Issues and Controversies in the Evolution of Oral Rehydration Therapy (ORT)
Abstract
:1. Introduction
2. Basic Principles of Oral Therapy Methodology
3. Home Therapy with the WHO 90 ORS Using the 2:1 Regimen
4. The Evolution of ORT and ORS
5. Major Differences in Pathophysiology of Cholera and Non-Cholera AWDs
6. Limitations of Existing Studies
7. Discussion
8. Conclusions
Funding
Institutional Review Board Statement
Informed Consent Statement
Conflicts of Interest
Abbreviations
AWD | Acute Watery Diarhhea |
ORS | Oral Rehydratation Solution |
ORT | Oral Rehydratation Therapy |
ORS75 | ORS with 75 mEq/L Sodium (Na+) |
ORS90 | ORS With 90 mEq/L Sodium (Na+) |
ORS120 | ORS With 120 mEq/L Sodium (Na+) |
GDR | Gross Diarrhea Rate, ml/hr |
NGB | Net Gut Balance (oral intake) − (stool+vomitus) in Liters |
PNGB | Positive Net Gut Balance |
CHOLERA | AWD Caused by Vibrio cholerae |
ETEC | Enterotoxigenic Escherichia coli |
NONVIBRIO CHOLERA | Severe AWD Due to ETEC or Bacteria with Cholera Toxin Analogs |
References
- WHO. Reduced Osmolarity Oral Rehydration Salts (ORS) Formulation; Department of Child and Adolescent Health and Development. Available online: https://apps.who.int/iris/handle/10665/67322 (accessed on 20 October 2020).
- Musekiwa, A.; Volmink, J.; Cochrane Infectious Diseases Group. Oral Rehydration Salt Solution for Treating Cholera: ≤270 mOs/L solutions vs. ≤310 mOsm/L Solutions. Cochrane Database Syst. Rev. 2011, 2011, CD003754. [Google Scholar] [CrossRef] [Green Version]
- CHOICE Study Group. Multicenter, randomized, double-blind clinical trial to evaluate the efficacy and safety of a reduced osmolarity oral rehydration salts solution in children with acute watery diarrhea. Pediatrics 2001, 107, 613–618. [Google Scholar] [CrossRef]
- Alam, S.; Afzal, K.; Maheshwari, M.; Shukla, I. Controlled trial of hypo-osmolar versus world Health Organization Oral rehydration solution. Indian Pediatrics 2000, 37, 952–960. [Google Scholar]
- Pulungsih, S.P.; Punjabi, N.H.; Rafli, K.; Rifajati, A.; Kumala, S.; Simanjuntak, C.H.; Yuwono Lesmana, M.; Subekti, D.; Sutoto; Fontaine, O. Standard WHO_ORS versus reduced-osmolarity ORS in the management of cholera patients. J. Health Popul. Nutr. 2006, 24, 107–112. [Google Scholar]
- Alam, N.H.; Majumder, R.N.; Fuchs, G.J.; The CHOICE study group. Efficacy and safety of oral rehydration solution with reduced osmolarity in adults with cholera: A randomized double-blind clinical trial. Lancet 1999, 354, 296–299. [Google Scholar] [CrossRef]
- Faruque, A.S.G.; Mahalanabis, D.; Hamadani, J.D.; Zetterstrom, R. Reduced osmolarity oral rehydration salt in cholera. Scan. J. Infect Dis. 1996, 28, 87–90. [Google Scholar] [CrossRef] [PubMed]
