Comparison of sucrose with glucose in oral therapy of infant diarrhoea

Effect of preoperative oral rehydration before cesarean section on ultrasound assessment of gastric volume and intraoperative hemodynamic changes: a randomized controlled trial

BACKGROUND

Cesarean section often requires an urgent transfusion load due to decreased blood pressure after spinal anesthesia. This prospective randomized study aimed to investigate whether a preoperative oral rehydration solution (ORS) stabilized perioperative circulatory dynamics.

METHODS

Sixty-three parturients scheduled for cesarean section under combined spinal epidural anesthesia (CSEA) were randomly allocated to one of three groups: Group O received 500 mL ORS before bedtime and 500 mL 2 h before CSEA; Group M received mineral water instead of ORS; and Group C had no fluid intake (controls). After entering the operating room, stomach size was measured using ultrasound. Blood samples were obtained, and CSEA was induced. Vasopressors were administered when systolic blood pressure was < 90 mmHg or decreased by > 20%. As a vasopressor, phenylephrine (0.1 mg) was administered at ≥ 60 beats/min heart rate or ephedrine (5 mg) at < 60 beats/min heart rate. The primary outcome was the total number of vasopressor boluses administered. Secondary outcomes were the cross-sectional area of the stomach antrum, maternal plasma glucose levels, serum sodium levels, total intravenous fluid, bleeding volume, urine volume, operative time, and cord blood gas values after delivery.

RESULTS

The total number of vasopressor boluses was lower in Group O than in Group C (P < 0.05). Group O had lower total dose of phenylephrine than Group C (P < 0.05). There were no significant differences between Group M and other groups. No differences were detected regarding secondary outcomes.

CONCLUSIONS

In women scheduled for cesarean section, preoperative ORS stabilized perioperative circulatory dynamics. Neither ORS nor mineral water consumption increased the stomach content volume.

TRIAL REGISTRATION

This trial is registered in the University Hospital Medical Information Network Clinical Trials Registry (UMIN000019825: Date of registration 17/11/2015).

The History of Intravenous and Oral Rehydration and Maintenance Therapy of Cholera and Non-Cholera Dehydrating Diarrheas: A Deconstruction of Translational Medicine: From Bench to Bedside?

The "bench to bedside" (BTB) paradigm of translational medicine (TM) assumes that medical progress emanates from basic science discoveries transforming clinical therapeutic models. However, a recent report found that most published medical research is false due, among other factors, to small samples, inherent bias and inappropriate statistical applications. Translation-blocking factors include the validity (or lack thereof) of the underlying pathophysiological constructs and related therapeutic paradigms and adherence to faulty traditional beliefs. Empirical discoveries have also led to major therapeutic advances, but scientific dogma has retrospectively retranslated these into the BTB paradigm. A review of the history of intravenous (I.V.) and oral therapy for cholera and NDDs illustrates some fallacies of the BTB model and highlights pitfalls blocking translational and transformative progress, and retro-translational factors, including programmatic modifications of therapeutic advances contradicting therapeutic paradigms and medical economic factors promoting more expensive and profitable medical applications inaccessible to resource-limited environments.

Advances in the Development of Antiviral Compounds for Rotavirus Infections

Group A rotaviruses (RVAs) are the major cause of severe acute gastroenteritis (AGE) in children under 5 years of age, annually resulting in nearly 130,000 deaths worldwide. Social conditions in developing countries that contribute to decreased oral rehydration and vaccine efficacy and the lack of approved antiviral drugs position RVA as a global health concern. In this minireview, we present an update in the field of antiviral compounds, mainly in relation to the latest findings in RVA virion structure and the viral replication cycle. In turn, we attempt to provide a perspective on the possible treatments for RVA-associated AGE, with special focus on novel approaches, such as those representing broad-spectrum therapeutic options. In this context, the modulation of host factors, lipid droplets, and the viral polymerase, which is highly conserved among AGE-causing viruses, are analyzed as possible drug targets.

