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PubMed1994

Oral rehydration solutions (ORS): enhancement by a soluble fiber.

OBJECTIVE: This study was designed to test the hypothesis that, in an animal model of protein-energy malnutrition (PEM), carboxymethylcellulose (CMC), a viscous additive for the World Health Organization Oral Rehydration Solution (WHO-ORS), previously found to be effective in rats with osmotic diarrhea as an enhancer of water and sodium absorption, would also improve the performance of the WHO-ORS. This hypothesis was based on the changes in fluid and electrolyte transport that could be induced by an increase in the viscosity. METHODS: We evaluated CMC in young rats fed a low-protein, low-energy diet for 3 weeks to induce PEM. Control (CTL) rats were fed a nutritionally complete diet. The ORS were tested with an in vivo perfusion procedure under anesthesia. RESULTS: CMC addition (0, 2.5, 5.0 and 10.0 g/L) sharply increased the rates of net water and sodium absorption in both groups of rats, especially in the PEM animals. Net water absorption increased from (means +/- SEM) 0.75 +/- 0.06 to 2.21 +/- 0.18, 3.35 +/- 0.20 and 8.46 +/- 0.84 microL/min x cm in the PEM rats (0, 2.5, 5.0 and 10.0 g/L CMC, respectively). For the same CMC concentrations, sodium absorption improved from 178.8 +/- 20.3 to 402.4 +/- 18.4, 486.4 +/- 29.2 and 898.4 +/- 21.4 nmol/min x cm, respectively. CTL rats also showed marked increases. Rates of lumen-to-serosa water influx improved in both groups without major changes in water efflux. Net water and sodium absorption appeared related to the log of the ORS viscosity. CONCLUSIONS: The results further support the concept that increased viscosity induced by CMC enhances the effectiveness of ORS.

Absorption↗
PubMed1990

How much oral rehydration solution is actually administered during home-based therapy?

In some parts of the world up to one-half of all deaths in young children are attributable to dehydration associated with diarrhoea. As a countermeasure, mothers in underdeveloped countries are being successfully taught to give oral rehydration solution at home. There are, however, serious doubts as to whether mothers give their children enough. The focus of our investigation was a methodology capable of establishing the exact quantity of fluid administered by unsupervised mothers at home. Accurate quantitative data are essential for programme planning and evaluation. In our sample of 44 cases, only two children received more than 90 ml kg-1 day-1. The mean observed value was 44 ml kg-1 day-1 (SD 28.4); well below the recommended dosage. Preliminary data were also gathered on natural consequences which may discourage use of ORS such as vomiting, increased frequency of watery stools, and distaste for the solution.

Age Factors↗
PubMed2000

Oral rehydration solution therapy in the management of children with rotavirus diarrhea.

Rotavirus infections are the most common cause of gastroenteritis among children younger than 3 years of age and are associated with sporadic outbreaks of diarrhea in elderly and immunocompromised patients. Oral rehydration solutions (ORS) are formulated to correct dehydration and acidosis. Currently, ORS do not promote intestinal healing; however, investigators are examining the role of nutrition in promoting intestinal healing. This article reviews the composition of several ORS in human medicine and summarizes our current knowledge of the nutritional treatment of rotavirus diarrhea and intestinal healing.

Administration, Oral↗
PubMed1985

Mothers can prepare and use rice-salt oral rehydration solution in rural Bangladesh.

A feasibility study of rice-salt solution for oral rehydration (OR) was conducted in a village in the Chandpur area of rural Bangladesh in 1983. 305 mothers of children aged 0-4 years were interviewed with a pretraining questionnaire to find out about the availability of rice. The mothers were then trained and encouraged to use rice-salt OR solution to treat patients with diarrhoea. Evaluation of training was assessed by means of field diarrhoea surveillance, case follow-up, rice-salt OR solution sample analysis, and a post-training survey. The study showed that mothers in rural areas could prepare rice-salt OR solution quite easily and use it to treat diarrhoea patients. Mothers considered that this method would increase the utilisation of OR treatment in rural homes. After training rice-salt OR solution was the most common method of treatment for diarrhoea.

Administration, Oral↗
PubMed1995

Clinical trial of glucose-oral rehydration solution (ORS), rice dextrin-ORS, and rice flour-ORS for the management of children with acute diarrhea and mild or moderate dehydration.

