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PubMedDate not supplied

Comparison of glucose/electrolyte and glucose/glycine/electrolyte oral rehydration solutions in hospitalized children with diarrhea in Costa Rica.

The experience of Nalin et al. and Patra et al. with a "super oral rehydration solution (ORS)" containing glucose plus glycine to enhance the intestinal absorption of sodium and water prompted us to investigate a similar ORS containing the standard World Health Organization (WHO/ORS) plus either 55 or 110 mmol/L glycine in infants and small children with noncholera diarrhea. We did not find a statistically significant difference between the glycine-fortified ORS and the standard WHO/ORS with respect to the clinical outcome and composition of serum electrolytes.

Bicarbonates↗
PubMed1999

Proabsorptive effect of glycerol as a glucose substitute in oral rehydration solutions.

We hypothesized that glycerol, a readily diffusable hydrophilic substance, may effectively substitute for glucose and enhance intestinal water and sodium absorption in an oral rehydration solution (ORS). This was evaluated using a low osmolality (230-240 mOsm/kg) ORS containing 75 mmol/L sodium and a combination of glucose:glycerol (in mmol/L) 75:0, 50:25; 37.5:37.5, 25:50, 10:65, or 0:75 during 3-hour long in vivo rat jejunal perfusions. Water, sodium, potassium, glucose and glycerol absorption, and unidirectional fluid movement (J(in), J(eff)) were determined. Sodium and net water absorptions were maximal at glucose:glycerol ratios between 37.5:37.5 and 10:65 mmol/L. In the absence of glucose (0:75), absorption of water and electrolytes was lower than at any other concentration. The greater net rehydration seemed to be due to a higher J(in) as glycerol was increased up to 65 mmol/L. Potassium absorption followed a similar pattern. With 50 mmol/L glycerol and 25 mmol/L glucose, there was a marked expansion of the lamina propria extracellular space and increased intercellular expansion between enterocytes. These results indicate that glycerol may be an effective partial substitute for glucose in ready-to-use ORS by producing an improved rate of water and electrolyte absorption.

Journal Article↗
PubMed1997

Gum arabic promotes rat jejunal sodium and water absorption from oral rehydration solutions in two models of diarrhea.

BACKGROUND & AIMS: We have shown that addition of gum arabic (GA) to a 90 mmol/L sodium-111 mmol/L glucose oral rehydration solution (ORS) enhances its effectiveness for water and electrolyte absorption in normal rats. The present study extends these observations on GA in ORS to two rat models of diarrheal disease. METHODS: Juvenile rats were either treated for 1 week with magnesium citrate-phenolphthalein to produce chronic osmotic-secretory diarrhea or luminally exposed to 10 mmol/L theophylline to induce jejunal secretion. In both models jejunal perfusion was used to assess absorption. RESULTS: Addition of 2.5 or 5.0 g/L GA to ORS increased roughly twofold absorption of sodium, potassium, and water in the model of chronic osmotic-secretory diarrhea. Rats perfused with GA-supplemented ORS showed an expansion of the basolateral intercellular spaces between villus absorptive epithelial cells and the lamina propria, reflecting enhanced water and sodium absorption. Similarly, addition of 2.5, 5.0, or 10.0 g/L GA to the ORS neutralized theophylline-induced abolition of net sodium and potassium absorption and reversed water and glucose malabsorption. CONCLUSIONS: These experimental studies in models of diarrhea suggest that GA may be a useful additive to ORS for the potentiation of water and electrolyte absorption.

Absorption↗
PubMed2005

[The low quality of home-made oral rehydration solution in Salvador, Bahia (Brazil)].

In 1988 a nation-wide campaign aiming to inform the Brazilian population about preparation and use of simple sugar/salt oral rehydration solution (ORS) was carried out. The campaign was massively shown by the media. This preliminary study assessed the quality of ORS prepared by 23 mothers of in-patient children from a pediatric hospital in Salvador, State of Bahia. Fourteen (60.9%) among the 23 mothers prepared solutions containing Na concentrations ranging from 30 to 80 mmol/L which is recommended by the World Health Organization. Eleven (47.8%) solutions contained glucose within the recommended range of 30 to 112 mmoI/L Only 6 (26%) out of the 23 mothers prepared ORS with simultaneously adequate Na and glucose concentrations. However, just 3 (13%) out of these 6 ORS also presented balanced electrolyte concentrations. Potential iatrogenicity due to high concentrations of Na and glucose was found in 30.4% and 43.5% of the solutions, respectively. These data raise serious concerns about the quality of home-made sugar/salt ORS, and therefore about its use as a safe agent in a campaign of diarrhoeal diseases control.