- Bhattacharya, M.K.; Bhattacharya, S.K.; Dutta, D.; Deb, A.K.; Deb, M.; Dutta, A.; Saha, C.A.; Nair, G.B.; Mahalanabis, D. Efficacy of oral hyposmolar glucose-based and rice-based oral rehydration salt solutions in the treatment of cholera in adults. Scan. J. Gastroent. 1998, 33, 159–163. [Google Scholar] [CrossRef]
- Dutta, M.K.; Bhattacharya, M.K.; Deb, A.K.; Sarkar, A.; Chatterjee, A.; Biswas, A.B.; Chatterjee, K.; Nair, G.B.; Bhattacharya, S.K. Evaluation of oral hypo-osmolar glucose-based and rice-based oral rehydration solutions in the treatment of cholera in children. Acta Paediatr. 2000, 89, 787–790. [Google Scholar] [CrossRef]
- Alam, N.H.; Yunus, M.; Faruque, A.S.G.; Gyr, N.; Sattar, S.; Parvin, S.; Ahmed, J.U.; Salam, M.A.; Sack, D.A. Symptomatic hyponatremia during treatment of dehydrating diarrheal disease with reduced osmolarity oral rehydration solution. JAMA 2006, 296, 567–573. [Google Scholar] [CrossRef]
- Phillips, R.A. Asiatic cholera. Ann. Rev. Med. 1968, 19, 69–79. [Google Scholar] [CrossRef]
- Nalin, D.R. Oral therapy for diarrheal diseases. J. Diarrheal Dis. Res. 1987, 5, 283–292. [Google Scholar]
- Hirschhorn, N.; Kinzie, J.I.; Sachar, D.B.; Northrup, R.S.; Taylor, J.O.; Ahmad, S.Z.; Philllips, R.A. Decrease in net stool output in cholera during intestinal perfusion with glucose-containing solutions. NEJM 1968, 279, 176–181. [Google Scholar] [CrossRef]
- Nalin, D.R.; Levine, M.M.; Hornick, R.; Bergquist, E.; Hoover, D.; Holley, H.P.; Waterman, D.; Van Blerk, J.; Matheny, S.; Sotman, S.; et al. The problem of emesis during oral glucose-electrolytes therapy given from the onset of severe cholera. Trans. Roy. Soc. Trop. Med. Hyg. 1979, 73, 10–14. [Google Scholar] [CrossRef]
- Cash, R.A.; Nalin, D.R.; Toaha, K.M.M.; Huq, Z. Acetate in the correction of acidosis secondary to diarrhea. Lancet 1969, 294, 302–303. [Google Scholar] [CrossRef]
- Harvey, R.M.; Enson, Y.; Lewis, M.L.; Greenough, W.B.; Ally, K.; Panno, R.A. Hemodynamic studies on cholera, Effects of hypovolemia and acidosis. Circulation 1968, 37, 709–728. [Google Scholar] [CrossRef] [Green Version]
- Nalin, D.R.; Cash, R.A.; Islam, R.; Molla, M.; Phillips, R.A. Oral maintenance therapy for cholera in adults. Lancet 1968, 292, 370–373. [Google Scholar] [CrossRef]
- El-Mougi, M.; Hendaw, A.; Koura, H.; Hegazi, E.; Fontain, O.; Pierce, N.F. Efficacy of standard glucose-based and reduced-osmolarity maltodextrin-based oral rehyration solutions: Effect of sugar malabsorption. Bull. WHO 1996, 74, 471–477. [Google Scholar]
- Lifschitz, F.; Coello-Ramirez, P.; Gutierrez, L.L.C. Monosaccharide intolerance and hypoglycemia in infants with diarrh74, 471-477.ea: Metabolic studies in 23 infants. J. Peds 1970, 77, 604–612. [Google Scholar] [CrossRef]
- Hirschhorn, N.; Nalin, D.R.; Cash, R.A. CHOICE Study Group Trial. Pediatrics 2002, 109, 713–715. [Google Scholar] [CrossRef]
- Saniel, M.C.; Zimicki, S.; Carlos, C.C.; Maria, A.C.S.; Balis, A.C.; Malacad, C. J. Diarrhoeal Dis. Res. 1997, 15, 47–52.