OBJECTIVE: To assess the effects of glucose (G)-oral rehydration solution (ORS), rice dextrin (RD)-ORS, and rice flour (RF)-ORS on fluid intake, rapidity of rehydration, and stool output of children with acute diarrhea and mild or moderate dehydration. METHODS: The study was a randomized, double-masked clinical trial. One hundred forty-six male infants, ages 3 to 36 months, were randomly assigned to one of three treatment groups. Clinical evaluations and fluid balances were conducted every 2 to 4 hours for 48 hours. Principal outcome variables were ORS consumption, recovery of hydration status, and fecal output. RESULTS: The groups were similar at admission with regard to age, nutritional status, history of the current episode, and clinical status. There were no differences in ORS consumption by treatment group during any period of study. During the first 6-hour period, patients in group RF had less stool output (16 +/- 14 g/kg/body weight) than those in group G (22 +/- 20 g/kg) or RD (21 +/- 19 g/kg; P < .05). After 12 hours of hospitalization, there were no differences by treatment group. Recovery of hydration status, changes in serum sodium and potassium, and duration of diarrhea in the hospital were similar in all three groups. CONCLUSION: There was a 24% to 27% reduction in stool output during the first 6 hours of treatment among children who received RF-ORS compared with those who received G-ORS or RD-ORS, but this effect did not persist after the first 12 hours of therapy. Because this difference was of small magnitude and limited duration, it has minor clinical importance. Thus, we conclude that the three solutions had similar efficacy for children with acute, watery diarrhea and mild or moderate dehydration.

Acute Disease↗
PubMed2002

Zinc supplementation in oral rehydration solutions: experimental assessment and mechanisms of action.

BACKGROUND: Zinc deficiency is associated with chronic diarrhea. This condition is generally linked to an overproduction of nitric oxide (NO), which induces secretion and cellular damage as a free radical. Use of oral rehydration solutions (ORS) is an important part of diarrhea treatment, especially early in infancy and for patients with cholera. The presence of zinc in an ORS could be a positive factor in recovery from diarrheal disease. OBJECTIVE: This study was undertaken to determine whether zinc added to an ORS could regulate the synthesis of NO metabolites in the lumen of zinc deficient rat intestine, acting as a gastrointestinal protector and thus accelerating normalization of intestinal function and zinc status. METHODS: The effects of zinc on NO metabolism were studied in young male rats fed a zinc deficient diet for three weeks to mimic the condition of patients with recurrent diarrheal episodes. During the fourth week of the zinc deficient feedings, experimental diarrhea was induced using cathartics (magnesium citrate plus phenolphthalein) that exacerbate NO production. A standard ORS with or without 1 mM zinc was given to the rats for the last two days. A control group received a zinc sufficient diet. Rats were killed at each stage. Intestinal nitric oxide synthase (NOS) was assayed, cecal fluid contents were analyzed for nitrates and nitrites, intestinal histology was examined, and activation of nuclear factor NF-kappaB DNA binding activity was determined. RESULTS: Rats fed the zinc-deficient diet for three weeks gained less weight than rats fed a normal zinc content diet and had a lower plasma zinc than controls (51.6 +/- 5.4 [n = 101 vs. 143.6 +/- 7.2 microg/dL [n = 11], p < 0.05). Recovery with ORS+Zn resulted in a higher plasma zinc than with the ORS-Zn (ORS+Zn: 186.5 +/- 12.2; ORS-Zn: 57.5 +/- 6.6 microg/dL, p < 0.05). The zinc-deficient diet did not alter mucosal NOS, as compared to the values of rats fed a normal diet. However, those animals which received five days of cathartic fluids had a small intestinal NOS higher than that of all other groups. Either ORS+Zn or ORS-Zn normalized NOS activity, regardless of cathartic treatment. The rats fed the zinc deficient diet had generally a higher content of NO metabolites in the cecum than rats fed a normal diet. After recovery with either type of ORS, rats given the cathartic remained with higher cecal NO metabolite concentrations than rats that had no induced diarrhea. After recovery with ORS+Zn, intestinal villi showed significant expansion of the lamina propria, an indication of greater absorption of fluid, while with ORS-Zn this was not present. Small intestinal homogenates of rats recovering with ORS+Zn had a decreased NF-kappaB DNA binding activity than tissues from rats consuming ORS-Zn. CONCLUSIONS: The results are consistent with the hypothesis that addition of Zn to an ORS may contribute to improving the physiologic status of the small intestine and potentially reduce the risks of recurrent diarrhea episodes.

