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Nausea, Vomiting, and Noninflammatory Diarrhea. MANDELL, DOUGLAS, AND BENNETT'S PRINCIPLES AND PRACTICE OF INFECTIOUS DISEASES 2015. [PMCID: PMC7173487 DOI: 10.1016/b978-1-4557-4801-3.00100-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Binder HJ, Brown I, Ramakrishna BS, Young GP. Oral rehydration therapy in the second decade of the twenty-first century. Curr Gastroenterol Rep 2014; 16:376. [PMID: 24562469 PMCID: PMC3950600 DOI: 10.1007/s11894-014-0376-2] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Oral rehydration solution (ORS) was established as the cornerstone of therapy for dehydration secondary to acute infectious diarrhea approximately 40 years ago. The efficacy of ORS is based on the ability of glucose to stimulate Na and fluid absorption in the small intestine via a cyclic AMP-independent process. Despite the establishment that ORS is the primary reason for the substantial reduction in morbidity and mortality from diarrhea in children in developing countries, the use of ORS has lagged for many reasons. This review highlights efforts to establish a major reformulation of ORS following the demonstration that short-chain fatty acids (SCFA) stimulate colonic Na and fluid absorption by a cyclic AMP-independent mechanism. The addition of high-amylose maize starch (HAMS), a microbially-fermentable (or 'resistant') starch, to ORS results in delivery of non-absorbed carbohydrate to the colon where it is fermented to SCFA. To date, three randomized controlled trials with a HAMS-ORS in south India have demonstrated a substantial decrease in diarrhea duration in both adults and children hospitalized for acute diarrhea. Significant efforts are now underway to establish this dual-action, modified HAMS-hypoosmolar ORS solution as the standard ORS for the treatment of dehydration from acute diarrhea.
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Affiliation(s)
- Henry J. Binder
- Department of Internal Medicine, Yale School of Medicine, P.O. Box 208019, New Haven, CT 06520 USA
| | - Ian Brown
- Flinders Centre for Innovation in Cancer, Flinders University, Adelaide, SA Australia
| | - B. S. Ramakrishna
- SRM Institutes for Medical Sciences, Vadapalani, Chennai, 600 026 India
| | - Graeme P. Young
- Flinders Centre for Innovation in Cancer, Flinders University, Adelaide, SA Australia
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Sepúlveda J, Valdespino JL, García-García L. Cholera in Mexico: the paradoxical benefits of the last pandemic. Int J Infect Dis 2005; 10:4-13. [PMID: 16326125 DOI: 10.1016/j.ijid.2005.05.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2005] [Revised: 05/09/2005] [Accepted: 05/27/2005] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To describe the impact of preventive and control measures in Mexico prior to, and during, the cholera epidemic of 1991-2001. METHODS When cholera appeared in Latin America in January 1991, the Mexican government considered that it represented a national security problem. Therefore, actions were implemented within the health sector (e.g. epidemiological surveillance, laboratory network and patient care) and other sectors (public education and basic sanitation). RESULTS The first case occurred in Mexico in June 1991. The incidence rate remained below 17.9 per 100,000 inhabitants and affected mainly rural areas. The last cholera report occurred in 2001. The disease never became endemic. The population benefited not only from acquisition of knowledge about preventive measures, but also from modification of risky practices and from reinforcement of city and municipal drinking water supplies. CONCLUSION Control strategies had an overall impact in decreasing diarrheal mortality among children under five years of age. Additionally the country did not suffer from a decrease in tourism or economic consequences. This experience can be considered as the operationalization of a new public health system spanning multisectorial activities, involving community participation, political will and with impact on public health and economic issues.
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Affiliation(s)
- Jaime Sepúlveda
- Coordination of the National Institutes of Health, Periférico Sur, No. 4118-1er. piso, Mexico, DF CP 01900, Mexico
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Krishnan S, Rajan DP, Ramakrishna BS. The ability of enteric diarrhoeal pathogens to ferment starch to short-chain fatty acids in vitro. Scand J Gastroenterol 1998; 33:242-6. [PMID: 9548615 DOI: 10.1080/00365529850170793] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Short-chain fatty acids (SCFA), produced in the normal colon by bacterial fermentation, are decreased in acute diarrhoea. This may have deleterious effects on epithelial function in the colon. METHODS The ability of several diarrhoeal pathogens to produce SCFA when incubated with starch in vitro was studied. Isolated pathogens were incubated for 24 h with either no added substrate, glucose, or starch under anaerobic conditions, and SCFA were quantitated by gas-liquid chromatography. RESULTS Unlike the normal colonic flora, the pathogens produced acetate but not propionate or butyrate. D-Lactate was also produced by all the pathogens studied. When the pathogens were incubated in anaerobic medium containing starch, significantly greater amounts of acetate and significantly lesser amounts of lactate were produced. CONCLUSIONS The inability of enteric pathogens to produce butyrate may impair epithelial cell function, whereas production of D-lactate may enhance mucosal damage in diarrhoeal disease. The presence of luminal starch may be helpful in shifting the fermentation profile to a more favourable pattern.
