Oral rehydration therapy (ORT) with glucose-electrolyte solution is sufficient to treat the vast majority of episodes of watery diarrhoea from acute gastroenteritis. As a simple, effective, cheap and readily administered therapy for a potentially lethal condition, ORT must rank as a major advance in therapy. It is effective because glucose-coupled sodium transport continues during diarrhoea and so enhances replacement of water and electrolyte losses in the stool.
Oral rehydration salts (ORS) The WHO/UNICEF recommended formulation is:
Sodium chloride 3.5 g/1
Potassium chloride 1.5 g/1
Sodium citrate 2.9 g/1
Anhydrous glucose 20.0 g/1
This provides sodium 90 mmol/1, potassium 20 mmol/1, chloride 80 mmol/1, citrate 10 mmol/1, glucose 111 mmol/1 (total osmolarity 311 mmol/1).9
Several other formulations exist, some with less sodium (see national formularies).10
Rehydration therapy with commercial soft drinks alone will fail because their sodium content is too low (usually less than 4 mmol/1). The glucose may be replaced by another substrate such as glycine or rice powder. Indeed cereal-based ORS, relying on starch (to produce glucose) from many sources (rice, wheat, corn, potato) have the advantage of controlling diarrhoea much more effectively than the glucose-based preparations. This may be because undigested starch is fermented in the colon to short-chain fatty acids, which stimulate colonic sodium and water absorption. Thus almost every household in the world can find the essential components of an effective oral rehydration mixture: cereals and salt.
Most cases can be adequately treated by assiduous attention to oral intake, but fluid and electrolyte depletion is especially dangerous in children and intravenous fluid replacement in hospital may be needed. Antimotility drugs are inappropriate for severe diarrhoea in young children; any marginal effect they may have is liable to be counterbalanced by hazardous adverse effects (see below).
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