Unique Regulation of Intestinal Villus Epithelial Cl-/HCO3- Exchange by Cyclooxygenase Pathway Metabolites of Arachidonic Acid in a Mouse Model of Spontaneous Ileitis

Electrolytes (NaCl) and fluid malabsorption cause diarrhea in inflammatory bowel disease (IBD). Coupled NaCl absorption, mediated by Na⁺/H⁺ and Cl^-/HCO₃^- exchanges on the intestinal villus cells brush border membrane (BBM), is inhibited in IBD. Arachidonic acid metabolites (AAMs) formed via cyclooxygenase (COX) or lipoxygenase (LOX) pathways are elevated in IBD. However, their effects on NaCl absorption are not known. We treated SAMP1/YitFc (SAMP1) mice, a model of spontaneous ileitis resembling human IBD, with Arachidonyl Trifluoro Methylketone (ATMK, AAM inhibitor), or with piroxicam or MK-886, to inhibit COX or LOX pathways, respectively. Cl^-/HCO₃^- exchange, measured as DIDS-sensitive ³⁶Cl uptake, was significantly inhibited in villus cells and BBM vesicles of SAMP1 mice compared to AKR/J controls, an effect reversed by ATMK. Piroxicam, but not MK-886, also reversed the inhibition. Kinetic studies showed that inhibition was secondary to altered K_m with no effects on V_max. Whole cell or BBM protein levels of Down-Regulated in Adenoma (SLC26A3) and putative anion transporter-1 (SLC26A6), the two key BBM Cl^-/HCO₃^- exchangers, were unaltered. Thus, inhibition of villus cell Cl^-/HCO₃^- exchange by COX pathway AAMs, such as prostaglandins, via reducing the affinity of the exchanger for Cl^-, and thereby causing NaCl malabsorption, could significantly contribute to IBD-associated diarrhea.

Issues and Controversies in the Evolution of Oral Rehydration Therapy (ORT)

The original studies demonstrating the efficacy of oral glucose-electrolytes solutions in reducing or eliminating the need for intravenous therapy to correct dehydration caused by acute watery diarrheas (AWD) were focused chiefly on cholera patients. Later research adapted the oral therapy (ORT) methodology for treatment of non-cholera AWDs including for pediatric patients. These adaptations included the 2:1 regimen using 2 parts of the original WHO oral rehydration solution (ORS) formulation followed by 1 part additional plain water, and a “low sodium” packet formulation with similar average electrolyte and glucose concentrations when dissolved in the recommended volume of water. The programmatic desire for a single ORS packet formulation has led to controversy over use of the “low sodium” formulations to treat cholera patients. This is the subject of the current review, with the conclusion that use of the low-sodium ORS to treat cholera patients leads to negative sodium balance, leading to hyponatremia and, in severe cases, particularly in pediatric cholera, to seizures and other complications of sodium depletion. Therefore it is recommended that two separate ORS packet formulations be used, one for cholera therapy and the other for non-cholera pediatric AWD.

Severe Gastrointestinal Hemorrhage in a Child after Taking an Improper Oral Rehydration Solution

Oral rehydration solution (ORS) is safe and effective for the prevention and treatment of dehydration in children. It has been commercially available as a small packaging unit that needs to be taken with a specified amount of water. Intake of incorrectly formulated ORS results in side effects, such as electrolyte imbalance and upper gastrointestinal (GI) disturbance. We experienced a case of severe GI hemorrhage from gastric and duodenal ulcers in a previously healthy child following intake of incorrectly formulated ORS. GI hemorrhage in children is often life threatening and reaching a diagnosis may be challenging. Commercially manufactured packets of powdered oral rehydration salts have been widely used and GI hemorrhage associated with an improperly diluted ORS has been rarely reported. Caution and education for proper preparation of ORS are imperative.

Potency of Oral Rehydration Solution in Inducing Fluid Absorption is Related to Glucose Concentration

Oral rehydration solutions (ORSs) is the key treatment of acute diarrhea in children, as it restores the electrolyte balance by stimulating the intestinal sodium/glucose transporter SGLT1 to induce fluid absorption. The World Health Organization (WHO) and The European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) proposed ORSs with different chemical compositions. The main agent of childhood acute gastroenteritis is rotavirus (RV). We evaluate the effects of ORS with different concentration of glucose and sodium on RV induced secretion. Ussing chambers technique was used for electophysiology experiments to evaluate ion fluid flux. ESPGHAN ORS (sodium 60 mmol/L and glucose 111 mmol/L) induced a more potent proabsorptive effect in Caco-2 cells than WHO ORS, and this effect depended on the sodium/glucose ratio. Titration experiments showed that RV-induced fluid secretion can be reverted to a proabsorptive direction when sodium and glucose concentration fall in specific ranges, specifically 45–60 mEq/L and 80–110 mM respectively. The results were confirmed by testing commercial ORSs. These findings indicated that ORS proabsorptive potency depends on sodium and glucose concentrations. Optimal ORS composition should be tailored to reduce RV-induced ion secretion by also considering palatability. These in vitro data should be confirmed by clinical trials.

