Clinical Research Directory

Rapid Rehydration for Severe Hypernatremia

The goal of this study is to show the feasibility of rapid identification, consenting, randomization, treatment, and follow-up of patients with severe hypernatremia (Na ≥ 155 mEq/L). The investigators plan to randomize 80 patients with severe hypernatremia to rapid hydration (aiming for a correction rate of 18m Eq/L/24h) versus standard of care therapy. The aim of this study is to show the feasibility of the proposed protocol and to collect preliminary safety and efficacy data to inform a subsequent multicenter RCT powered to assess the effect of rapid hydration of patients with severe hypernatremia on 30-day survival.

Hypernatremia Fluid Therapy in Childhood Diarrhoea

Hypernatremic dehydration is a life-threatening condition, particularly in children under two years of age, with mortality rates reaching up to as high as 19%. Infants are highly susceptible due to immature renal function, increased insensible water loss, and limited ability to express thirst. Severe hypernatremia can cause cerebral complications such as brain shrinkage, haemorrhage, seizures, paralysis, and encephalopathy. Furthermore, rapid or improperly managed fluid and electrolyte treatment can increase the risk of cerebral oedema and death. Although gradual sodium correction is widely recommended for hypernatremia, the optimal rate, route, and type of fluid therapy remain uncertain. Current treatment practices vary and no standardized protocol has been validated in randomized clinical trials for young children. This gap contributes to persistently high mortality and neurological morbidity. The goal of this clinical trial is to determine whether oral rehydration therapy is non-inferior to intravenous fluid therapy in the management of hypernatremic dehydration among children under five years of age with diarrhoea. The main questions it aims to answer are: Does oral rehydration therapy result in mortality rates comparable to those of intravenous fluid therapy among children with hypernatremic dehydration? Does oral rehydration therapy achieve safe correction of serum sodium levels and comparable neurological and clinical outcomes relative to intravenous fluid therapy? Researchers will compare oral rehydration therapy using oral rehydration salt (ORS) solution with intravenous fluid therapy using half-strength acetate in 5% dextrose to determine whether oral therapy is non-inferior to intravenous therapy in reducing mortality and improving clinical outcomes. Total 268 participants will: Be randomly assigned to 1:1 to receive either oral rehydration therapy or intravenous fluid therapy. Receive standardized fluid volumes calculated according to paediatric treatment protocols. Undergo clinical assessments and laboratory investigations, including serial serum sodium measurements, during hospitalization. Be monitored for adverse outcomes, including convulsions, fluid overload, and renal impairment. Have neurological status assessed using the Glasgow Coma Scale (GCS) on admission and at discharge. Attend follow-up assessments at 1 month and 6 months after discharge for neurodevelopmental evaluation using the Denver Developmental Screening Test II.

Early Versus Conventional Cessation of Hydrocortisone in Septic Shock

Septic shock is one of the causes of death in ICU and hospital. Refractory shock is the problem which healthcare providers should recognize though it is difficult to handle with. The corticosteroid called hydrocortisone is one of the treatment in refractory septic shock which requires vasopressor to maintain blood pressure. In recovery phase of septic shock and weaning off vasopressor, there is no definite way to taper off hydrocortisone.