Single solution for oral therapy of diarrhoea

Promotion of Oral Rehydration Therapy Comparing a Homemade Rice-Powder Gruel and Oral Rehydration Salts

Characteristics of the use of two oral rehydration solutions [rice-based gruel (RBG) or oral rehydration salts (ORS)] were assessed in 162 mothers of children under five years of age who presented a first episode of diarrhoea during the study period, in 12 rural villages of Central Mexico. Eighty-six mothers lived in six villages randomly assigned to receive the RBG promotion and 76 lived in six villages assigned to receive the ORS promotion. The intervention strategy, relying on face-to face contact by health auxiliaries who teach mothers about the dangers of dehydration, how to recognize it, and how to prepare and feed an oral rehydration solution, closely resembled that used by the National Program for the Control of Diarrheal Diseases. Before the intervention, 42% of all mothers used RBG and 58% used ORS; 8% of mothers who used RBG and 18% of those who used ORS used the beverage for rehydration purposes. After the intervention, in the villages where RBG was promoted, 57 (66%) of the mothers used RBG and 14 (16%) used ORS. In the villages where ORS was promoted, 9 (12%) of the mothers used RBG and 58 (76%) used ORS. In both groups, all mothers used at least one other beverage (usually herbal tea) during diarrhoea. but the promoted beverages were used first The use of the promoted beverage was higher when mothers had used it before the intervention. Eighty-six percent of mothers who prepared RBG used the promoted concentration of ingredients, whereas all mothers who prepared ORS correctly diluted one package in 1 L of water. After the intervention, 54% and 67% of mothers said they used RBG and ORS specifically to prevent dehydration.

Clinical Trial of a Rice-Powder Oral Rehydration Beverage

A clinical trial was conducted to assess the efficacy of a rice-based gruel as a rehydration solution, identified in a previous study to be widely used by mothers during diarrhoeal episodes in their children. Seventy children under five years of age, admitted to a paediatric hospital with clinical dehydration secondary to acute diarrhoea, were randomly assigned to receive rice-based gruel (n = 37) or oral rehydration salts (ORS) (n = 33). The hydration status was measured on admission and hourly until discharge, for a maximum of 8 hours, after which treatment was considered to have failed in children who had not been rehydrated Successful rehydration was achieved in 92% of the patients receiving rice-based gruel and 91% of those receiving ORS. Over 50% of all patients were rehydrated 4 to 5 hours after treatment was initiated; at these times the faecal output was statistically significantly lower in patients receiving rice-based gruel than in those receiving ORS. More patients were discharged from the study with hypernatraemia in the group receiving ORS than in the group receiving rice-based gruel, whereas the number of patients with hyponatraemia on discharge was similar in both groups. Faecal sodium concentrations were similar on admission in both groups but were statistically significantly lower at discharge in the group receiving rice-based gruel. We concluded that rice-based gruel could be safely used as an oral rehydration solution at the community level.

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.

Acute secretory diarrheas. Current concepts in pathogenesis and treatment

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.

Oral rehydration therapy of infantile diarrhea: a controlled study of well-nourished children hospitalized in the United States and Panama

Although oral glucose-electrolyte solutions containing 90 mmol of sodium per liter have been widely used in the treatment of acute diarrhea among under-nourished children in the developing world, they have rarely been studied in well-nourished children. We therefore conducted a controlled randomized study among well-nourished children three months to two years who were hospitalized with acute diarrhea (52 in the United States, and 94 in Panama), to compare the efficacy of this solution with that of one containing 50 mmol of sodium per liter and with standard intravenous therapy. Oral rehydration with both solutions according to protocol was successful in 97 of 98 children (one required unscheduled intravenous therapy), and in 87 (89 per cent) no intravenous therapy was required. All of six children admitted with hypernatremia were successfully treated with oral therapy alone. We conclude that glucose-electrolyte oral solutions containing either 50 or 90 mmol of sodium per liter are effective and safe in the treatment of well-nourished children hospitalized with acute diarrhea, and that they may completely replace the intravenous fluids in the majority of such children.

Oral rehydration for diarrhoeal diseases in children

Electrolyte disturbances and response to oral electrolyte therapy were studied in 88 children with mild to moderate dehydration due to acute gastroenteritis. A solution with a sodium concentration of 50 mmol/litre was tested in a group of 60 children and results obtained with those in a group of 28 children taking a standard oral solution with a concentration of 90 mmol/litre. Adequate hydration was accomplished in both groups and none of them received intravenous fluids. Neither group received additional water or other fluid in the first 24 hours. There was a significant rise in sodium concentration with both solutions and none of the children developed hypernatraemia. A significant rise in potassium is observed in children with clinical kwashiorkor when hydrated with the low sodium solution.

Decline of hypernatraemia as a problem in gastroenteritis

During the 5-year period 1973--77 there was a considerable change in infant feeding practice (the use of low solute cows' milk formulae instead of high solute formulae and the later introduction of solid foods into the diet) which should have led to a reduced incidence of hypernatraemia among infants admitted to hospital with gastroenteritis. We have compared the incidence of hypernatraemia in such infants admitted during three 12-month periods between January 1973 and December 1977. Our results show there was such a reduction; they also show that hypernatraemia did not occur in infants fed a low solute milk formula alone.