The effect of oral rehydration solution and recommended home fluids on diarrhoea mortality

Background Most diarrhoeal deaths can be prevented through the prevention and treatment of dehydration. Oral rehydration solution (ORS) and recommended home fluids (RHFs) have been recommended since 1970s and 1980s to prevent and treat diarrhoeal dehydration. We sought to estimate the effects of these interventions on diarrhoea mortality in children aged <5 years.

Methods We conducted a systematic review to identify studies evaluating the efficacy and effectiveness of ORS and RHFs and abstracted study characteristics and outcome measures into standardized tables. We categorized the evidence by intervention and outcome, conducted meta-analyses for all outcomes with two or more data points and graded the quality of the evidence supporting each outcome. The CHERG Rules for Evidence Review were used to estimate the effectiveness of ORS and RHFs against diarrhoea mortality.

Results We identified 205 papers for abstraction, of which 157 were included in the meta-analyses of ORS outcomes and 12 were included in the meta-analyses of RHF outcomes. We estimated that ORS may prevent 93% of diarrhoea deaths.

Conclusions ORS is effective against diarrhoea mortality in home, community and facility settings; however, there is insufficient evidence to estimate the effectiveness of RHFs against diarrhoea mortality.

Treatment of rotaviral gastroenteritis with Qiwei Baizhu powder

AIM: To observe the effects of Qiwei Baizhu Powder (QWBZP) on rotaviral gastroenteritis in children and in animal models.

METHODS: Enrolled patients were divided into two groups, and one group was treated with oral rehydration solution (ORS) and the other treated with oral liquid of QWBZP. Neonate mice were orally infected with 50 μL rotavirus suspension (4 × 10⁸ PFU/mL) and treated with ORS or oral liquid of QWBZP, respectively.

RESULTS: Eighty-three cases of rotaviral gastroenteritis treated with QWBZP revealed a better efficacy than that treated with ORS (χ² = 10.87, P ＜ 0.05). The contents of sodium and glucose as well as number of patients with positive human rotavirus antigen in stool in QWBZP group were all less than that in ORS group. In animal models, QWBZP was found effective in treating rotavirus gastroenteritis in neonate NIH mice, as compared with control groups. In QWBZP group, the mortality of infected mice was decreased by 73.3%, the body weight of infected mice was increased, the contents of sodium and glucose as well as number of mice with positive rotavirus antigen in feces were significantly reduced, and the pathological changes such as damage of small intestinal mucosa and villi were also obviously alleviated.

CONCLUSION: QWBZP has effects on improving the absorptive function of small intestine, shortening the duration of diarrhea and rotavirus shedding from stool and alleviating the pathological changes of small intestine induced by rotavirus.

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.

Fluid and carbohydrate replacement during intermittent exercise

Most studies relating to fluid replacement have addressed the problem of drinking during prolonged exercise. Fluid replacement is also very important for intermittent exercise, although it has not been extensively studied. More studies in this area would help coaches and athletes understand the importance of fluid balance and carbohydrate supplementation during intermittent exercise. Based on available data, it can be concluded that: (i) because of high exercise intensity, sweat loss and glycogen depletion during intermittent exercise are at least comparable with those during continuous exercise for a similar period of time. Therefore, the need to ingest a sport drink or replacement beverage during intermittent exercise may be greater than that during continuous exercise in order to maintain a high level of performance and to help prevent the possibility of thermal injury when such activity occurs in a warm environment; (ii) the volume of ingested fluid is critical for both rapid gastric emptying and complete rehydration; and (iii) osmolality (250 to 370 mOsm/kg), carbohydrate concentration (5 to 7%), and carbohydrate type (multiple transportable carbohydrates) should be considered when choosing an effective beverage for rehydration and carbohydrate supplementation during intermittent exercise.