- Isolauri, E. Evaluation of an oral rehydration solution with Na+ 60 mmol/L. in infants hospitalized for acute diarrhea or treated as outpatients. Acta Paediatr. Scand 1985, 74, 643–649. [Google Scholar] [CrossRef]
- Nalin, D.R.; Levine, M.M.; Mata, L.; de Cespedes, C.; Vargas, W.; Lizano, C.; Loria, A.R.; Simhon, A.; Mohs, E. Oral rehydration and maintenance of children with rotavirus and bacterial diarrheas. Bull. WHO 1979, 57, 453–459. [Google Scholar]
- Snyder, J.D.; Merson, M.H. The magnitude of the problem of acute diarrheal disease: A review of active surveillance data. Bull. WHO 1982, 60, 506–513. [Google Scholar]
- GBD 2016 Diarrhoeal Disease Collaborators. Estimates of the global, regional and national morbidity, mortality and aetiologies of diarrhea in 195 countries: A systematic analysis for the Global Burden of Disease Study 2016. Lancet 2018, 18, 1211–1228. [Google Scholar] [CrossRef] [Green Version]
- Ruxin, J. Magic Bullet: The history of oral rehydration therapy. Med. Hist. 1994, 38, 363–397. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Cash, R.A.; Nalin, D.R.; Forrest, J.; Abrutyn, E. Rapid correction of the acidosis and dehydration of cholera with an oral solution. Lancet 1970, 296, 549–550. [Google Scholar] [CrossRef]
- Nalin, D.R.; Cash, R.A. Oral or nasogastric maintenance therapy for diarrheas of unknown etiology resembling cholera. Trans. Roy. Soc. Trop. Med. Hyg. 1970, 64, 769–771. [Google Scholar] [CrossRef]
- Greenough, W.B.; Gordon, R.S., Jr.; Rosenberg, I.S.; David, B.I.; Benenson, A.H. Tetracycline in the treatment of cholera. Lancet 1964, 1, 335–337. [Google Scholar] [CrossRef]
- Cash, R.A.; Nalin, D.R.; Rochat, R.; Reller, B.; Haque, E.; Rahman, M. A clinical trial of oral therapy in a rural cholera treatment center. Am. J. Trop. Med. Hyg. 1970, 19, 653–656. [Google Scholar] [CrossRef]
- Nalin, D.R.; Cash, R.A. Sodium content in oral therapy for diarrhea. Lancet 1976, 2, 957. [Google Scholar] [CrossRef]
- Pierce, N.F.; Banwell, J.G.; Mitra, R.C.; Caranasos, G.J.; Keimowitz, R.I.; Mondal, A.; Manji, P.M. Effect of intragastric glucose-electrolyte infusion upon water and electrolyte balance in Asiatic cholera. Gastroenterology 1968, 55, 333–344. [Google Scholar] [CrossRef]
- Nalin, D.R. Oral Cholera Therapy. Ann. Intern. Med. 1970, 72, 288–289. [Google Scholar] [CrossRef]
- Molla, A.M.; Ahmed, S.M.; Greenough, W.B., III. Rice-based oral rehydration solution decreases the stool volume in acute diarrhea. Bull. WHO 1985, 63, 751–756. [Google Scholar]
- Roy, S.K.; Rabbani, G.H.; Black, R.E. Oral rehydration solution safely used in breast-fed children without additional water. J. Trop. Med. Hyg. 1984, 87, 11–13. [Google Scholar] [PubMed]
- Nalin, D.R.; Levine, M.M.; Mata, L.; de Cespedes, C.; Vargas, W.; Lizano, C.; Loria, A.R.; Simhon, A.; Mohs, E. Comparison of sucrose with glucose in oral therapy of infant diarrheas. Lancet 1978, 312, 277–279. [Google Scholar] [CrossRef]
- Pizarro, D.; Possada, G.; Villavicencio, N.; Mohs, E.; Levine, M.M. Hypernatremic and hyponatremic diarrheal dehydration. Treatment with oral glucose-electrolyte solution. Am. J. Dis. Child. 1983, 137, 730–734. [Google Scholar] [CrossRef] [PubMed]
- Nalin, D.R.; Harland, E.; Ramlal, A.; Swaby, D.; McDonald, J.; Gangarosa, R.; Levine, M.; Akierman, A.; Antonine, M.; Mackenzie, K.; et al. Comparison of low and high sodium and potassium content in oral rehydration solutions. J. Pediatr. 1980, 97, 848–853. [Google Scholar] [CrossRef]
- Clancy, B.M.; Czech, M.P. Hexose transport stimulation and membrane redistribution of glucose transporter isoforms in response to cholera toxin, dibutyryl cyclic AMP and insulin in3T3-L1 adipocytes. J. Biol. Chem. 1990, 265, 12434–12443. [Google Scholar] [CrossRef]
- Nath, S.K.; Rautureau, M.; Heyman, H. Emergence of Na+-glucose cotransport in an epithelial secretory cell line sensitive to cholera toxin. Am. J. Physiol. 1989, 1069, G335–G341. [Google Scholar] [CrossRef]