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Affiliation(s)
- S Krishnan
- Wellcome Trust Research Laboratory, Dept. of Gastrointestinal Sciences, Christian Medical College Hospital, Vellore, India
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Abstract
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.
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Affiliation(s)
- X Shi
- Gatorade Sports Science Institute, Gatorade Company, Barrington, Illinois, USA
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Dias JA, Thillainayagam AV, Hoekstra H, Walker-Smith JA, Farthing MJ. Improving the palatability of oral rehydration solutions has implications for salt and water transport: a study in animal models. J Pediatr Gastroenterol Nutr 1996; 23:275-9. [PMID: 8890078 DOI: 10.1097/00005176-199610000-00012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
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.
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Affiliation(s)
- J A Dias
- Department of Digestive Diseases Research Centre, Medical College of St. Bartholomew's Hospital, West Smithfield, London, United Kingdom
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Abstract
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.
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Affiliation(s)
- M J Farthing
- Department of Gastroenterology, St. Bartholomew's Hospital, London, U.K
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Alam AN, Alam NH, Ahmed T, Sack DA. Randomised double blind trial of single dose doxycycline for treating cholera in adults. BMJ (CLINICAL RESEARCH ED.) 1990; 300:1619-21. [PMID: 2196962 PMCID: PMC1663251 DOI: 10.1136/bmj.300.6740.1619] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To compare the efficacy of a single dose of doxycycline (200 or 300 mg) with the standard multiple doses of tetracycline in patients with cholera. DESIGN Randomised double blind controlled trial. Patients were given a single 200 mg dose of doxycycline, a single 300 mg dose of doxycycline, or multiple doses of tetracycline (500 mg, six hourly intervals). SETTING Hospital in Bangladesh treating diarrhoea. PATIENTS 261 Patients aged over 15 admitted to the hospital with severe dehydration due to acute watery diarrhoea associated with Vibrio cholerae. All vibrios isolated from the stools and rectal swabs of patients, including those patients with prolonged excretion of vibrios, were sensitive to tetracycline. The stools of all patients at admission were negative for shigella and salmonella. INTERVENTIONS All patients received rapid intravenous acetate solution for the first four hours after admission to hospital. They were then entered in the study and randomised. Oral rehydration was started immediately after the intravenous treatment. If signs of severe dehydration reappeared during oral treatment patients were given rapid intravenous acetate solution until dehydration was fully corrected. MAIN OUTCOME MEASURES Stool output in first 24 hours and till diarrhoea stopped, total intake of oral rehydration fluid, duration of diarrhoea, and excretion of vibrio after receiving antibiotic treatment. RESULTS The median stool outputs during the first 24 hours (275 ml/kg body weight) and till diarrhoea stopped (296 ml/kg body weight) were significantly higher in patients receiving 200 mg doxycycline as a single dose than in patients receiving either standard tetracycline (242 ml/kg body weight and 254 ml/kg body weight) or 300 mg doxycycline (226 ml/kg body weight and 255 ml/kg body weight). Similarly, median consumption of oral rehydration solution (18.45 l) was significantly higher in patients receiving 200 mg doxycycline than in patients receiving either 300 mg doxycycline (16.10 l) or standard tetracycline (14.80 l). Almost equal numbers of patients in each group required unscheduled intravenous acetate solution to correct dehydration during antibiotic treatment. Patients treated with doxycycline (low or high dose), however, had more prolonged excretion of bacteria. CONCLUSIONS A single 300 mg dose of doxycycline is as effective as the standard multiple dose tetracycline treatment for cholera in terms of stool output, duration of diarrhoea, vomiting, and requirement for oral rehydration solution.
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Affiliation(s)
- A N Alam
- International Centre for Diarrhoeal Disease, Research, Bangladesh, Dhaka
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da Cunha Ferreira RM. Optimising oral rehydration solution composition for the children of Europe: clinical trials. ACTA PAEDIATRICA SCANDINAVICA. SUPPLEMENT 1989; 364:40-50. [PMID: 2701835 DOI: 10.1111/j.1651-2227.1989.tb11319.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
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.
