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PubMed1990

Bacterial contamination of reconstituted oral rehydration solution.

The extent and nature of bacterial contamination in oral rehydration solution reconstituted for use by individuals and for group of patients was studied. Twenty three volunteers (all qualified doctors) were asked to reconstitute a packet of prepackaged salt in half litre of clean unboiled water obtained from taps at their residence. Five ml aliquots of ORS were collected at 6, 12 and 24 hours after reconstitution for bacteriologic study. The water used by volunteers to reconstitute the ORS as well as throat swabs, peri-anal swabs and nail clippings of volunteers yielded pathogenic bacteria in all the subjects/samples. All the 23 specimens of ORS prepared by volunteers when cultured at 6 hours after reconstitution yielded pathogenic bacteria. The bacterial colony counts were found to be unacceptably high at 12 hours. Five ml samples of reconstituted ORS prepared in bulk in the children ward of PGIMER, Chandigarh were cultured at 12, and again at 24 hours after reconstitution on 10 different days. These yielded Klebsiella pneumoniae in 8 specimens (80%) and E. coli in 2 (20%). The bacterial colony count was unacceptably high, 12 hours after reconstitution.

Bacteria↗
PubMed1994

Randomised double blind trial of hypotonic oral rehydration solutions with and without citrate.

Hypotonic oral rehydration salts solutions (ORS) have been proved to be better than isotonic solutions with respect to water absorption. To establish whether a base precursor is essential in the composition of a hypotonic ORS with improved absorption properties, a randomised double blind clinical trial was conducted comparing two formulas of hypotonic ORS, each with an osmolality of 224 mmol/l, with or without citrate, in a group of 107 children admitted to hospital with acute diarrhoea. The two solutions were effective in the correction of dehydration and there was no difference between the treatments in the duration of diarrhoea. The patients receiving the hypotonic ORS with citrate consumed less of the solution, however, and their metabolic acidosis was corrected earlier. It is concluded that citrate is clinically advantageous in a hypotonic ORS, but a hypotonic formula without a base precursor is also effective.

Citrates↗
PubMed2003

Efficacy and safety of a modified oral rehydration solution (ReSoMaL) in the treatment of severely malnourished children with watery diarrhea.

OBJECTIVES: Efficacy, development of overhydration, and correction of electrolyte disturbances of severely malnourished children with acute diarrhea using a modified oral rehydration solution for malnourished children (termed ReSoMaL and recommended by the World Health Organization [WHO]) were evaluated and compared with standard WHO-oral rehydration solution (ORS). STUDY DESIGN: Children age 6 to 36 months with severe malnutrition and acute watery diarrhea were randomized to ReSoMaL (n=65) or standard WHO-ORS (n=65). Major outcome measures included the number of children who developed overhydration and the number who corrected hypokalemia. RESULTS: The numbers of children who developed overhydration were not significantly different (ReSoMaL vs WHO-ORS, 5% vs 12%, P=.2). ReSoMaL corrected basal hypokalemia in a greater proportion of children by 24 hours (36% vs 5%, P=.0006) and 48 hours (46% vs 16%, P=.004) compared with WHO-ORS. More children on ReSoMaL than WHO-ORS remained hyponatremic at 48 hours (29% vs 10%, P=.017). Three children in the ReSoMaL group developed severe hyponatremia by 24 hours, with one experiencing hyponatremic convulsions (serum sodium, 108 mmol/L). CONCLUSIONS: ReSoMaL has a large beneficial effect on potassium status compared with standard ORS. However, ReSoMaL therapy may result in symptomatic hyponatremia and seizures in patients with severe diarrhea.

Child, Preschool↗
PubMed1998

Carob bean juice: a powerful adjunct to oral rehydration solution treatment in diarrhoea.