- Moule, S.K.; Bradford, N.M.; McGivan, J.D. Short-term stimulation of Na+-dependent amino acid transport by dibutryl cyclic AMP in hepatocytes. Characteristics and partial mechanism. Biochem. J. 1987, 241, 737–743. [Google Scholar] [CrossRef] [Green Version]
- Tai, Y.H.; Perez, E.; Desjeux, J.F. Cholera toxin and cyclic AMP stimulate D-glucose absorption in rat ileum. In Ion Gradient-Coupled Transport; Alverado, F., Van Os, C.H., Eds.; Elsevier: Amsterdam, The Netherlands, 1986; pp. 403–406. [Google Scholar]
- Wright Em Hirsh, J.R.; Loo, D.D.; Zampighi, G.A. Regulation of Na+/glucose cotransporters. J. Exp. Biol. 1997, 200, 287–293. [Google Scholar]
- Flach, C.F.; Lange, S.; Jennische, E.; Lonnroth, I. Cholera toxin induces expression of ion channels and carriers in small intestinal mucosea. FEBS Lett. 2004, 561, 122–126. [Google Scholar] [CrossRef] [Green Version]
- Schiller, L.E.; Santa Ana, C.; Porter, J.; Fortran, J.S. Glucose-stimulated sodium transport by the human intestine during experimental cholera. Gastroenterology 1997, 112, 1529–1535. [Google Scholar] [CrossRef]
- Nalin, D.R.; Cash, R.A.; Rahaman, M.; Yunus, M. Effect of glycine and glucose on sodium and water absorption in patients with cholera. Gut 1970, 11, 768–772. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Patra, F.C.; Mahalanabis, D.; Jalan, K.N.; Sen, A.; Banerjee, P. In search of a super solution:controlled trial of glycine-glucose oral rehydration solution in infantile diarrhea? Acta Pediatr. Scand 1984, 73, 18. [Google Scholar] [CrossRef] [PubMed]
- Patra, F.C.; Sack, D.A.; Islam, A.; Alam, A.N.; Mazumder, R.N. Oral rehydration formula containing alanine and glucose for treatment of diarrhea: A controlled trial. BMJ 1989, 298, 1353–1356. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Punjabi, N.H.; Kumala, S.; Rasidi, C.; Witham, N.D.; Pulungsih, S.P.; Rivai, A.R.; Sukri, N.; Burr, D.H.; Lesmana, M. Improving the ORS: Does glutamine have a role? Am. J. Trop. Med. Hyg. 1991, 45, 114–115. [Google Scholar]
- Amankwah, E.N.; Adu, E.; Barimah, V.M.J.; Van Twisk, C. Amino acid profiles of some varieties of rice, soybean and groundnut grown in Ghana. J. Food Process. Technol. 2015, 6, 420–423. [Google Scholar]
- Vesikari, T.; Isolauri, E. Glycine supplemented oral rehydration solutions for diarrhea. Arch. Dis. Child. 1986, 61, 372–376. [Google Scholar] [CrossRef] [Green Version]
- Pizarro, D.; Levine, M.M.; Posada, G.; Sandi, L. Comparison of glucose/electrolyte and glucose/glycine/electrolyte oral rehydration solutions in hospitalized children with diarrhea in Costa Rica. J. Pediatr. Gastroenterol. Nutr. 1988, 7, 411–416. [Google Scholar] [CrossRef]
- Ribiero, H.D.C., Jr.; Lifshitz, F. Alanine-based oral rehydration therapy for infants with acute diarrhea. J. Pediatr. 1991, 118, S86–S90. [Google Scholar]
- Gutierrez, C.; Villa, S.; Mota, F.R.; Calva, J.J. Does an L-glutamine-containing, glucose–free, oral rehydration solution reduce stool output and time to rehydrate in children with acute diarrhea? A double-blind randomized clinical trial. J. Health Popul. Nutr. 2007, 3, 278–284. [Google Scholar]
- Gore, S.M.; Fontaine, O.; Pierce, N. Impact of rice based oral rehydration solution on stool output and duration of diarrhea:meta-analysis of 13 clinical trials. BMJ 1992, 304, 28791. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Mahalanabis, D.; Faruque, A.G.; Hoque, S.S.; Faruque, S.M. Hypotonic oral rehydration solution in acute diarrhea: A controlled clinical trial. Acta Pediatr. 1995, 84, 289–293. [Google Scholar] [CrossRef] [PubMed]
- Davidson, G.P.; Barnes, G.L. Structural and functional abnormalities of the small intestine in infants and young children with rotavirus enteritis. Acta Paediatr. 1979, 68, 181–186. [Google Scholar] [CrossRef]
- Navarro, H.; Arruebo, M.P.; Alcalde, A.I.; Sorribas, V. Effect of erythromycin on D-galactose absorption and sucrose activity in rabbit jejunum. Can. J. Physiol. Pharmacol. 1993, 71, 191–194. [Google Scholar] [CrossRef] [PubMed]