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Patra FC, Sack DA, Islam A, Alam AN, Mazumder RN. Oral rehydration formula containing alanine and glucose for treatment of diarrhoea: a controlled trial. BMJ (CLINICAL RESEARCH ED.) 1989; 298:1353-6. [PMID: 2502251 PMCID: PMC1836607 DOI: 10.1136/bmj.298.6684.1353] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To determine whether adding L-alanine to the glucose based oral rehydration solution recommended by the World Health Organisation would improve its efficacy in treating acute diarrhoea. DESIGN Randomised double blind controlled trial of oral rehydration solution containing L-alanine and glucose. SETTING Inpatient service of a hospital treating diarrhoea. PATIENTS 97 Male patients aged 6-59 years admitted to the hospital with acute and severe dehydration due to diarrhoea associated with Vibrio cholerae or enterotoxigenic Escherichia coli. Forty nine received the standard glucose based oral rehydration solution (control group) and 48 this solution with alanine added (study group). INTERVENTIONS All of the patients received rapid intravenous acetate solution for the initial four hours after admission, which fully corrected the signs of dehydration. They were then admitted to the study and randomised. Immediately after the intravenous treatment oral rehydration treatment was started. All of the patients received oral tetracycline for 48 hours, starting 24 hours after start of the study. If signs of dehydration reappeared during oral treatment patients were given rapid intravenous acetate solution until they were fully corrected and then continued to take the assigned oral rehydration solution. END POINT Passage of the last watery stool. MEASUREMENTS AND MAIN RESULTS The median stool output/kg body weight during the initial 24 hours of oral rehydration treatment and until diarrhoea stopped was reduced in the study group compared with the control group from 309 ml to 196 ml and from 393 ml to 236 ml respectively. Intake of oral rehydration solution and intravenous acetate solution was reduced from 455 ml to 308 ml and from 616 ml to 425 ml respectively. Two patients in the study group compared with 18 patients in the control group required unscheduled rapid intravenous acetate solution to correct signs of dehydration during oral rehydration treatment. CONCLUSION Oral rehydration solution containing L-alanine was considerably better than standard oral rehydration solution at reducing the severity of symptoms and the need for fluid of male patients with diarrhoea associated with V cholerae and enterotoxigenic E coli.
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Affiliation(s)
- F C Patra
- International Centre for Diarrhoeal Disease Research, Bangladesh
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Abstract
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.
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Affiliation(s)
- A Mackenzie
- Department of Gastroenterology, Royal Children's Hospital, Parkville, Australia
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Alam AN, Sarker SA, Molla AM, Rahaman MM, Greenough WB. Hydrolysed wheat based oral rehydration solution for acute diarrhoea. Arch Dis Child 1987; 62:440-4. [PMID: 3300569 PMCID: PMC1778371 DOI: 10.1136/adc.62.5.440] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
A randomised three cell study was carried out in 78 children with acute diarrhoea to evaluate the relative efficacy of oral rehydration solution (ORS) made from partially hydrolysed wheat grain, cooked rice powder, or glucose. Twenty six patients with comparable age, body weight, duration of diarrhoea, and degree of dehydration were studied in each of the three groups. Initial rehydration was carried out by using intravenous Dhaka solution within one to two hours followed by administration of oral rehydration solution. The mean ORS intake during the first and second 24 hours of treatment in patients with cholera receiving wheat-ORS and rice-ORS was significantly less compared with those receiving glucose-ORS. The stool output during the same period in patients receiving wheat-ORS and rice-ORS was significantly less compared with those receiving glucose-ORS. Similar trends in both ORS intake and stool output were observed during the next 24 hours.
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Molla A, Gyr K, Molla AM, Bardhan P, Patra FC. Preserved exocrine function in patients with acute cholera and acute non-cholera diarrhoea. INTERNATIONAL JOURNAL OF PANCREATOLOGY : OFFICIAL JOURNAL OF THE INTERNATIONAL ASSOCIATION OF PANCREATOLOGY 1986; 1:259-64. [PMID: 3681027 DOI: 10.1007/bf02795251] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Exocrine pancreatic function was assessed by means of the Lundh test in 14 patients with acute cholera and 18 patients with acute infectious non-cholera diarrhoea within the first 24 h of their admission. Mean tryptic activity amounted to 39.8 +/- 4.8 microEq/min/ml in the cholera group and to 64.4 +/- 11.0 microEq/min/ml in the non-cholera group. None of these patients shared a value below the lower limit of normal. In fact, the mean tryptic activity per 2 h was significantly higher than that reported previously in a control group from the Bengal area. It is therefore concluded that the exocrine pancreatic function is preserved and responds to food stimulation in various types of acute infectious diarrhoea, including cholera. These findings provide the pathophysiological background for the recent observation that oral rehydration solutions containing high-molecular-weight nutrients such as rice powder are at least as efficient or even more potent than the WHO-recommended glucose-electrolyte formula in acute diarrhoea.
