Oral rehydration in acute infantile diarrhoea with a glucose-polymer electrolyte solution.

Seven infants with mild acute diarrhoeal dehydration were rehydrated with an oral sugar-electrolyte solution containing a glucose polymer mixture. Six of them were rehydrated successfully. The high sodium content of the solution (90 mmol/l) was based on the WHO/UNICEF recommended glucose-electrolyte solution and was implicated as the cause of increases in serum sodium in 4 infants, one of whom developed serious hypernatraemia associated with glucose-positive stools. A solution with a lower sodium and glucose-polymer content may be of nutritional benefit in the oral rehydration of acute infantile diarrhoea.     

Can acetate replace bicarbonate in oral rehydration solution for infantile diarrhoea?

In a double-blind trial two groups of 20 infants and young children suffering from diarrhoeal dehydration and acidosis were successfully treated with an acetate and a bicarbonate containing oral rehydration solution. The former was found to be as effective as the latter and was equally acceptable to the patient.     

Oral rehydration therapy

In this lecture presented to the 30th Congress of the Turkish National Pediatric Society in 1986, the author describes how oral rehydration therapy (ORT) has demonstrated its efficacy and been adopted even by physicians in the developed world. The traditional approach of clear liquids by mouth is an imprecise and inappropriate means of rehydration. During the 1st 8-24 hours after intestinal water losses, a solution containing sodium and potassium chloride, bicarbonate, and glucose is necessary to meet deficits; other sources of liquid such as breast milk and rice water can be offered to satisfy thirst after rehydration has been achieved. Studies in the US have repeatedly confirmed the benefit and cost-effectiveness of ORT. Also successful has been the use of oral electrolyte solutions at the onset of diarrhea before dehydration becomes a problem. An appropriate sodium and potassium concentration, with 2% glucose, facilitates absorption across the intestinal mucosa without an increase in the intraluminal osmotic load. Calories need to be provided within 24 hours after the initiation of ORT, especially in malnourished infants. Clean water is essential if infection is to be overcome. Finally, it is stressed that medications to slow intestinal motility are not indicated since diarrhea helps to eliminate offending organisms and their toxins.     

Oral rehydration therapy

Diarrhea is a major cause of mortality and morbidity affecting infants and children in many parts of the world. Research and understanding of normal and abnormal gastrointestinal physiology allowed the development of oral electrolyte solutions to treat dehydration. These solutions were initially used for treatment of cholera in areas with poor access to medical care and are now used extensively by the WHO. Therapy with OES has expanded to other nonsecretory causes of diarrhea. Two types of solutions are available in the United States. Maintenance solutions contain 40 to 60 mEq per liter of sodium and are used for prevention of dehydration or after rehydration. Rehydration solutions contain 60 to 90 mEq per liter of sodium and are effective for the oral repletion of fluid and electrolyte deficits in both secretory and nonsecretory diarrhea.     

Can potassium citrate replace sodium bicarbonate and potassium chloride of oral rehydration solution?

Ninety four children aged less than 5 years with diarrhoeal dehydration and acidosis were treated randomly with either World Health Organisation (WHO) oral rehydration solution containing sodium chloride, potassium chloride, sodium bicarbonate and glucose or an oral solution with tripotassium citrate monohydrate replacing the sodium bicarbonate and potassium chloride in the WHO solution. Fifty five children (58%) were hypokalaemic (potassium less than 3.5 mmol/l) on admission. All but two in the citrate group were successfully treated. There were no significant differences in rehydration solution intake, stool output, gain in body weight, and fall in plasma specific gravity and haematocrit between the two treatment groups after 48 hours'' treatment. Significant improvement in the serum potassium concentration was observed in the hypokalaemic children receiving potassium citrate solution compared with children receiving WHO solution after 24 and 48 hours'' treatment. None developed hyperkalaemia. Although children receiving potassium citrate solution corrected their acidosis at a slower rate than the WHO solution group during the first 24 hours, by 48 hours satisfactory correction was observed in all. Tripotassium citrate can safely replace sodium bicarbonate and potassium chloride and may be the most useful and beneficial treatment for diarrhoea and associated hypokalaemia.     

Oral rehydration in infantile diarrhoea. Controlled trial of a low sodium glucose electrolyte solution.

The paper describes the first controlled trial of an oral glucose electrolyte solution designed on the basis of the optimum pathophysiological needs for rehydration in infantile diarrahoea. The solution, having a sodium concentration of 50 mmol/l, was tried in a group of 20 infants with moderate to severe dehydration due to acute diarrhoea and was compared with a matched group of 19 infants predominantly under 2 years of age taking a 'standard' oral solution with a sodium concentration of 90 mmol/l. They could be hydrated as well with a low sodium oral solution alone as with the standard solution. Intravenous fluid was not required in either group. The group treated with the high soldium 'standard' solution appeared to develop hypernatraemia and/or periorbital oedema more frequently than the other group. Also, the low sodium solution eliminated the need for additional free water orally.