Animals↗
PubMed1996

Can a super oral rehydration solution stimulate intestinal repair in acute viral enteritis?

This study was designed to screen several treatments for their effects on mucosal repair in an established model of piglet rotavirus enteritis. Six ingredients selected to facilitate repair were added to the oral rehydration solution (ORS) and subsequently to the diet: L-glutamine (GLN); rice solids; a soluble fiber (carboxymethylcellulose); nucleotides; polyamines; and fructooligo-saccharides. Rotavirus infection consistently induced a watery diarrhoea lasting 5 to 10 days and produced a jejunal mucosal lesion which was maximal at 3 days, post-inoculation (manifested by a reduction of villus surface area to 30% to 50% of normal). By 7 to 10 day post-inoculation, the villus surface area returned to 50% to 80% of normal. None of the supplemental ingredients added to the ORS had a significant effect in either shortening the clinical illness or in stimulating recovery of the affected mucosa. It is concluded that several types of "Super ORS" are ineffective in enhancing repair in viral enteritis in neonatal colostrum-deprived piglets. These results do not rule out beneficial effects of the additives tested in subjects with more extensive intestinal damage, in those who receive breast milk, or in those with bacterial enteritis.

Animals↗
PubMed1997

L-arginine in low concentration improves rat intestinal water and sodium absorption from oral rehydration solutions.

BACKGROUND: The nitric oxide (NO) precursor L-arginine has been shown to produce variable effects on intestinal absorptive function, including ion transport. AIMS: To determine whether there is an optimal concentration of L-arginine, promoting proabsorptive effects from oral rehydration solutions (ORS) with 90 or 60 mM sodium. SUBJECTS AND METHODS: In vivo perfusion of rat jejunum with determination of net water absorption, unidirectional fluid exchanges, sodium and calcium transport, and glucose absorption. RESULTS: L-Arginine (1 mM) added to the 90 mM sodium ORS increased intestinal absorption of both sodium and water. Higher concentrations of L-arginine (2 to 10 mM) lacked this stimulatory effect. At 20 mM, L-arginine decreased sodium absorption below baseline. With a 60 mM sodium ORS, 2 mM L-arginine had a maximal fluid and electrolyte proabsorptive effect. At 20 mM L-arginine, net water absorption was indistinguishable from that obtained in the absence of L-arginine, and lower than with 2 mM L-arginine. Sodium absorption remained raised above baseline in perfusions with 10 and 20 mM L-arginine. Morphologically, villi from perfusions with increased absorption showed a large expansion of intercellular and lamina propria intercellular spaces. CONCLUSIONS: Low concentrations of L-arginine seem to stimulate water and electrolyte absorption by the small intestine. This effect is consistent with NO induced vasodilation, may be vaso-constrictive and thereby reverse fluid and electrolyte transport.

Animals↗
PubMed1995

Acceptability of a rice-based oral rehydration solution in Port Moresby General Hospital's Children's Outpatient Department.

The guardians of children brought to the Port Moresby General Hospital's Children's Outpatient Department with a chief complaint of diarrhoeal disease were questioned regarding their preference of glucose-based vs rice-based oral rehydration solution (ORS) in order to determine the acceptability of a rice-based ORS. Of the 93 guardians interviewed, greater than 60% preferred the glucose-based solution in its mixability, appearance and taste, and 65% initially reported that their children preferred the taste of the glucose solution. However, after a 30-minute trial, only 58% of children still preferred the glucose solution. In a country where diarrhoeal disease is a leading cause of child death and guardians are the primary health care providers, the acceptability of an ORS is critical to the morbidity and mortality of Papua New Guinea's children.

Adult↗
PubMed1990

[Oral rehydration solutions with 60 or 90 nmol/L of sodium for infants with acute diarrhea in accord with their nutritional status].