Improving the palatability of oral rehydration solutions has implications for salt and water transport: a study in animal models

It is believed that improving the taste of oral rehydration solutions (ORSs) might lead to greater patient acceptability. A pilot trial showed that replacing glucose with sucrose and increasing the citrate concentration at the expense of chloride improves palatability. However, the transport implications of such modifications are not known. Three hypotonic experimental ORSs (Suc/cit-ORS, 211 mosmol/kg; Suc/Cl-ORS, 224 mosmol/kg; and Glu-ORS, 224 mosmol/kg) were compared with a standard European ORS (Euro-ORS, 265 mosmol/kg) by in vivo perfusion of entire rat small intestine in normal adult rats and rotavirus-infected neonates. All ORSs were of identical sodium, potassium, chloride, and citrate content except that in the Suc/cit-ORS, chloride was removed in favor of increased citrate, and the chloride concentration in Euro-ORS was higher than in the others. Suc/cit-ORS and Suc/Cl-ORS had glucose partially replaced by sucrose while Glu-ORS and Euro-ORS contained only glucose. In normal small intestine, water absorption was greater from Glu-ORS than Suc/cit-ORS or Euro-ORS, although water absorption was similar from Suc/cit-ORS and Suc/Cl-ORS. In the rotavirus model, Glu-ORS produced more water absorption than Euro-ORS or either sucrose ORS. In both models, Suc/cit-ORS caused sodium and chloride secretion. Glucose absorption was similar from all ORSs. These findings indicate that attempts to improve ORS palatability by adding sucrose or increasing citrate at the expense of chloride would incur a significant penalty in terms of salt and water absorption.

Oral rehydration therapy

Oral rehydration therapy (ORT) with glucose-electrolyte solutions has been considered to be one of the greatest therapeutic advances of this century. ORT is effective in acute diarrheal disease of diverse etiology. The most widely used oral rehydration solution (ORS) worldwide is that recommended by the World Health Organisation (Na 90, K 20, glucose 111 and citrate 10 mmol/L). Attempts to improve the efficacy of ORS have been made by using complex substrates (rice and other cereals) in place of glucose, and by reducing osmolality by decreasing glucose and sodium concentrations in monomeric ORS. ORS may have wider applications in the management of patients with the short bowel syndrome and in post-surgical patients.

Rehydration and nutritional management

Diarrhoea remains a leading worldwide cause of morbidity and mortality. In developing countries alone, 1.5 billion episodes of diarrhoea occur per year in children under 5 years of age and approximately 4,000,000 of these result in death. Early, appropriate therapy decreases the risk of complications and death due to diarrhoea. Regardless of the causative agent, oral rehydration and nutritional management are the mainstays of good management of infants, children and adults with diarrhoea. Diarrhoeal disease control programmes throughout the developing world have adopted the WHO case management plan as a standard. In this chapter, we review the history, successes and shortcomings of various oral rehydration therapies and recommend a case management approach that is similar to the WHO plan. Although ORT is safe, effective, convenient and economical, this therapy has not been universally implemented in health care settings. The challenge for clinical and public health practitioners in developing and developed countries is to identify and overcome the barriers that exist so that all patients with diarrhoea will have the opportunity to receive optimal care.

Optimising oral rehydration solution composition for the children of Europe: clinical trials

Clinical trials testing different oral rehydration solutions (ORS) are reviewed. The effects of individual components and their concentrations are analysed in order to establish margins of safety for the composition of the ideal ORS for children in Europe. Glucose is the solute of choice for ORS and concentrations of 70-140 mmol/l are adequate. Glucose may be replaced by sucrose or glucose polymers. "Low" sodium concentrations (35-60 mmol/l) are advised for rehydration and maintenance in acute non-cholera diarrhoea, for children of all ages, including neonates, and for any degree of dehydration except shock. Although intended for children who are not malnourished, the European ORS should have an adequate potassium concentration (20-30 mmol/l), namely the same concentration as found in WHO-ORS. Chloride concentration depends upon other constituents of ORS, namely sodium and potassium, but the range of 30-90 mmol/l is considered to be adequate. Base or base precursors are not required for correction of acidosis except in the severe cases that always need intravenous replacement. A relatively low osmolality seems advisable.