English Abstract↗
PubMed2000

Evaluation of oral hypo-osmolar glucose-based and rice-based oral rehydration solutions in the treatment of cholera in children.

UNLABELLED: In a randomized controlled clinical trial, the efficacy of a low-sodium low-glucose oral rehydration solution (ORS) and a low-sodium rice-based ORS was compared with standard WHO glucose ORS in the treatment of severe cholera in children aged 2-10y. In total, 120 children were evaluated for the study, of whom 58 patients were positive for Vibrio cholerae and were included in the study. Of these 58 cases, 19 received rice-based hypo-osmolar ORS, 20 received WHO-ORS and 19 received glucose-based hypo-osmolar ORS. The clinical characteristics (age, preadmission duration of diarrhoea, frequency of stool before admission, incidence of vomiting, body weight and volume of initial fluid requirement) were comparable in the three treatment groups. All patients received tetracycline in a dose of 50 mg/kg/d of body weight in 4 divided doses for 3 d. CONCLUSIONS: Patients who received rice-based hypo-osmolar ORS had subsequently reduced (p < 0.05) stool output, ORS consumption and diarrhoea duration than the patients who received either WHO-ORS or glucose-based hypo-osmolar ORS.

Child↗
PubMed1998

Induced diarrhoea in horses. Part 2: Response to administration of an oral rehydration solution.

Hydration status, electrolyte balance and acid-base balance were studied in four adult standardbred geldings with castor oil-induced diarrhoea. The horses received an oral rehydration solution (ORS) at a point when signs consistent with mild decreases in effective circulating fluid volume were first detected. Within 1.5 h of ORS administration, all horses exhibited a significant metabolic acidosis. At this time, mean values for venous blood pH, [HCO3], and standard base excess were 7.264 +/- 0.011, 17.7 +/- 0.3 mmol L-1, and -8.2 +/- 0.4 mmol L-1, respectively. Throughout the duration of the study, plasma volume did not change significantly, despite a decreasing trend, which tended to recover towards normal values 8 h after administration of the ORS. Signs of abdominal discomfort were observed in all horses following the last of three doses of ORS (8-10 L) administered at 30 min intervals. Faecal fluid sodium concentration increased significantly with diarrhoea, and reached values fourfold those in normal horses, while faecal dry matter sodium concentration increased exponentially following the onset of clinical signs. Despite this increase in sodium concentration, faecal fluid remained hypotonic at all stages. Our findings suggest that, while ORS can help restore systemic fluid balance, several factors influence their effectiveness. Two likely factors identified in this study were the ionic composition of the ORS as well as the rate of administration. We concluded that the electrolyte composition of current ORS may not be ideal to treat diarrhoea in horses and that administration of 8-10 of ORS every 30 min via nasogastric tube may result in too rapid small intestinal transit to allow sufficient time for absorption.

Acidosis↗
PubMed1997

Cellulose derivatives and intestinal absorption of water and electrolytes: potential role in oral rehydration solutions.

The physicochemical and structural characteristics of several types of carboxymethylcellulose (CMC) and of methylcellulose (MC) were examined in relation to their capacity to modify water and sodium absorption in oral rehydration solutions (ORS) at various concentrations, using a jejunal perfusion procedure in rats. Comparison of intrinsic low-viscosity CMC of various degrees of substitution (DS) revealed that net water absorption increased as the DS was augmented. A stimulatory effect on sodium absorption occurred only at a low (2.5 g/l) CMC concentration. With products of medium DS, stimulation of net water and sodium absorption was observed only with low-viscosity CMC at 2.5 g/l, but not at 5.0 g/l. In perfusions with CMC of medium and high DS there was a reduction of water and sodium absorption, ultimately resulting in net sodium secretion with 5.0 g/l high-DS CMC. MC perfused at 5.0 or 10.0 g/l reduced net water absorption and reversed sodium transport from absorptive to secretory status. These results show that while low-viscosity-grade, low-DS CMC in low concentrations may facilitate solute uptake and concurrent water absorption from ORS by the jejunum, high intrinsic viscosity and possible chemical interaction of solutes with the modified celluloses tend to block water uptake and produce fluid stasis and electrolyte secretion. Thus, the data suggest that only certain types of CMC may be proabsorptive when added to ORS, while high-viscosity and high-DS CMC or MC induce electrolyte malabsorption and eventual catharsis.

