Clinical application of oral rehydration solution

Jee Hyun Lee

doi:10.5124/jkma.2012.55.6.525

J Korean Med Assoc > Volume 55(6); 2012 > Article

Lee: Clinical application of oral rehydration solution

Focused Issue of This Month

Diarrheal Disease in Children

Journal of the Korean Medical Association

Journal of the Korean Medical Association 2012; 55(6): 525-531.

Published online: June 14, 2012

DOI: http://dx.doi.org/10.5124/jkma.2012.55.6.525

Clinical application of oral rehydration solution

Jee Hyun Lee, MD

Department of Pediatrics, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.

Corresponding author: Jee Hyun Lee, izzih@medimail.co.kr

Received March 07, 2012 Accepted March 21, 2012

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The administration of oral rehydration solution (ORS) has rescued the lives of people with diarrhea. Although diarrhea mortality rates have dropped by 75% from 1980 to 2008 in worldwide, diarrhea continues to be a major cause of child death, especially in children younger than 5 years. The clinical application of the standard WHO-ORS in large-scale campaigns resulted in decreased mortality associated with acute diarrheal disease in children. Many clinical trials on variants of ORS such as hypo-osmolar solutions, rice-based solutions, zinc supplementation, and the addition on other advantageous substances have been performed to improve outcomes of diarrheal treatment. This paper reviews the pathophysiologic base and history of ORS, composition of ORS, and its clinical use for acute diarrhea and other intestinal diseases.

Oral rehydration solution; Acute diarrhea; Child

References

1. Water with sugar and salt. Lancet 1978;2:300-301.

2. Kosek M, Bern C, Guerrant RL. The global burden of diarrhoeal disease, as estimated from studies published between 1992 and 2000. Bull World Health Organ 2003;81:197-204.

3. Victora CG, Bryce J, Fontaine O, Monasch R. Reducing deaths from diarrhoea through oral rehydration therapy. Bull World Health Organ 2000;78:1246-1255.

4. Black RE, Cousens S, Johnson HL, Lawn JE, Rudan I, Bassani DG, Jha P, Campbell H, Walker CF, Cibulskis R, Eisele T, Liu L, Mathers C. Child Health Epidemiology Reference Group of WHO and UNICEF. Global, regional, and national causes of child mortality in 2008: a systematic analysis. Lancet 2010;375:1969-1987.

5. Hartling L, Bellemare S, Wiebe N, Russell K, Klassen TP, Craig W. Oral versus intravenous rehydration for treating dehydration due to gastroenteritis in children. Cochrane Database Syst Rev 2006;3):CD004390.

6. Guerrant RL, Carneiro-Filho BA, Dillingham RA. Cholera, diarrhea, and oral rehydration therapy: triumph and indictment. Clin Infect Dis 2003;37:398-405.

7. Santosham M, Chandran A, Fitzwater S, Fischer-Walker C, Baqui AH, Black R. Progress and barriers for the control of diarrhoeal disease. Lancet 2010;376:63-67.

8. Farthing MJ. History and rationale of oral rehydration and recent developments in formulating an optimal solution. Drugs 1988;36:Suppl 4. 80-90.

9. Nalin DR, Cash RA, Islam R, Molla M, Phillips RA. Oral maintenance therapy for cholera in adults. Lancet 1968;2:370-373.

10. Finberg L. A commentary on the use of rational oral electrolyte therapy. Arch Pediatr Adolesc Med 1999;153:910-912.

11. Fayad IM, Hirschhorn N, Abu-Zikry M, Kamel M. Hypernatraemia surveillance during a national diarrhoeal diseases control project in Egypt. Lancet 1992;339:389-393.

12. Mauer AM, Dweck HS, Finberg L, Holmes F, Reynolds JW, Suskind RM, Woodruff CW, Hellerstein S. American Academy of Pediatrics Committee on Nutrition: use of oral fluid therapy and posttreatment feeding following enteritis in children in a developed country. Pediatrics 1985;75:358-361.

13. Recommendations for composition of oral rehydration solutions for the children of Europe: report of an ESPGAN Working Group. J Pediatr Gastroenterol Nutr 1992;14:113-115.

14. World Health Organization. United Nations Children's Fund. WHO/UNICEF joint statement: clinical management of acute diarrhea 2004;Geneva: World Health Organization.

