Glucose rehydration therapy

The movement of Na+ and glucose from the lumen of the intestine across the epithelial cell to the blood sets up a difference in osmotic pressure across the cell. As a result, water flows through the cell, across the apical and basolateral membranes by simple diffusion. Hence the uptake of water requires both Na+ and glucose (or amino acids) to be present in the lumen of the intestine. The presence of water alone in the lumen of the intestine is much less effective. This is the basis of glucose rehydration therapy as a remedy for dehydration a solution of glucose and salt (NaCl) is administered to the patient. This is a simple, inexpensive but extremely important treatment which has saved the lives of many infants in developing countries who would have otherwise died of the effects of dehydration, usually associated with diarrhea. 

The necessary components of oral rehydration therapy (ORT) solutions include glucose, sodium, potassium, chloride, and water (Table 39-2). The American Academy of Pediatrics recommends rehydration with an electrolyte-concentrated rehydration phase followed by a maintenance phase using dilute electrolyte solutions and larger volumes. 

CM was started on intravenous insulin, fluids, and electrolyte replenishment. Her nausea and vomiting resolved and, although initially, she required 60-70 units of insulin intravenously per day to attain glycaemic control, her blood glucose dropped to 7.4 mmol/L after 4 days of intensive care. However, despite treatment of her diabetic ketoacidosis, including significant rehydration therapy, CM was still found to have an elevated but stable serum creatinine of 246 micromol/L, and so she was transferred from the intensive care unit to the renal unit for further management. 

Oral rehydration therapy consists of a mixture of salt and glucose, or another carbohydrate, in clean, preferably boiled, water. Commercial sachets of the materials are available and form the most suitable treatment for children and the elderly. 

Oral rehydration therapy is a simple, cheap and effective treatment for diarrhoea-related dehydration, such as that caused by cholera or rotavirus. It consists of a solution of salt and glucose and is administered orally. It has saved millions of children from diarrhoea, stiU a leading cause of death, particularly in the developing world. The standard manufactured WHO/UNICEF solution contains ... 

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. 

Gavin N, Merrick N, Davidson B. Efficacy of glucose-based oral rehydration therapy. Pediattics 1996 98 45-51. 

Simple Rehydration Therapy Depends on the Osmotic Gradient Created by Absorption of Glucose and Na ... 

Dennis Veere. Dennis Veere was diagnosed with cholera. He was ) placed on intravenous rehydration therapy, followed by oral rehydration therapy with high glucose and Na -containing fluids (to be continued in Chapter 11). 

The treatment of HHS centers around aggressive rehydration and restoration of glucose and electrolyte homeostasis the rate of correction of these variables must be monitored closely. Low-dose insulin therapy may be required. 

Regardless of the serotypes, the primary goal of therapy is restoration of fluid and electrolyte losses caused by watery diarrhea. ORT is the preferred method of rehydration, and several studies showed reduction in fluid requirements by 32% to 35% when rice-based instead of glucose-based ORT solutions are used (50-80 g rice instead of 20 g glucose per liter). In patients who cannot tolerate ORT, IV Ringer s lactate solution can be used. Normal saline is not recommended because it does not correct metabolic acidosis. After rehydration, maintenance fluid is given based on accurate recording of intake and output volumes. 

An understanding of osmosis and the intestinal absorption of salt and glucose forms the basis for a simple therapy that saves millions of lives each year, particularly in less-developed countries. In these countries, cholera and other intestinal pathogens are major causes of death of young children. A toxin released by the bacteria activates chloride secretion by the intestinal epithelial cells into the lumen water follows osmotlcally, and the resultant massive loss of water causes diarrhea, dehydration, and ultimately death. A cure demands not only killing the bacteria with antibiotics, but also rehydration— replacement of the water that is lost from the blood and other tissues. 

The need for fluid replacement is obvious. Oral rehydration is preferred over intravenous administration of fluids and electrolytes since it is noninvasive. In many third world countries, it is the only therapy available in remote areas. The rehydration formula includes 50-80 g/L rice (or other starch), 3.5 g/L sodium chloride, 2.5 g/L sodium bicarbonate, and 1.5 g/L potassium chloride. Oral rehydration takes advantage of the cotransport of Na and glucose across the cells lining the intestine. Thus, the channel protein brings glucose into the cells, and Na+ is carried along. Movement of these materials into the cells will help alleviate the osmotic imbalance, reduce the diarrhea, and correct the fluid and electrolyte imbalance. 

Insulin therapy is adjusted based on hourly measurements of blood glucose and - if possible -blood ketones, the overall aim being a gradual decline in both. The initial decline is to a large extent due to rehydration and expansion of the extracellular volume. Repeated analysis of arterial blood gases may be indicated but only in those patients with very low pH values and/or poor chn-ical condition. Measurements of ketone levels in urine is in general unreliable in this phase these methods measure acetoacetate, which is quantitatively of minor importance compared with... 

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