Animals↗
PubMed1990

Sorghum-based oral rehydration solution in the treatment of acute diarrhoea.

Sixty four children between 2.5 months and 5 years of age were randomly treated in a country hospital in Jos, Nigeria, with either the oral rehydration solution (ORS) as recommended by the World Health Organisation (WHO) or a cereal-based electrolyte solution, containing 60 g/l sorghum powder. Both groups were well comparable in many aspects, except for the nutritional status and the use of ORS before admission. In both aspects the sorghum-ORS group was at a disadvantage. During treatment there were no significant differences between the two groups in amount of fluid used, number of stools and duration of diarrhoea. Though weight gain in the two treatment groups was not significantly different, median weight gain in the sorghum-ORS group was 295 g, vs 155 in the WHO-ORS group. Seven children died, two (6%) in the sorghum-ORS group and five (17%) in the WHO-ORS group. Sorghum-ORS was well accepted and tolerated. This study suggests that sorghum-ORS can safely be used as an alternative in the treatment of diarrhoea.

Acute Disease↗
PubMed2006

Oral rehydration solution to prevent nephrotoxicity of amphotericin B.

Treatment with amphotericin B deoxycholate (AB) is associated with dose-related nephrotoxicity. We conducted an open and randomized trial to evaluate the efficacy of an oral rehydration solution (ORS) to prevent nephrotoxicity of AB, compared with an intravenous saline solution (SS). Adult patients with mucosal leishmaniasis in whom AB was indicated received either three liters or ORS or one liter of SS. Renal function tests were performed at baseline and during treatment. Forty-eight patients were included (ORS = 25, SS = 23). No difference was observed in serum creatinine, creatinine clearance, serum urea, and serum sodium values during treatment, but serum potassium values were lower in the SS group than in the ORS group (P < 0.03). Treatment was more temporarily discontinued in the SS group than in the ORS group (7 patients versus 1 patient, P = 0.02). We conclude that ORS is comparable to SS in preventing glomerular damage of AB, but more effective in preventing hypokalemia.

Adult↗
PubMed1989

Impact of acute diarrhoea & oral rehydration solution on nutritional status of preschool children.

A total of 838 children under 5 yr of age were followed up in 2 villages of Punjab for a period of one year for diarrhoea morbidity, oral rehydration solution (ORS) usage and nutritional status. Overall frequency of diarrhoea was 0.78 episode/child/year. Children weighing less than or equal to 70 per cent of reference weight for age had about 25 per cent higher incidence of diarrhoea (102 episodes/100 child/yr) as compared to those who weighed greater than or equal to 71 per cent (75 episodes/100 children/yr; P less than 0.05). At the end of one year there was no significant difference in the weight and arm circumference growth of children who had diarrhoea and received ORS and those who did not. Prevalence of malnutrition (weight for age criteria) in children with and without diarrhoea at the beginning and end of the study also remained unchanged, irrespective of ORS usage. These observations indicate that in rural areas with low diarrhoea morbidity (i) pre-existing malnutrition (weight for age less than 70%) is associated with 25 per cent higher diarrhoea incidence; (ii) acute diarrhoea does not significantly affect weight and arm circumference growth and prevalence of malnutrition; and (iii) the long-term nutritional benefit of ORS if any, is doubtful.

Child, Preschool↗
PubMed1996

Self-reported concepts about oral rehydration solution, drug prescribing and reasons for prescribing antidiarrhoeals for acute watery diarrhea in children.