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Affiliation(s)
- A Molla
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
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Abstract
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.
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Saunders DR, Sillery JK. Absorption of carbohydrate-electrolyte solutions in rat duodenojejunum. Implications for the composition of oral electrolyte solutions in man. Dig Dis Sci 1985; 30:154-60. [PMID: 3967562 DOI: 10.1007/bf01308203] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
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.
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Newton CR, Gonvers JJ, McIntyre PB, Preston DM, Lennard-Jones JE. Effect of Different Drinks on Fluid and Electrolyte Losses from a Jejunostomy. Med Chir Trans 1985; 78:27-34. [PMID: 3968667 PMCID: PMC1289541 DOI: 10.1177/014107688507800106] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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.
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Islam MR, Samadi AR, Ahmed SM, Bardhan PK, Ali A. Oral rehydration therapy: efficacy of sodium citrate equals to sodium bicarbonate for correction of acidosis in diarrhoea. Gut 1984; 25:900-4. [PMID: 6086466 PMCID: PMC1432566 DOI: 10.1136/gut.25.8.900] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Forty patients with moderate degrees of dehydration and acidosis because of acute watery diarrhoea were successfully treated randomly with either WHO recommended oral rehydration solution containing 2.5 g sodium bicarbonate or an oral solution containing 2.94 g sodium citrate in place of sodium bicarbonate per litre of oral rehydration rehydration solution. Efficacies were compared by measuring oral fluid intake, stool and vomitus output, change in body weight, hydration status, and rate of correction of acidosis during a period of 48 hours. Seventy five per cent (21 cases) in the citrate group and 83% (19 cases) in the bicarbonate group were successfully rehydrated (p greater than 0.05). There were no significant differences in intake, output, gain in body weight, fall in haematocrit and plasma specific gravity, and correction of acidosis between the two groups of patients within 48 hours after initiation of therapy. The solution with sodium citrate base was as effective as WHO-oral rehydration solution for management of diarrhoea. This study shows the efficacy, safety, and acceptability of citrate containing oral rehydration solution for rehydration and correction of acidosis in diarrhoea.
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Abstract
Acute secretory diarrheas constitute a major source of mortality and morbidity world-wide. Our current understanding of the underlying mechanisms involved is reviewed with particular reference to cholera and enterotoxigenic E. coli infections. From the physiological principles involved, a unified concept for the treatment of acute secretory diarrheas is presented. The importance of rehydration is highlighted and practical instructions for the use of oral glucose-electrolyte solutions in the treatment of acute secretory diarrhoeas are given, along with some discussion of the rationale behind their use and optimum composition. The important role of nutritional factors during acute diarrhoea is underlined and the place of various drugs, some established, some experimental, are briefly discussed.
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Meeuwisse GW. High sugar worse than high sodium in oral rehydration solutions. ACTA PAEDIATRICA SCANDINAVICA 1983; 72:161-6. [PMID: 6340410 DOI: 10.1111/j.1651-2227.1983.tb09689.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
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.
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Saberi MS, Assaee M. Oral hydration of diarrhoeal dehydration. Comparison of high and low sodium concentration in rehydration solutions. ACTA PAEDIATRICA SCANDINAVICA 1983; 72:167-70. [PMID: 6340411 DOI: 10.1111/j.1651-2227.1983.tb09690.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
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.
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Nalin DR, Cash RA. Rice powder and electrolyte solutions. Lancet 1982; 2:155-6. [PMID: 6123863 DOI: 10.1016/s0140-6736(82)91119-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Molla AM, Sarker SA, Hossain M, Molla A, Greenough WB. Rice-powder electrolyte solution as oral-therapy in diarrhoea due to Vibrio cholerae and Escherichia coli. Lancet 1982; 1:1317-9. [PMID: 6123635 DOI: 10.1016/s0140-6736(82)92396-0] [Citation(s) in RCA: 101] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
124 patients with acute diarrhoea due to Vibrio cholerae or Escherichia coli were treated with either the standard sucrose-electrolyte solution or a cereal-based electrolyte solution, containing 30 g rice powder per litre and electrolytes as recommended by the World Health Organisation. The treatments were compared by measuring the rate of purging, change in body weight, serum specific gravity, urine output, and post-hydrolysis sugar content in the stool. The proportions of successfully treated patients in the rice-powder group were 80% for cholera patients and 88% for E. coli patients--no different from those in patients receiving the sucrose-electrolyte solution. Failure was due to rates of purging that exceeded the patient's ability to drink enough replacement solution. This study suggests that a rice-powder electrolyte solution is efficient and safe to use as a rehydrating oral fluid in acute diarrhoea.