15. Hahn S, Kim S, Garner P. Reduced osmolarity oral rehydration solution for treating dehydration caused by acute diarrhoea in children. Cochrane Database Syst Rev 2002;1):CD002847.

16. Farthing MJ. Oral rehydration: an evolving solution. J Pediatr Gastroenterol Nutr 2002;34:Suppl 1. S64-S67.

17. Atia AN, Buchman AL. Oral rehydration solutions in non-cholera diarrhea: a review. Am J Gastroenterol 2009;104:2596-2604.

18. Guarino A, Albano F, Guandalini S. Working Group on Acute Gastroenteritis. Oral rehydration: toward a real solution. J Pediatr Gastroenterol Nutr 2001;33:Suppl 2. S2-S12.

19. Elliott EJ, Cunha-Ferreira R, Walker-Smith JA, Farthing MJ. Sodium content of oral rehydration solutions: a reappraisal. Gut 1989;30:1610-1621.

20. Rautanen T, el-Radhi S, Vesikari T. Clinical experience with a hypotonic oral rehydration solution in acute diarrhoea. Acta Paediatr 1993;82:52-54.

21. International Study Group on Reducedosmolarity ORS solutions. Multicentre evaluation of reduced-osmolarity oral rehydration salts solution. Lancet 1995;345:282-285.

22. Fontaine O, Gore SM, Pierce NF. Rice-based oral rehydration solution for treating diarrhoea. Cochrane Database Syst Rev 2000;2):CD001264.

23. Murphy C, Hahn S, Volmink J. Reduced osmolarity oral rehydration solution for treating cholera. Cochrane Database Syst Rev 2004;4):CD003754.

24. CHOICE Study Group. Multicenter, randomized, double-blind clinical trial to evaluate the efficacy and safety of a reduced osmolarity oral rehydration salts solution in children with acute watery diarrhea. Pediatrics 2001;107:613-618.

25. Gregorio GV, Gonzales ML, Dans LF, Martinez EG. Polymer-based oral rehydration solution for treating acute watery diarrhoea. Cochrane Database Syst Rev 2009;2):CD006519.

26. Salazar-Lindo E, Sack RB, Chea-Woo E, Leon-Barua R, Kay BA, Yi A, Robertson AD. Bicarbonate versus citrate in oral rehydration therapy in infants with watery diarrhea: a controlled clinical trial. J Pediatr 1986;108:55-60.

27. Rautanen T, Salo E, Verkasalo M, Vesikari T. Randomised double blind trial of hypotonic oral rehydration solutions with and without citrate. Arch Dis Child 1994;70:44-46.

28. Lukacik M, Thomas RL, Aranda JV. A meta-analysis of the effects of oral zinc in the treatment of acute and persistent diarrhea. Pediatrics 2008;121:326-336.

29. Lazzerini M, Ronfani L. Oral zinc for treating diarrhoea in children. Cochrane Database Syst Rev 2008;3):CD005436.

30. Zavaleta N, Figueroa D, Rivera J, Sanchez J, Alfaro S, Lonnerdal B. Efficacy of rice-based oral rehydration solution containing recombinant human lactoferrin and lysozyme in Peruvian children with acute diarrhea. J Pediatr Gastroenterol Nutr 2007;44:258-264.

31. The International Study Group on Improved ORS. Impact of glycine-containing ORS solutions on stool output and duration of diarrhoea: a meta-analysis of seven clinical trials. Bull World Health Organ 1991;69:541-548.

32. Te Loo DM, van der Graaf F, Ten WT. The effect of flavoring oral rehydration solution on its composition and palatability. J Pediatr Gastroenterol Nutr 2004;39:545-548.

33. American Academy of Pediatrics, Provisional Committee on Quality Improvement, Subcommittee on Acute Gastroenteritis. Practice parameter: the management of acute gastroenteritis in young children. Pediatrics 1996;97:424-435.

34. Caeiro JP, DuPont HL, Albrecht H, Ericsson CD. Oral rehydration therapy plus loperamide versus loperamide alone in the treatment of traveler's diarrhea. Clin Infect Dis 1999;28:1286-1289.

35. Nightingale JM, Lennard-Jones JE, Walker ER, Farthing MJ. Oral salt supplements to compensate for jejunostomy losses: comparison of sodium chloride capsules, glucose electrolyte solution, and glucose polymer electrolyte solution. Gut 1992;33:759-761.

Table 1

Composition of ORSs

ORS, oral rehydration solution; WHO, World Health Organization.