Sixty-seven general practitioners (GPs) and 27 paediatricians practising in Karachi were interviewed to evaluate their knowledge and attitude towards use of oral rehydration solution (ORS) and management of acute watery diarrhoea (AWD) in children and to define factors for their self-reported prescribing of antidiarrhoeals. Whilst nearly 50% of them reported ORS to be palatable and acceptable by children, 80% reported that ORS was not accepted by parents as sole treatment. Eighty per cent of GPs and 37% of paediatricians reported prescribing antidiarrhoeals for AWD in children, and 'parental pressure' and 'use as placebo' were the commonest reasons. In addition 45% of GPs believed in the efficacy of antidiarrhoeals and thought these drugs necessary for the control of diarrhoea.

Child, Preschool↗
PubMed1996

Electrolyte fluxes in the gut and oral rehydration solutions.

This article provides a brief overview of the normal physiology of water and electrolyte fluxes across the gut as a prerequisite for understanding the pathologic disturbances occurring with diarrheal illnesses. In turn, the rationale for the use of oral rehydration solutions in diarrheal disorders is explored.

Acute Disease↗
PubMedDate not supplied

[Comparison of an oral rehydration solution (ORS 90) and a "supersolution" during acute infantile diarrhea].

As acute diarrhoea gives rise to a loss of water and electrolytes, the most effective therapy results the oral rehydration. Harrison and Darrow tried this way first. Only in the years '60 we began to use oral rehydration commonly. Usually, solutions contain glucose, Na, K, Cl, Bicarbonate in various concentration. When glucose is replaced by rice starch or when amino acid are added, then we have a "supersolution". Nutrients intake provides more calories and increases absorption Na-depending. We used one of these new "supersolutions". Two groups of children, hospitalised for acute diarrhoea, were treated with different rehydration solutions. The first one (Dicodral Forte), prepared according to the WHO, contains glucose and electrolytes as we know. The second one (Amidral) has rice starch instead of glucose and presents a lower concentration of Na and Cl. The present study looked over: A) Weight increase from the first to the third day of hospitalisation in our department. B) Duration of diarrhea. C) Number of stools. D) Haematological values before and after rehydration. All the patients ingested the same amount of solution. Children which received WHO's solution presented diarrhea longer than others (2.55 +/- 2.06 vs 2.2 +/- 1.1 days). Number of stools was below average too (3.05 +/- 2.64 vs 2.8 +/- 1.5). Refeeding was done employing the same milk used in former times. AMIDRAL was used to dilute the milk when it was possible. Most important result is the increase of weight we had using this "supersolution". 15/20 children which received AMIDRAL showed an increase of their weight as shown in Tab. 1.

Acute Disease↗
PubMed1996

Efficacy of standard glucose-based and reduced-osmolarity maltodextrin-based oral rehydration solutions: effect of sugar malabsorption.

Previously we reported that standard oral rehydration salts (ORS) solution is not as effective as a reduced-osmolarity glucose-based ORS for the treatment of children with acute noncholera diarrhoea: with standard ORS the diarrhoea lasts longer, stool output is greater, serum sodium is higher, and there is more need for supplemental intravenous infusion. We studied a reduced-osmolarity maltodextrin (MD)-based ORS to determine whether it had similar benefits, and also the effect of sugar malabsorption on the efficacy of standard and MD-based ORS. A total of 90 boys aged 3-24 months with acute noncholera diarrhoea and moderate dehydration were randomly assigned to either standard ORS (glucose 20 g/l, osmolarity 311 mmol/l) or MD-ORS (MD 50 g/l, osmolarity 227 mmol/l). There were no differences in treatment results. Some 46% of subjects had a high total stool output (> 300 g/kg), which was unrelated to the type of ORS given. High stool output was significantly associated with a longer duration of diarrhoea (33 vs. 15 hours; P < 0.001), a persistently elevated serum sodium (149 vs. 144 mmol/l at 24 h; P < 0.02), the need for intravenous infusion (11/41 vs. 0/48; P < 0.002), and an increase in faecal reducing substances (10.8 vs. 3.4 g/l at 24 h; P < 0.001). We conclude that some children given standard ORS develop osmotic diarrhoea owing to the combined effect of transient sugar malabsorption and slight hypertonicity of the ORS. Earlier studies show that this adverse outcome can largely be avoided when extra water is given in reduced-osmolarity glucose-based ORS. Reduced osmolarity has no benefit, however, when glucose is replaced by maltodextrin, probably because the sugars released by hydrolysis of MD, when malabsorbed, raise the intraluminal osmolarity to equal or exceed that of standard ORS. Thus, reduced-osmolarity glucose-based ORS is superior to both standard ORS and reduced-osmolarity solutions based on maltodextrin and probably other complex carbohydrates. Studies are in progress to define the optimal formulation of reduced-osmolarity glucose-based ORS.