In children, the treatment of acute diarrhoea with the World Health Organization (WHO) standard oral rehydration solution (ORS) provides effective rehydration but does not reduce the severity of diarrhoea. In community practice, carob bean has been used to treat diarrhoeal diseases in Anatolia since ancient times. In order to test clinical antidiarrhoeal effects of carob bean juice (CBJ), 80 children, aged 4-48 months, who were admitted to SSK Tepecik Teaching Hospital with acute diarrhoea and mild or moderate dehydration, were randomly assigned to receive treatment with either standard WHO ORS alone or a combination of standard WHO ORS and CBJ. Three patients were excluded from the study because of excessive vomiting. In the children receiving ORS + CBJ the duration of diarrhoea was shortened by 45%, stool output was reduced by 44% and ORS requirement was decreased by 38% compared with children receiving ORS alone. Weight gain was similar in the two groups at 24 h after the initiation of the study. Hypernatraemia was detected in three patients in the ORS group but in none of those in the ORS + CBJ group. The use of CBJ in combination with ORS did not lead to any clinical metabolic problem. We therefore conclude that CBJ may have a role in the treatment of children's diarrhoea after it has been technologically processed, and that further studies would be justified.

Acute Disease↗
PubMed1994

Neurohumoral mechanism involved in augmentation of canine jejunal absorption following oral rehydration solutions.

Throughout the world diarrheal diseases kill over 5 million children annually. Oral rehydration therapy, initially using glucose-based solutions and more recently cereal-based solutions, prevents complications and death from dehydration. These experiments compared the effect of these two rehydration solutions and a mixed meal on jejunal water and ionic transport. Five dogs had 25-cm proximal jejunal Thiry-Vella fistulae constructed. Following recovery, jejunal absorption studies (N = 40) were performed using an isotonic electrolyte solution containing [14C]PEG to calculate net fluxes of water, sodium, and chloride. Each study consisted of a 1-hr basal period, followed by a 3-hr experimental period. Each animal was randomly studied in each of four study groups: control, mixed meal, glucose-based and cereal-based rehydration solution. In the mixed meal, glucose-based, and cereal-based solution groups there were significant increases (P < 0.0001) in jejunal Thiry-Vella fistula water and ion absorption following the stimuli, in the absence of direct luminal nutrient contact with the Thiry-Vella fistula. There were no differences between the observed responses to the glucose-based or cereal-based rehydration solutions. Glucose-based and cereal-based rehydration solutions were equally effective in stimulating jejunal absorption of water and electrolytes, but less effective than a mixed meal. Both food and oral rehydration solutions appear to increase jejunal absorption partially via a neurohumoral mechanism that is independent of luminal nutrient contact with the Thiry-Vella fistula.

Animals↗
PubMed1997

Nitric oxide counteracts 5-hydroxytryptamine- and cholera toxin-induced fluid secretion and enhances the effect of oral rehydration solution.

The effects of pharmacological modulation of the nitric oxide (NO) pathway on intestinal fluid transport were studied in a model of ligated jejunal loops of anaesthetized rats in vivo. Close intraarterial infusion of 5-hydroxytryptamine (5-HT) (0.16 microg/min) induced net fluid secretion. Intravenous infusion of the NO synthase inhibitor N(omega)-nitro-L-arginine methyl ester (L-NAME) (0.55 mg/kg per min) reversed net fluid absorption in controls to net secretion and significantly enhanced 5-HT-induced fluid secretion. 5-HT-induced net fluid secretion was inhibited by intravenous infusion of L-arginine (8.88 mg/kg per min), sodium nitroprusside (22.2 microg/kg per min), or 3-morpholino sydnonimine (SIN-1) (22.2 microg/kg per min). Intraluminal instillation of cholera toxin (0.5 microg/ml) induced net secretion, which was significantly enhanced by L-NAME and reduced by L-arginine. Another series of experiments was performed using a model of luminally perfused jejunal loops. Cholera toxin (10 microg/ml) induced profuse net fluid secretion also in this model. L-Arginine and sodium nitroprusside significantly enhanced net fluid absorption compared to controls and abolished the secretory effect of cholera toxin. Luminal perfusion with oral rehydration solution enhanced net absorption of fluid in controls and reversed cholera toxin-induced secretion to absorption. Intravenous infusion, but not intraluminal administration, of L-arginine significantly enhanced the antisecretory effect of oral rehydration solution. These results give further support to the existence of an intestinal NO-mediated proabsorptive tone, which also downregulates fluid secretion elicited by different enterotoxins or mediators of secretion. Intravenous administration of exogenous sources of NO counteracts intestinal fluid accumulation and augments the antisecretory effect of oral rehydration solution, findings which may lead to therapeutic consequences.

