoea, acidosis or osmotic diarrhoea. We concluded that increased NO production may contribute to impaired mucosal barrier function and hypokalaemia in acute gastroenteritis, which may be the cost of the known gut-protective and antimicrobial effects mediated by NO in acute intestinal inflammation.

Affiliation

Northern Territory Clinical School, Flinders University, Royal Darwin Hospital, P.O. Box 41326, Casuarina, Darwin, NT 0811, Australia..

Citation

Transactions of the Royal Society of Tropical Medicine and Hygiene 2003 Jan-Feb; 97(1): 115-20

ISSN

0035-9203

Pubmed ID

https://pubmed.ncbi.nlm.nih.gov/12886817/?otool=iaurydwlib

Link

https://hdl.handle.net/10137/5855

MESH subject

Acute Disease

Diarrhea

Humans

Hypokalemia

Infant

Intestinal Absorption

Logistic Models

Nitrates

Nitric Oxide

Nitrites

Northern Territory

Nutrition Disorders

Nutritional Status

Oceanic Ancestry Group

Permeability

Regression Analysis

Title

Increased nitric oxide production in acute diarrhoea is associated with abnormal gut permeability, hypokalaemia and malnutrition in tropical Australian aboriginal children.

Type of document

Journal Article

Entity Type

Publication

Author(s)	Kukuruzovic R Brewster DR Gray E Anstey NM
Publication Date	2003-01
Abstract	Australian Aboriginal children hospitalized with diarrhoeal disease have severe manifestations with acidosis, hypokalaemia, osmotic diarrhoea and abnormal small bowel permeability. Nitric oxide (NO) production is increased in diarrhoeal disease, but its relationship to mucosal function and diarrhoeal complications is not known. We examined the relationship between NO production and complications of acute diarrhoea in Aboriginal and non-Aboriginal children between February 1998 and February 2000. We enrolled 318 children admitted to Royal Darwin Hospital into one of three groups: acute diarrhoea, non-diarrhoeal controls with no inflammatory illness, and non-diarrhoeal controls with inflammatory illness. Nitric oxide production was measured by urine nitrate-creatinine (NOx/Cr) excretion on a low nitrate diet. Small bowel intestinal permeability was measured by the lactulose-rhamnose (L/R) ratio on a timed blood specimen. The NOx/Cr ratios were markedly elevated in Aboriginal diarrhoeal cases (geometric mean [GM] = 1.23, 95% confidence interval [95% CI] 1.07-1.44), lowest in non-Aboriginal non-inflammatory controls (GM = 0.13, 95% CI 0.10-0.16) and intermediate in all other groups (GM = 0.35, 95% CI 0.28-0.43). Convalescent levels (day 5) in the Aboriginal diarrhoeal group (GM = 1.02, 95% CI 0.82-1.28) were slower to fall than L/R ratios. Multivariate analysis in the diarrhoeal group indicated that high NO production was associated with abnormal permeability, hypokalaemia and malnutrition, but not with the severity of diarrhoea, acidosis or osmotic diarrhoea. We concluded that increased NO production may contribute to impaired mucosal barrier function and hypokalaemia in acute gastroenteritis, which may be the cost of the known gut-protective and antimicrobial effects mediated by NO in acute intestinal inflammation.
Affiliation	Northern Territory Clinical School, Flinders University, Royal Darwin Hospital, P.O. Box 41326, Casuarina, Darwin, NT 0811, Australia..
Citation	Transactions of the Royal Society of Tropical Medicine and Hygiene 2003 Jan-Feb; 97(1): 115-20
ISSN	0035-9203
Pubmed ID	https://pubmed.ncbi.nlm.nih.gov/12886817/?otool=iaurydwlib
Link	https://hdl.handle.net/10137/5855
MESH subject	Acute Disease Diarrhea Humans Hypokalemia Infant Intestinal Absorption Logistic Models Nitrates Nitric Oxide Nitrites Northern Territory Nutrition Disorders Nutritional Status Oceanic Ancestry Group Permeability Regression Analysis
Title	Increased nitric oxide production in acute diarrhoea is associated with abnormal gut permeability, hypokalaemia and malnutrition in tropical Australian aboriginal children.
Type of document	Journal Article
Entity Type	Publication

Increased nitric oxide production in acute diarrhoea is associated with abnormal gut permeability, hypokalaemia and malnutrition in tropical Australian aboriginal children.

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