- Rhoads, J.M.; MacLeod, R.J.; Hamilton, J.R. Diminished brush border membrane sodium-dependent L-alanine transport in acute viral enteritis in piglets. J. Pediatr. Gastroenterol. Nutr. 1989, 9, 225–231. [Google Scholar] [CrossRef]
- Nalin, D.R.; Ally, K.; Hare, K.; Hare, R. Effects of cholera enterotoxin on jejunal osmoregulation of mannitol solutions in dogs. J. Infect. Dis. 1972, 125, 528–532. [Google Scholar]
- Gray, G.M.; Ingelfinger, F.J. Intestinal absorption of sucrose in man: The site of hydrolysis and absorption. JCI 1965, 44, 399098. [Google Scholar] [CrossRef]
- Mathews, C.J.; MacLeod, R.J.; Zheng, S.X.; Hanrahan, J.W.; Bennett, H.P.; Hamilton, J.R. Characterization of the inhibitory effect of boiled rice on intestinal chloride secretion in guinea pig crypt cells. Gastroenterology 1999, 116, 1342–1347. [Google Scholar] [CrossRef]
- Macleod, R.; Bennett, H.; Hamilton, J. inhibition of intestinal secretion by rice. Lancet 1995, 346, 90–92. [Google Scholar] [CrossRef]
- Alam, V.A.; Ahmed, T.; Khatum; Molla, A.M. Effect of food with two or four rehydration therapies: A randomized controlled clinical trial. Gut 1992, 33, 560–562. [Google Scholar]
- Santosham, M.; Fyad, I.; Hashem, M.; Goepp, J.G.; Refaf, M.; Sack, B. A comparison of rice-based oral rehydration solute and early feeding for the treatment of acute diarrhea in infants. J. Pediatr. 1990, 116, 868–875. [Google Scholar] [CrossRef]
- Clarke, A.M.; Miller, M.; Shields, R. Intestinal transport of sodium, potassium and water in the dog during sodium depletion. Gastroenteritis 1967, 52, 846–858. [Google Scholar] [CrossRef]
- Houston, K.A.; Gibb, J.G.; Maitland, K. Oral rehydration of malnourished children with diarrhea: A systematic review (version 3). Wellcome Open Res. 2017, 2, 66. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Arieff, A.I.; Ayus, J.C.; Fraser, C.I. Hyponatremia and death or permanent brain damage in healthy children. BMV 1992, 304, 1218–1222. [Google Scholar]
- Rondon-Berrios, H.; Berl, T. Mild chronic hyponatremia in the ambulatory setting: Significance and management. Clin. J. Am. Soc. Nephrol. 2015, 10, 2268–2278. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Shahrin, L.; Chistri, M.J.; Huq, S.; Nishath, T.; Christy, M.D.; Hannan, A.; Ahmed, T. Clinical manifestations of hyponatremia and hypernatremia in under-five diarrheal children in a diarrhea hospital. J. Trop. Pediatr. 2016, 62, 206–212. [Google Scholar] [CrossRef] [Green Version]
- Khan, W.A.; Dhar, U.; Salam, M.A.; Griffiths, J.K.; Rand, W.; Bennish, M.L. Central nervous system manifestations of childhood shigellosis: Prevalence, risk factors and outcome. Pediatrics 1999, 103, E18. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Mitra, A.K.; Khan, M.R.; Alam, A.N. Complications and outcome of disease in patients admitted to the intensive care unit of a diarrhoeal diseases hospital in Bangladesh. Trans. Roy. Soc. Trop. Med. Hyg. 1991, 85, 685–687. [Google Scholar] [CrossRef]
- Chisti, M.J.; Pietroni, M.A.; Smith, J.H.; Bardhan, P.K.; Salam, M.A. Predictors of death in under-five chidren with diarrhea admitted to a critical care ward in an urban hospital in Bangladesh. Acta Paediatr. 2011, 100, e275–e279. [Google Scholar] [CrossRef] [PubMed]
- Samadi, A.R.; Wahed, M.A.; Islam, M.R.; Ahmed, S.M. Consequences of hyponatraemia and hypernatraemia in children with acute diarrhea in Bangladesh. BMJ Clin. Res. Ed. 1983, 286, 671–673. [Google Scholar] [CrossRef] [Green Version]
- Sazawal, S.; Black, R.E.; Bhan, M.K.; Bhandari, N.; Sinha, A.; Jalla, S. Zinc supplementation in young children with acute diarrhea in India. NEJM 1995, 333, 839–844. [Google Scholar] [CrossRef] [PubMed]
- Phillips, R.A. Cholera in the perspective of 1966. Ann. Int. Med. 1966, 65, 922–930. [Google Scholar] [CrossRef] [PubMed]
- Available online: www.alibaba.com/amino-acid-glycine-price (accessed on 18 December 2020).