Animals↗
PubMed1994

Absorption of a hypotonic oral rehydration solution in a human model of cholera.

The development of oral rehydration solutions (ORSs) has been one of the important therapeutic advances of this century. The optimal formulation, however, of ORSs for both cholera and other infective diarrhoeas is still debated. Part of the problem in developing ORSs has been the lack of adequate test systems for the assessment of new formulations before clinical trial. We have developed a jejunal perfusion, cholera toxin induced, secretory model in humans and have compared net water and solute absorption from a hypotonic ORS (HYPO-ORS: sodium 60 mmol/l, glucose 90 mmol/l, osmolality 240 mOsm/kg) and the British Pharmacopoeia recommended ORS (UK-ORS: sodium 35 mmol/l, glucose 200 mmol/l, osmolality 310 mOsm/kg) in six healthy volunteers. A plasma electrolyte solution (PES) was also perfused in all subjects to confirm a secretory state. Only HYPO-ORS reversed sodium secretion to absorption (p < 0.01). Both ORSs promoted net water absorption but this was greatest with HYPO-ORS (p < 0.01). Glucose and potassium absorption rates were similar for both ORSs whereas chloride absorption mirrored sodium absorption and was greatest from HYPO-ORS (p < 0.05). These results, in a biologically relevant model of secretory diarrhoea, suggest it may be possible to achieve improved rates of rehydration by the use of hypotonic ORS with mid range sodium concentrations.

Adult↗
PubMedDate not supplied

Enteral resuscitation of burn shock using World Health Organization oral rehydration solution: a potential solution for mass casualty care.

Enteral resuscitation could provide a means to resuscitate burn shock when intravenous (IV) therapy is unavailable, such as in mass disasters. We evaluated the extent of intestinal absorption and resuscitative effects of World Health Organization Oral Rehydration Solution after a 40% TBSA burn in anesthetized swine compared with the IV infusion of lactated Ringer's infused by Parkland formula. Plasma volume (PV) was measured using indocyanine green dye dilution. Intestinal absorption was assessed using phenol red as a nonabsorbable marker. Changes in hematocrit, hemodynamics, and measured PV showed equivalent resuscitative effects of enteral and IV resuscitation. The duodenal fluid absorption rate started at 77 +/- 32 ml/hr per meter of intestine during the first hour and increased to 296 +/- 40 ml/hr during the fourth hour of resuscitation, with a total of 93 +/- 2% of World Health Organization Oral Rehydration Solution infused into the intestine being absorbed. Intestinal absorption rates after burn injury are sufficient to resuscitate a 40% TBSA burn.

Animals↗
PubMed2000

The nutrient content and effectiveness of rice flour and maize flour based oral rehydration solutions.

The effectiveness of rice flour and maize flour based oral rehydration solution (ORS) in treating mild and moderate dehydration was studied among 88 children aged to 6 to 42 months at the Oni Memorial Children Hospital, Ibadan. In this randomized clinical trial, fifty children were treated with rice-based ORS while fifty-three received the maize-based ORS, over a four hour period. There was clinical improvement in the signs of dehydration with a significant increase in body weights and a significant fall in the packed cell volume following the administration of the two preparations. The maize-ORS contains 4.3 g protein, 179.3 Kilocalories and rice-ORS contains 3.6 g protein and 152.1 Kilocalories per litre of the preparation, respectively. It is concluded that rice and maize based ORS were acceptable and effective in oral rehydration of diarrhoea patients. They may also contribute to the nutrient intake of patients with (mild to moderate) 'some' dehydration. However other sources of energy, protein and mineral intake should be continued in these patients.

Body Weight↗
PubMed1995

Hypotonic oral rehydration solution in acute diarrhoea: a controlled clinical trial.

In a controlled trial, a hypotonic oral rehydration solution (ORS) (Na+67, K+20, Cl-66, citrate 7, glucose 89 mmol/l osmolality 249 mosmol/kg) was compared with a standard WHO-ORS (Na+90, K+20, Cl-80, citrate 10, glucose 111 mmol/l, osmolality 311 mosmol/kg) in 60 children aged 5-24 months with acute watery diarrhoea. In the hypotonic ORS group, stool frequency, proportion of children who vomited, ORS requirements and purging rate over 24-48 h were reduced by 33% (p = 0.01), 30% (p = 0.02), 21% (p = 0.067) and 21% (p = 0.03), respectively. The proportion of children who vomited and the purging rate over 48 h were reduced by 23% (p = 0.03) and 10% (p = 0.097), respectively. Serum electrolytes after 48 h were comparable. The beneficial effect of hypotonic ORS was most marked in, and largely contributed by, the subgroup negative for rotavirus.