Carbohydrate Metabolism↗
PubMed2005

Antidiarrheal effects of L-histidine-supplemented rice-based oral rehydration solution in the treatment of male adults with severe cholera in Bangladesh: a double-blind, randomized trial.

BACKGROUND: Because of the antisecretory potential of L-histidine in the intestinal tract, its antidiarrheal effects were determined in cholera. METHODS: In a double-blind trial of 126 adult male patients with cholera, L-histidine (2.5 g/L) was mixed with a rice-based oral rehydration solution (ORS) and administered to 62 patients; 64 patients received the same ORS without L-histidine. All patients received ciprofloxacin at a dosage of 500 mg every 12 h for 72 h. Fluid output (of stool, urine, and vomit) and intake (of ORS, water, and intravenous fluid) were determined every 8 h for 72 h. RESULTS: Administration of ORS with L-histidine significantly (P<.05) reduced the frequency of stool output during 32-64 h after initiation of ORS treatment, compared with that in patients given ORS without L-histidine ([all data are means+/-SD] 32-48 h, 11.5+/-6.9 mL/kg vs. 18.8+/-16.0 mL/kg; 40-48 h, 6.7+/-4.4 mL/kg vs. 11.5+/-9.7 mL/kg; and 56-64 h, 6.3+/-5.8 mL/kg vs. 7.8+/-4.1 mL/kg). An overall reduction of 22% in the volume of stool was observed in patients given ORS without L-histidine. The amount of required unscheduled intravenous fluid was lower in patients given ORS with L-histidine, compared with that in patients given ORS without L-histidine (0-24 h, 82.5+/-44.4 mL/kg vs. 158.6+/-72.2 mL/kg [P<.01]; and 24-48 h, 41.6+/-40.4 mL/kg vs. 52.5+/-22.1 mL/kg [P>.05]). Administration of ORS with L-histidine also significantly reduced (P<.05) the intake of ORS and the duration of illness. No adverse effects were observed in these patients. CONCLUSIONS: L-histidine reduces the weight of stool and the frequency of stool output in cholera and could be a useful and safe adjunct treatment that will increase the success rate of ORS and antibiotic therapy in cholera.

Adult↗
PubMed2002

Efficacy of zinc-fortified oral rehydration solution in 6- to 35-month-old children with acute diarrhea.

OBJECTIVE: To determine the efficacy of zinc-fortified oral rehydration salts solution (ORS) in comparison to ORS without zinc in 6- to 35-month-old urban children with acute diarrhea not sick enough to be hospitalized. DESIGN: Double-blind, randomized, controlled trial. METHODS: Children (n = 1219) with acute diarrhea were randomly assigned to one of 3 groups. The first group received a zinc syrup (15 mg zinc to 6- to 11-month-old children and 30 mg to 12- to 35-month-old children), the second group received zinc premixed with ORS (40 mg/L), and the control children received ORS only. Households were visited twice weekly until recovery. RESULTS: The total number of stools was lower in the zinc-ORS group (rate ratio, 0.83; 95% CI, 0.71-0.96), as was the proportion of children with watery stools (odds ratio, 0.61; 95% CI, 0.39-0.95), compared with the control group; there was no significant effect on diarrheal duration. ORS intake and proportion of children with vomiting were not significantly different between the zinc-ORS and control groups. The zinc syrup group had lower diarrheal duration (relative hazards, 0.89; 95% CI, 0.80-0.99) and total stools (rate ratio, 0.73; 95% CI, 0.70-0.77) than control children. CONCLUSIONS: Zinc-ORS was moderately efficacious in reducing the severity of acute diarrhea without increasing vomiting or reducing ORS intake.

Acute Disease↗