Oral rehydration in infantile diarrhoea in the developed world

Acute diarrhoea is an important health problem in developed countries, particularly in young children. The attack rates for viral diarrhoea are similar in developed and developing countries. Rotavirus is the most common pathogen, followed by adenovirus. Bacterial diarrhoea is less common in developed than developing countries. The 2 most common bacterial pathogens are Campylobacter jejuni and Salmonella. The most serious consequence of diarrhoea is dehydration, and the treatment for this is the same whatever the pathogen. Recently, there have been major changes in the management of diarrhoea with emphasis on oral rehydration and early feeding. Two controversial areas are the sodium content of solutions designed for developed countries and the best route of administration of fluids to children with moderately severe dehydration. There have been 4 randomised controlled trials in developed countries comparing oral and intravenous rehydration. The findings have confirmed the experience in developing countries that most children without shock can be rehydrated orally, thus substantially reducing the need for intravenous fluids. It is important to give physiologically balanced solutions which contain 2% glucose and 50 to 90 mmol/L of sodium. Many of the commercially available oral solutions are appropriate for rehydration and maintenance of hydration in infants with diarrhoea of all types. They are recommended particularly for the prevention of dehydration in children of all ages with severe diarrhoea and for the treatment of dehydration. Children with mild diarrhoea and no dehydration can be given commercial clear fluids diluted with water, or homemade solutions made with table sugar and water. Salt must not be used. Babies should continue on breast milk or formula with extra water. Education is the key to successful oral rehydration, and the ultimate aim should be the prevention of dehydration.

The benefits of the very early introduction of powdered rice and dried edible seeds (Dal moong) in the oral rehydration solution during the treatment of acute infectious diarrhoea of infancy

We have examined whether the addition of powdered rice and pulses (Dal moong) to oral rehydration solution will decrease the purging rate and thereby increase the efficacy of the oral rehydration therapy. The study was carried out on 60 male infants, with acute watery diarrhoea, moderate dehydration but without fever, vomiting, or other conditions like septicaemia and meningitis. The infants were treated with either the standard WHO oral rehydration salt solution (ORS) or with a modified solution where glucose was removed and powdered rice and Dal moong were added. We found that the infants receiving ORS with powdered rice and Dal moong had significantly lower fluid losses in the stools, a significant and more rapid weight gain, and needed significantly less fluid than the infants receiving ORS only.

Oral rehydration therapy--a review

REHYDRATION AND maintenance of adequate fluid and electrolyte balance is the key to the management of the child with acute diarrheal disease. Oral rehydration treatment has been shown to be simple, practical, inexpensive, highly effective and safe for developing as well as for developed countries. A better understanding of the physiological mechanisms implicated in diarrheal illness as well as extensive clinical testing of oral rehydration solutions have lead to the improvement of the composition of electrolyte, carbohydrate and base constituents. The widespread use of oral rehydration therapy may result in a decreased need for hospitalization and less discomfort and complications which are associated with intravenous rehydration therapy.

Rapid diagnosis of rotavirus gastroenteritis by a commercial latex agglutination test

The Rotalex test, a commercial latex agglutination test for rotavirus, was compared with direct electron microscopy (EM) and the Rotazyme test I, a commercial enzyme immunoassay, for detection of rotavirus in stools of children and neonates. For initial stool specimens from 265 children (less than 3 years old) with diarrhea, the Rotalex test had a sensitivity of 81.7% and specificity of 99.5% compared with EM results. Positive and negative predictive values were 98 and 94.9%, respectively. The Rotalex test was slightly more sensitive and specific than the Rotazyme test. When daily stool specimens from patients with rotavirus gastroenteritis were examined, the sensitivity of the Rotalex test varied depending on the time of stool collection relative to the onset of symptoms. Sensitivity was 100 (20/20), 96 (23/24), and 54% (7/13) during 1 to 4, 5 to 7, and 8 to 18 days, respectively, after the onset of symptoms. The sensitivity of the Rotazyme test varied similarly with days from onset. We also examined 214 EM-negative stool specimens from asymptomatic newborns. False positivity by the Rotalex test was only 3.3% (7/214) compared with 4.2% (9/215) for the Rotazyme test. The Rotalex test was as sensitive and specific as EM for detection of rotavirus during the acute stage of illness and much faster and cheaper than EM or the Rotazyme test. The test appears to be suitable for routine use in small hospitals, emergency wards, or even the physician's office for rapid diagnosis of rotavirus gastroenteritis.

Oral hydration solutions: experimental optimization of water and sodium absorption

Eight solutions of potential efficacy for hydration orally, which differed in composition, osmolality, and pH, were tested in an in vivo perfusion system on rat jejunum to assess the rate of water and sodium absorption or secretion. Optimal results were obtained with a preparation of the type recommended by the World Health Organization, containing 60 mEq/L sodium and 111 mM glucose; there was a maximum influx of both water and sodium, which may be ideal for rehydration. It appeared that the critical factor was the molar relationship between glucose and sodium at a 2:1 ratio. Sodium absorption was inversely correlated with glucose concentration in the perfusates. Osmolality and pH may also have a role in the regulation of fluxes across the mucosa. Citrate at concentrations up to 30 mEq/L did not interfere with water absorption. The data presented may thus contribute to a better rationale for the use of orally administered hydration solutions and guidelines for the preparation of more effective ready-to-use solutions.