Acute Disease↗
PubMed1985

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.

Acidosis↗
PubMed1991

[The evaluation of the efficacy of 1st- and 2d-generation oral rehydration solutions in treating patients with acute intestinal infections].

The efficacy of the solutions of oral rehydration salts (ORS) of the first and second generations was estimated in the treatment of patients with acute intestinal infections. 150 patients with food toxicoinfections were examined. Two groups of the patients received the solutions of ORS of the first generation (glucosalan and citroglucosalan) and one group were given the second generation ORS solution based on the rice and salt, manufactured by Galactina (Switzerland). The clinical cases were analyzed. Some biochemical parameters that characterize certain aspects of homeostasis and bioenergetics were explored. The authors emphasize a greater effectiveness of the second generation solutions of ORS producing not only detoxification and rehydration but also serving as a food.

Acute Disease↗
PubMed1989

A comparison of two oral rehydration solutions in experimental models of dehydration and diarrhoea in calves.

Two oral rehydration solutions (ORS 1 and ORS 2) were evaluated in isolated intestinal loops of anaesthetised calves, in an experimental model of dehydration in the calf, in calves with experimentally induced diarrhoea and in 164 calves with clinical diarrhoea. The studies in isolated intestinal loops indicated that water absorption was significantly greater from ORS 2 than from ORS 1. After the intraperitoneal administration of hypertonic mannitol combined with intravenous diuretics, the plasma volume of calves was reduced by about 30 per cent, and was more rapidly expanded after treatment with ORS 2 than ORS 1. The plasma volume remained significantly reduced (P less than 0.01) three hours after dosing with ORS 1 whereas after treatment with ORS 2 it was not significantly different from the initial value. Acidosis was corrected to a significantly (P less than 0.01) greater extent after treatment with ORS 2, and peripheral perfusion also returned to normal more rapidly in calves given ORS 2. In newly purchased calves in which diarrhoea was induced experimentally with an E coli challenge, base deficit and diarrhoea were corrected more rapidly in the calves receiving ORS 2. When the solutions were tested in the treatment of 164 clinical cases of diarrhoea and dehydration there was no statistically significant difference in mortality between the formulations, although the overall mortality was 4.8 per cent in the calves treated with ORS 2, compared with 8.6 per cent in the calves treated with ORS 1. It was concluded that ORS 2 performed better than ORS 1 especially in the expansion of plasma volume and the correction of acidosis.

Acidosis↗
PubMed1992

Commercial oral rehydration solutions--pitfalls, knowledge, attitude and practices.

Locally available commercial preparations of oral rehydration solutions (ORS) were analyzed for their composition, package instructions and availability. A survey from 50 chemist stores, revealed that ORS packets available belonged to 28 different pharmaceutical companies. None of the shops stored more than five different brands and alternate preparations were handed over the counter freely. Only 48% of the available ORS formulations had the WHO recommended composition. In about one-fourth preparations, the sodium concentration was 30 mEq or less per litre. Forty-one per cent solutions had glucose concentrations more than 2%. The glucose and sodium ration of 1:1 was maintained in only 48% of the formulae. Bicarbonate and citrate both were used with almost equal frequency in these preparations. Cost, flavor, additional ingredients and package instructions varied widely in different packets. ORS formulations most commonly found in the drug stores had low sodium and high glucose concentration. The attitude of doctors and nurses of Pediatric Department and Chemists towards commercial ORS was also studied. While 92% doctors were aware about WHO-ORS, none of the chemists and only 4% nurses had this awareness. All the respondents could remember only up to 3 or 4 brand names and except 30% doctors, none were aware about the composition of those brands of ORS. Regarding importance of composition, preparations and precautions, practically nobody was up to the mark, but doctors were definitely better as compared to nurses and chemists.