- Available online: www.alibaba.com/glucosepowder (accessed on 18 December 2020).
- Khin-Maung-U; Bolin, T.D.; Duncombe, V.M.; Myo-Khin; Nyunt-Nyunt-Wai; Pereira, S.P.; Linklater, J.M. Epidemiology of small bowel bacterial overgrowth and rice carbohydrate malabsorption in Burmese (Myanmar) village children. Am. J. Trop. Med. Hyg. 1992, 47, 298–304. [Google Scholar] [CrossRef] [PubMed]
- Khinmaungu; Nyuntnyuntwai; Myokhin; Mumukhin; Tinu; Thanetoe. Effect of boiled-rice feeding in childhood cholera on clinical outcome. Hum. Nutr. Clin. Nutr. 1986, 40, 249–254. [Google Scholar]
- Fontaine, O.; Gore, S.M.; Pierce, N.F. Rice-based oral rehydration solution for treating diarrhea. Cochrane Database Syst. Rev. 1998, CD001264. [Google Scholar] [CrossRef]
- Eldridge, D.; Ledoux, M. Needs more salt: Old hydration habits are hard to break. Lancet 2014, 385, 1159–1160. [Google Scholar] [CrossRef]
- Duke, T.; Molyneux, E.M. Intravenous fluids for seriously ill children: Time to reconsider. Lancet 2003, 362, 1320–1323. [Google Scholar] [CrossRef]
- McNab, S.; Duke, T.; South, M.; Babl, F.E.; Lee, K.j.; Arnup, S.J.; Young, S.; Turner, H.; Davidson, A. 140 mmol/L of sodium versus 77 mmol/L. of sodium in maintenance intravenous fluid therapy for children in hospital (PIMS): A randomized controlled double-blind trial. Lancet 2015, 385, 1190–1197. [Google Scholar] [CrossRef]
- Friedman, J.N.; Beck, C.E.; DeGroot, J.; Geary, D.F.; Sklansky, D.J.; Freedman, S.B. Comparison of isotonic and hypotonic intravenous maintenance fluids: A randomized clinical trial. JAMA Pediatr. 2015, 169, 445–451. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Bhattachariya, S.K.; Dutta, P.; Dutta, D.; Chakraborti, M.K. Super ORS. Indian J. Public Health 1990, 34, 35–37. [Google Scholar]
- Nalin, D.R. A spoonful of sugar. Lancet 1978, 2, 264. [Google Scholar] [CrossRef]
- Nalin, D.R.; Cash, R.A. Oral or nasogastric maintenance for cholera patients in all age groups. Bull. WHO 1970, 43, 361–363. [Google Scholar]
Na+ Losses in Cholera Patient Given (ORS75 vs. ORS90) | ||
---|---|---|
ADULTS | CHILDREN | |
Stool Na+ (mEq/L) | 140 | 101 |
ORS Na+ | 75 vs. 90 | 75 vs. 90 |
Na+ Loss | −65 vs. −50 | −26 vs. −10 |
Stool Vol. (L) | 25 | 8 |
Total Na+ loss (mEq) * | −1625 vs. −1250 | −208 vs. −80 |
Recommended Safety Studies of 75 ORS in Cholera Patients | |
---|---|
STUDIES | PURPOSE |
Na+ Balance | Determine size of Na+ deficite |
Clinical Sequelae | R/O acute sequelae using standard tests |
Follow-up Studies | R/O developmental deficits and excess post-convalescent mortality |
ORS Suitable for Cholera Patients | |
---|---|
Dissolve 4 Packets of 90 ORS in 3 L Water | Resulting ORS Concentrations |
Na+ 120 * | |
K+ 27 * | |
Cl− 107 * | |
Citrate 13@ | |
Glucose 147@ |
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Nalin, D. Issues and Controversies in the Evolution of Oral Rehydration Therapy (ORT). Trop. Med. Infect. Dis. 2021, 6, 34. https://doi.org/10.3390/tropicalmed6010034
Nalin D. Issues and Controversies in the Evolution of Oral Rehydration Therapy (ORT). Tropical Medicine and Infectious Disease. 2021; 6(1):34. https://doi.org/10.3390/tropicalmed6010034
Chicago/Turabian StyleNalin, David. 2021. "Issues and Controversies in the Evolution of Oral Rehydration Therapy (ORT)" Tropical Medicine and Infectious Disease 6, no. 1: 34. https://doi.org/10.3390/tropicalmed6010034