A total of 186 infants suffering from dehydration due to acute diarrhea were studied and divided into two groups: 84 children were placed in group A and received the oral rehydration solution (ORS) recommended by the World Health Organization (WHO), know as ORS-90 and those placed in group B were given an ORS with 60 and 90 mmol/L of sodium and glucose, respectively, with an osmolality of 240 mOsm/kg (ORS-60). Seven patients from group A (8.3%) and two from group B (2.5%) could not be orally rehydrated and required intravenous rehydration. The children were divided according to their weight for their age into eutrophics, grade I malnutrition (10 to 25% deficit), grade II (26 to 40% deficit) and grade III (more than 40% deficit). In those patients who evolved favorably, the average rehydration time was 4.5 to 5.3 hours, independently from their nutritional state. In the same way, no important variations were seen in the average sodium and potassium serum levels once the dehydration was corrected, in either of the groups. Yet, both groups showed a persistence in hypokalemia and hyperkalemia seen when admitted, once the dehydration was corrected, demonstrating that the short time needed for the correction of the dehydration was insufficient to completely corrected the changes in serum potassium. Closer studies must be conducted on the hydric balance to adequately demonstrate if the new ORS-60 induces lesser losses through vomiting and feces when compared to the ORS-90 recommended by the WHO.

Acute Disease↗
PubMed1991

Glucose polymers as an alternative to glucose in oral rehydration solutions.

Several issues involving glucose-based oral rehydration therapy may limit its acceptability and sustained use. Our studies suggest that defined short-chain glucose polymers (2 to 9 glucose units) are hydrolyzed and absorbed faster than isocaloric solutions of D-glucose in the small intestine of the rat. Glucose polymers, primarily from rice-based solutions, have been shown to be as effective as glucose-based solutions. They offer additional advantages in reducing the amount and duration of diarrhea with lesser volumes of solution, thereby reducing the costs of treatment. Rice-based solutions provide high caloric density and increase the absorption of sodium without an osmotic overload. The result is increased net absorption of glucose, sodium, and water. Glucose polymers from rice or other starches in oral rehydration solutions may be effective, inexpensive, easily used, and safe treatments for acute diarrhea.

Animals↗
PubMed1997

Sagodana based verses rice based oral rehydration solution in the management of acute diarrhoea in Pakistani children.

This study was carried out to compare the efficacy of a cereal based ORS (prepared with 50 G of sagodana (cereal), 3.5 G/L sodium chloride, 1.5 G/L potassium chloride, 2.9 G/L trisodium citrate) with rice based oral rehydration solution (using same amounts of rice and electrolytes) for treatment of diarrhoea. One hundred and twelve children aged 3 months to 2 years with watery diarrhoea of less than 5 days duration with mild to moderate dehydration and no sepsis, were included in the study. The amount of ORS intake, stool volume and frequency were similar in both groups. Clinical success was seen in 79% of rice ORS group and 81% in sagodana group. Both can be used as a cereal based ORS in the management of acute diarrhoea in communities where it is culturally accepted and used as a weaning diet.

Acute Disease↗
PubMed1991

Comparison of glucose/electrolyte and maltodextrin/glycine/glycyl-glycine/electrolyte oral rehydration solutions in acute diarrhea in children.

Male children (N = 101) 6-35 months of age presenting with acute watery diarrhea for less than 48 h at home before hospitalization were admitted into a randomized, double-blind clinical trial. Fifty-one children were treated with standard oral rehydration solution (ORS) (World Health Organization [WHO] formulation containing citrate) and 50 were treated with an improved ORS formulation (containing, in addition to the standard formula, 20 g maltodextrin instead of glucose, and 4 g glycine and 4 g glycyl-glycine). None were given antibiotics. No i.v. infusions were given. Rotavirus was detected by enzyme-linked immunosorbent assay in stools of 43 children. Clinical characteristics of children in the two treatment groups were comparable. Improved ORS did not produce significant reduction in the volume of diarrhea stools. Children given improved ORS had greater weight gain than that observed in children treated with standard ORS, but the differences were not statistically significant except at the end of the first 24 h. Among children with rotavirus diarrhea, no significant differences were observed between the 23 children who received improved ORS and the 20 who received standard ORS.

Acute Disease↗
PubMed2003

[Sport drinks: not a suitable rehydration solution for children].

A two-months-old male infant with gastroenteritis had been given a sports drink (Aquarius) by the general practitioner as a treatment for dehydration and was referred because of ongoing vomiting and weight loss. The child recovered after reinstitution of normal bottle-feeding and administration of a regular oral rehydration solution (ORS). The sports drink was analysed and found to contain less salt than ORS. As a result, the salt:sugar ratio was not optimal. Sports drinks are therefore contraindicated in the treatment of dehydration in children.