Absorption of carbohydrate-electrolyte solutions in rat duodenojejunum. Implications for the composition of oral electrolyte solutions in man

Commonly used oral electrolyte solutions are based on glucose, or sucrose, and 90 mM Na+. We had been disappointed with the ability of such solutions to improve Na+ absorption in patients with extensive resection of distal small bowel. Therefore, we tested the effect on net Na+ and water transport of combinations of different carbohydrates (glucose, sucrose, and glucose polymers) and NaCl in the rat duodenojejunum. Absorption was measured under steady-state conditions in unanesthetized animals which were infused with a different combination every hour for up to 5 hr. Of the various combinations, 10 mM glucose polymer (equivalent to 56 mmol of glucose as glucose oligosaccharides), or 60 mM glucose promoted net Na+ absorption from 120 mM NaCl and 20 mM KCl, but the glucose polymer infusate promoted more rapid water absorption than did the infusate containing glucose. The infusate of 10 mM glucose polymer in saline was initially hypotonic (276 mosmol/kg), but it became isotonic (298 mosmol/kg) as the glucose polymer was hydrolyzed during its passage through the duodenojejunum. In contrast, an infusate of 60 mM sucrose with 120 mM NaCl and 20 mM KCl remained hypertonic (320 mosmol/kg), and it did not promote water and Na+ absorption by the duodenojejunum. The efficacy of 10 mM glucose polymer with 120 mM NaCl should be tested in patients with short-bowel syndrome due to distal bowel resection.

Effect of Different Drinks on Fluid and Electrolyte Losses from a Jejunostomy

The effectiveness of 5 different solutions on the absorption of fluid and electrolytes was tested in 7 patients with a proximal intestinal stoma and large fluid losses, all of whom previously needed intravenous infusions to maintain balance. In 4 patients it proved possible to replace the intravenous infusions with an enteral supplement. The WHO glucose/electrolyte solution without added potassium (NaCl 3.5 g, NaHCO3 2.5 g, glucose 20 g/l) gave satisfactory results, though was slightly less effective than a solution containing more sodium in which maltose was substituted for glucose. Neither sucrose nor an oligosaccharide*** (Caloreen) gave an advantage over glucose in the formulations used. In 3 patients losses were so great, and absorption of sodium from oral solutions so small, that intravenous supplements had to be continued. These 3 patients could be distinguished from the other 4 by the fact that more than 250 ml emerged from the stoma during the 3 hours after a drink of 500 ml of glucose/electrolyte solution. In all patients a drink of water or tea led to a loss of sodium from the stoma; water should be restricted in such patients and replaced by a glucose/electrolyte solution.

Hypernatremic diarrheal dehydration treated with "slow" (12-hour) oral rehydration therapy: a preliminary report

Thirty-five infants with hypernatremic diarrheal dehydration were given "slow" oral rehydration therapy, with deficits replaced over a period of 12 hours. A group of 24 infants received glucose-electrolyte solution for 8 hours, followed by plain water for 4 hours in a volume of 2:1; 11 other infants received equivalent volumes of glucose-electrolyte solution alone over 12 hours. Serum sodium concentrations fell to normal at similar rates in both groups. None of the 35 infants manifested convulsions. These preliminary results indicate that further evaluation of slow oral rehydration in infants with hypernatremic dehydration should be considered.

Pathogenesis of rotavirus-induced diarrhea. Preliminary studies in miniature swine piglet

The pathogenesis of diarrhea caused by rotavirus infection was studied in miniature swine piglets. The animals were inoculated orally with 2 X 10(7) plaque-forming units of porcine rotavirus (OSU strain). During the height of diarrhea, intestinal function was investigated by in vivo perfusion of a 30-cm segment of proximal jejunum and a 30-cm segment of distal ileum. Absorption of Na+ and water decreased and 3-O-methylglucose transport was markedly reduced, P less than 0.01 compared to control animals. Mucosal lactase and sucrase levels were depressed in both the jejunum and ileum, P less than 0.001. Na+,K+-ATPase activity was significantly depressed only in the ileum, P less than 0.001. These changes were associated with a marked reduction in villous height, suggesting that the diarrhea could be an osmotic diarrhea due to nutrient (carbohydrate) malabsorption. Fresh stool samples were obtained and analyzed immediately for NA+,K+, osmolarity, glucose, and lactose; the osmotic gap was also determined. Stool osmolarity continually increased from 248 +/- 20 mosm/liter prior to inoculation to 348 +/- 20 mosm/liter at 75 +/- 1 hr postinoculation (P less than 0.005); the majority of the fecal osmotic gap could be accounted for by the amount of lactose present in the stools. Stool sodium increased from 34 +/- 6 mM prior to inoculation to a maximum of 65 +/- 4 mM at 53 +/- 1 hr postinoculation, P less than 0.001. There was no significant change in potassium concentration.(ABSTRACT TRUNCATED AT 250 WORDS)