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Patra FC, Mahalanabis D, Jalan KN. Stimulation of sodium and water absorption by sucrose in the rat small intestine. ACTA PAEDIATRICA SCANDINAVICA 1982; 71:103-7. [PMID: 6814170 DOI: 10.1111/j.1651-2227.1982.tb09379.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
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.
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Sandle GI, Holmes R, Lobley RW. Glucose or sucrose for the oral treatment of infective diarrhoea? Lancet 1981; 1:998. [PMID: 6112405 DOI: 10.1016/s0140-6736(81)91760-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Barnes G, Smith A. Carbohydrate-free feeds for infants. Lancet 1981; 1:998-9. [PMID: 6112407 DOI: 10.1016/s0140-6736(81)91761-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Welsby PD. Vomiting and diarrhoea. Infect Dis (Lond) 1981. [DOI: 10.1007/978-94-011-7248-6_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Sack DA, Islam S, Brown KH, Islam A, Kabir AK, Chowdhury AM, Ali MA. Oral therapy in children with cholera: a comparison of sucrose and glucose electrolyte solutions. J Pediatr 1980; 96:20-5. [PMID: 7350310 DOI: 10.1016/s0022-3476(80)80317-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
We performed a double-blind trial comparing sucrose electrolyte oral solution with glucose electrolyte oral solution in children less than 5 years of age with severe cholera-like diarrhea. Of 111 patients studied (102 with bacteriologically confirmed cholera), 55 received sucrose solution and 56 received glucose solution. The success rates, as defined by the absence of the need to give unscheduled intravenous therapy, were similar in the two groups (73% and 77% in the sucrose and glucose groups, respectively). There was no difference in purging rates between the two groups. The primary determinant of success for oral fluid regardless of the sugar was the purging rate. Sucrose malabsorption was responsible for oral therapy failure in one child. This study demonstrates that sucrose is an effective alternative to glucose in the oral therapy solution, but either must be used in conjunction with intravenous solution when treating severe dehydrating diarrhea.
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Sack DA, Chowdhury AM, Eusof A, Ali MA, Merson MH, Islam S, Black RE, Brown KH. Oral hydration rotavirus diarrhoea: a double blind comparison of sucrose with glucose electrolyte solution. Lancet 1978; 2:280-3. [PMID: 209263 DOI: 10.1016/s0140-6736(78)91687-2] [Citation(s) in RCA: 107] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Of 57 male children, aged 5 months to 2 1/2 years with rotavirus diarrhoea, 28 were given oral therapy with sucrose electrolyte solution and 29 were given glucose electrolyte solution in a randomised double-blind trial. All were rehydrated and remained so on oral therapy alone. These patients were compared with 44 children, also with rotavirus, who were treated only with intravenous hydration. The oral therapy and intravenous therapy groups did not differ clinically in the rate of rehydration or the rate of purging. Vomiting did not prevent the giving of oral therapy during hospital admission. Bangladeshi children with rotavirus diarrhoea have a defect of carbohydrate digestion but this defect does not prevent the use of a sugar electrolyte solution for oral hydration.
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Nalin DR, Levine MM, Mata L, de Cespedes C, Vargas W, Lizano C, Loria AR, Simhon A, Mohs E. Comparison of sucrose with glucose in oral therapy of infant diarrhoea. Lancet 1978; 2:277-9. [PMID: 79080 DOI: 10.1016/s0140-6736(78)91686-0] [Citation(s) in RCA: 66] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
In a randomised double-blind trial, 51 5--10% dehydrated infants were rehydrated with oral electrolyte solutions containing sucrose or glucose. Most infants in both groups were successfully rehydrated, but the sucrose solution produced a slower correction of electrolyte abnormalities and a higher percentage of patients who needed more than 24 h of therapy. Where there is adequate knowledge of the oral therapy method sucrose can substitute for glucose in many cases; where there is a choice glucose is recommended.
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Bygbjerg IC. Making oral glucose-salt solutions. Lancet 1978; 1:611-2. [PMID: 76150 DOI: 10.1016/s0140-6736(78)91059-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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