Drug Compounding↗
PubMed1995

The effects of tonicity, glucose concentration and temperature of an oral rehydration solution on its absorption and elimination.

Effects of different tonicities, glucose concentrations and temperatures of an oral rehydration solution (ORS) on its uptake and elimination in resting horses were studied. Fluid and electrolyte deficits similar to those occurring during prolonged exercise were induced by the administration of 1 mg/kg bwt of frusemide i.m., 3 h prior to the ORS. Fluid was administered via nasogastric tube at a volume equivalent to 4% bodyweight, which approximated diuretic induced losses. The uptake of fluid was evaluated by changes in haematocrit (PCV) and plasma total protein concentration (TP). Changes in electrolyte balance were studied by measurements of plasma and urinary electrolyte concentrations while changes in bodyweight, urine volume and faecal water content were used to estimate retention of the administered fluids. Changes in acid base status were assessed from venous blood bicarbonate values. Fluid tonicity had a major effect on the uptake and elimination of the ORS. The hypertonic fluid (628 mOsm/kg bwt) was less rapidly absorbed and resulted in more rapid fluid and electrolyte excretion than the isotonic (314 mOsm/kg bwt) and hypotonic (water) fluids. The inclusion of glucose did not enhance the absorption of the ORS, although fluids containing higher concentrations of electrolytes resulted in more rapid elimination of fluid in urine. There was a direct relationship between higher concentrations of sodium in the ORS, plasma sodium values and osmolality. Fluid temperature (5, 21 and 37 degrees C) had no demonstrable effect on absorption of the ORS and elimination of fluids post administration. We concluded that while glucose concentration and fluid temperature have minimal effects on fluid absorption and elimination, fluid tonicity was a key element in the uptake and elimination of orally administered fluid. These findings are likely to be of relevance when administering ORS in association with exercise.

Absorption↗
PubMed2003

Review of a potential role for zinc supplementation in oral rehydration solutions.

Patients with short bowel syndrome often present with diarrhea and significant fluid and electrolyte abnormalities. Management consists of the use of medication, dietary modification, and oral rehydration solutions. Zinc deficiency has been shown to result in diarrhea. Oral zinc has been used for the management of acute diarrhea primarily in underprivileged children in developing countries. The effectiveness and feasibility of adding zinc to oral rehydration solutions (ORS) to abate and control diarrhea for adult patients with intestinal failure caused by short bowel syndrome has not been studied. Based on studies evaluating the use of oral zinc supplementation in the treatment of acute diarrhea, recommendations are made for the composition of ORS in adults.

Journal Article↗
PubMed1997

Oral rehydration solution in the year 2000: pathophysiology, efficacy and effectiveness.

The use of oral rehydration solution (ORS) with early refeeding forms the basis of therapy for dehydration secondary to diarrhoea ORS has produced such positive results in dehydrated patients that no further scientific demonstration is needed to confirm its efficacy. This review presents several issues that remain unsettled or controversial. They include the following. 1. The mechanism of water handling by the intestine is discussed; this is more complex than initially thought, at the epithelial, cellular and molecular level. 2. The composition of ORS which has been successfully adapted for the most frequent conditions, except for severely malnourished children, is described. 3. In contrast to the strong scientific basis and obvious efficacy in rehydration of ORS, its consequences for growth, nutrition and mortality are difficult to demonstrate, unless adequate long-term nutritional support is also provided in addition to ORS. 4. Finally, discrepancies between the recommendations and the practice of oral rehydration therapy are now well documented. Analysis of the causes of these discrepancies may participate in improving public health campaigns.

Dehydration↗
PubMed1989

Bicarbonate enhances sodium absorption from glucose and glycine rehydration solutions. An in vivo perfusion study of rat small intestine.

Sodium, potassium and water absorption was studied over the whole length of rat jejunum and ileum by an in vivo marker perfusion technique. The composition of solutions were similar to the oral rehydration solution currently in use for the treatment of acute diarrhoeal diseases. The study shows that bicarbonate and chloride containing glucose or glycine electrolyte solutions induce a significantly greater absorption of sodium, potassium and water compared to those containing chloride only. The study also confirms that an amino acid such as glycine is as efficient as glucose in promoting the absorption of sodium, potassium and water from rat small intestine.

Animals↗