High sugar worse than high sodium in oral rehydration solutions

The literature on oral sugar-electrolyte mixtures for treatment of acute diarrhoea is reviewed. Several trials have shown that the solution proposed by the WHO for developing countries containing inter alia 90 mmol/l of sodium and 111 mmol/l of glucose is safe for short term oral rehydration. When used in this manner there is no risk for development of hypernatraemia. The surplus base of the solution is not essential and, furthermore, other anions e.g. acetate may be substitute for bicarbonate. Other modifications of the WHO formula have also been successfully tried, e.g. sucrose 4% (117 mmol/l) instead of glucose 2% (111 mmol/l). A somewhat lower concentration of sucrose may, however, prove to be better. Most acute childhood diarrhoeas are not mediated by enterotoxin and thus not of the secretory type, but temporary malabsorption is common. Therefore, the amount of carbohydrate in oral sugar-electrolyte mixtures should be limited. Osmotic diarrhoea due to carbohydrate malabsorption is a more likely cause of hypernatraemia in dehydrated children than too much dietary sodium. In developed countries prepacked oral sugar-electrolyte mixtures are mainly designed for moderately sick children treated at home. There is no reason to raise the carbohydrate content of these mixtures above that of the WHO formula, but the sodium content must be lower. For most situations in home treatment 50 mmol/l of sodium will be adequate.

Oral hydration of diarrhoeal dehydration. Comparison of high and low sodium concentration in rehydration solutions

Oral hydration of diarrhoeal dehydration. Acta Paediatr Scand, 72:167, 1983.--Two groups of infants aged 2 to 20 months with moderate to severe dehydration were randomly assigned to either sucrose high sodium (90 mEq/l) or sucrose low sodium (58 mEq/l) solution in a double blind manner. Rehydration was assessed on clinical grounds and confirmed by serial determination of body weight, hematocrit, total serum protein and blood urea nitrogen. Twenty (80%) of 25 patients on sucrose high sodium solution and 20 (77%) of 26 patients on sucrose low sodium solution were successfully hydrated. Only the assigned sucrose-electrolyte solution was given during the average rehydration period of about 7 hours when the serum electrolytes were remeasured. Three patients on high sodium solution developed mild hypernatremia. Slight hyponatremia was encountered in 2 patients on low sodium solution. Purging rate was significantly higher in patients who failed as compared to those who succeeded. The results of this study suggest that oral sugar electrolyte solution with sodium concentration of 90 mEq/l is safe and effective in the majority of infants with diarrhoeal dehydration of diverse causes. However, intravenous fluids must be available particularly for those with a high purging rate as a significant number of them may fail.

Gastroenterological problems in childhood in Jordan

Gastrointestinal problems and, in particular, diarrhoeal illnesses are the commonest cause of morbidity and mortality among young children in Jordan. Children with diarrhea constitute about 20% of admissions to Jordan University Hospital (JUH). The aetiology of diarrhoea is multifactorial and bacterial pathogens are seldom isolated. Stool viruses have not been investigated. There is a steady fall in the prevalence of breast-feeding with a consequent increase in gastroenteritis, especially among the poor. The use of electrolyte solutions for oral rehydration therapy is encouraged, and the use of antibiotics in diarrhoeal illness is discouraged. The addition of sucrose instead of glucose to electrolyte solutions has also been adopted. Cow's milk protein intolerance, coeliac disease and chronic inflammatory bowel disease are rarely encountered. Hepatitis is common and is a major cause of morbidity among school children. Cystic fibrosis has been recognized in Jordan but is rare. JUH has been selected as the referral centre for cystic fibrosis in the Middle East.