Beverages↗
PubMed1981

Proliferation of enteropathogens in oral rehydration solutions prepared with river water from Honduras and Surinam.

Oral rehydration of infants with diarrhoea is an effective therapy that is becoming increasingly available in developing countries. To formulate judicious recommendations for preparation and storage of such solutions, we assessed the capability of recognized bacterial enteropathogens to survive and proliferate in solutions made either with sterile distilled or river water collected in two developing countries. Shigella flexneri, an enteropathogen typically transmitted by faecal/oral contact rather than by water or food, survived very poorly. In contrast, Vibrio cholerae and enterotoxigenic Escherichia coli, pathogens classically associated with transmission by food and water, reached concentrations of 103-104 per ml by 12 h and 104-106 by 24 h after inoculation of solutions made with river water and somewhat lower concentrations in distilled water. This potential exposure to bacteria must be considered in the context of the field situation where children are already ingesting high levels of bacteria in drinking water and food and where the oral rehydration solution would probably add little to their exposure. Although it is probably wise to prepare solutions fresh each day with water as free from faecal pollution as possible, in situations where lack of fuel to boil water or scarce supply of glucose/electrolyte packets preclude compliance with these recommendations prompt administration of oral rehydration solutions to infants with diarrhoea should nevertheless proceed.

Administration, Oral↗
PubMed1984

Growth of toxigenic Escherichia coli in oral rehydration solutions.

The ability of three strains of toxigenic Escherichia coli to grow in glucose-electrolyte oral rehydration solution (ORS) used for the treatment of dehydration due to diarrhea was studied. The purpose was to determine the potential risk that such home-based therapy might pose for transmission of infection if the ORS were contaminated with potential pathogens. Inocula of 10(5) unwashed organisms from broth culture were rapidly killed in ORS made with chlorinated tap water and increased by 1.5-2 log10 in ORS in triple-distilled laboratory water. When media constituents were first removed by washing, one strain failed to grow in ORS-distilled water, but multiplied to a level of 10(6) organisms/ml in ORS in water obtained from a rural village in the highlands of Guatemala. Multiplication of organisms in ORS depends on the presence of a nitrogen source. These limited data support current guidelines for preparation and use of ORS in the field employing available drinking water, as bacterial growth is restricted by the nitrogen content of the water.

Administration, Oral↗
PubMed1989

Oral rehydration solutions in 'section 30' areas. A study in two farming districts in the southern Transvaal.

Six hundred and twenty-three black mothers of young children were interviewed on the white-owned farms on which they lived and/or worked in two magisterial districts of the southern Transvaal. Only 8% described an acceptable method of preparing oral rehydration solution (ORS). Of those mothers whose children had recently had diarrhoea, 5% had given ORS. Thirty-one per cent of mothers had litre containers, sugar and salt in their homes, while 84% had cups, sugar and salt. Recommendations are made about health education appropriate to the needs and the resources of black women living on farms.

Diarrhea, Infantile↗
PubMed1991

Comparison of glucose/electrolyte and maltodextrin/glycine/glycyl-glycine/electrolyte oral rehydration solutions in cholera and watery diarrhoea in adults.

One hundred and eight male adults (mean age 33 +/- 1.7 years) presenting with watery diarrhoea of less than 48 hours duration at home prior to hospitalization and with clinically evident (grade II, severe) dehydration were admitted into a randomized double-blind clinical trial; 54 were treated with standard oral rehydration solution (ORS)--WHO formulation containing citrate--and 54 with an improved ORS formulation which contained, in addition to the standard formula, maltodextrin 20 g (instead of glucose), glycine 4 g and glycyl-glycine 4 g. Patients with clinical cholera were given tetracycline 500 mg q.i.d. Vibrio cholerae was detected in 85 patients. The clinical characteristics of patients in the two groups were comparable. The improved ORS did not reduce the volume of diarrhoeic stools in cholera; indeed, patients with cholera who were treated with improved ORS had larger diarrhoea stool volumes. However, those cholera patients given improved ORS showed significantly greater weight gains during the first six-hour period, at the end of the second day, and at discharge. On the other hand, non-cholera patients treated with improved ORS had significantly smaller diarrhoeic stool volumes during the six to 24-hour significantly smaller diarrhoeic stool volumes during the six to 24-hour period (i.e. during the commencement of maintenance rehydration therapy).

Adult↗