Stimulation of sodium and water absorption by sucrose in the rat small intestine

This study described the absorption of Na, K, Cl, H2O and sugars from an isosmotic sucrose electrolyte solution and compares it with the absorption of these substances from an isosmotic glucose electrolyte solution and a mannitol electrolyte solution, by an in vivo perfusion technique in the rat jejunum and ileum. The composition of the solutions was similar to the oral rehydrating solutions, currently in use for the treatment of acute diarrhoeal diseases. The study shows that an isosmotic sucrose containing electrolyte solution induces a significantly greater Na, Cl, and K absorption compared to glucose electrolyte solution. Water absorption however, is significantly less from the former solution probably due to osmotic drag of water into the lumen by the slowly absorbed fructose released from sucrose hydrolysis. These findings underline the clinical importance of using hyposmotic sucrose electrolyte solution for oral rehydration.

Oral solutions for infantile gastroenteritis--variations in composition

Four different carbohydrate electrolyte solutions were provided for children under 18 months with acute gastroenteritis treated as outpatients. Osmolality and sodium content were measured in samples of solutions as given by the parents. All types of feed were made up with marked inaccuracy. Osmolality was sometimes unacceptably high in solutions containing glucose, while the highest osmolality for sucrose solutions hardly exceeded the correct value for glucose solutions. Most parents could use a sachet with reasonable accuracy although there were still wide extremes of errors. The ideal preparation for use in developed countries may be a sachet containing sucrose and electrolyte, particularly if such sachets could be made generally available and not just for use in hospitals and clinics.

Oral rehydration therapy for treatment of rotavirus diarrhoea in a rural treatment centre in Bangladesh

In November 1977, an enzyme-linked immunosorbent assay for detecting rotavirus antigen was introduced in the laboratory of a rural treatment centre in Bangladesh. During the next 40 days rotavirus without other pathogens was found in the stools of 216 (45%) of 480 children under age 5 years who visited the centre with a gastrointestinal illness. 188 (87%) of these children were treated with oral rehydration alone, using the solution currently recommended by the World Health Organisation, while 28 (13%) also required some intravenous rehydration; there were no deaths. Oral rehydration treatment was judged successful in 205 (95%) of the rotavirus patients and was not associated with any serious side effects. Oral rehydration treatment, with this solution, has been used extensively and successfully in the treatment of enterotoxin-mediated diarrhoea and can also safely be used for treating rotavirus diarrhoea in infants and young children.

Diagnostic value of sucrose tolerance test in children evaluated by breath hydrogen measurement

An oral sucrose tolerance test was performed in a group of 103 children, aged between 3 months and 15 years because of episodic diarrhea and/or abdominal pains. Sucrose malabsorption defined as an abnormal increase in expired hydrogen, was found in only 3 children who suffered from congenital sucrase-isomaltase deficiency. This 1% incidence of sucrose malabsorption was lower than the incidence of lactose malabsorption found in this group (33%). Mean rise in blood glucose during the sucrose test was higher (3.4 +/- 1.4 vs. 2.4 +/- 1.2 mmol/l, p less than 0.0001) and the occurrence of false flat blood glucose curves was lower (3% vs. 12.8%, p less than 0.05) than during the lactose test. These findings are consistent with the higher sucrase activity in the small bowel mucosa compared to lactase. In contrast to the lactose tolerance test, sucrose tolerance test should not be used as a screening procedure for secondary disaccharidase deficiency in children.

The use of oral glucose electrolyte solution prepared with untreated well water in acute non-specific childhood diarrhoea

When untreated bacterially contaminated well water was used to constitute an oral glucose electrolyte solution, bacterial multiplication was significantly greater in the solution than in the well water. A controlled prospective trial in a West African village, comparing this solution with one prepared from clean drinking water, found no significant differences in the effects of the solutions when they were given to children suffering from acute diarrhoea. The intake of potentially pathogenic organisms from the well water solution was small compared to that from the local weaning foods. In remote areas of developing countries, where general and food hygiene is poor, it may prove possible to use such untreated water in the preparation of therapeutic glucose electrolyte solutions.

Oral rehydration of neonates with dehydrating diarrhoeas

Thirty-nine of forty neonates with mean dehydration equivalent to 6.7% of body-weight were orally rehydrated with a glucose/electrolyte solution. Only one patient required any intravenous fluids for rehydration. Hypernatraemia and acidosis present at admission were corrected within a few hours without complications. It seems that oral rehydration, is suitable for neonates as well as for children and adults.