Oral rehydration therapy

Worldwide, dehydration is especially problematic for children younger than age 5. However, the highest rate of death in the United States occurs among the elderly.5 Rehydration is the foundation of therapy for GI infections, and oral rehydration therapy (ORT) is usually preferred (Table 73-1). 

Farthing MJ Oral rehydration therapy. Pharmacol Ther 1994 64 477-492. 

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. 

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 ... 

Cholera Wyeth-Ayerst Oral rehydration therapy Vaccine not... 

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. 

Maintenance of the volume of the circulatory system is dependent on sodium ions and water. Oral rehydration therapy may involve drinking a solution of 90 mM NaCl. Replacing K and HCO3 may be a vital concern as well, though they are secondary to water and sodium. Diarrhea can result in acidosis because of the bicarbonate secreted into the lumen and the concomitant delivery of protons to the plasma. Hence, bicarbonate may be included during rehydration therapy to reverse acidosis. Acidosis is defined as a plasma pH less than 7.10. Generally, serious and life-threatening acidosis does not occur with mild or moderate cases of diarrhea. 

Rgure 3.5 How osmosis affects the performance of solutions used in oral rehydration therapy (ORT). 

Enhancing clinical efficacy of oral rehydration therapy is low osmolality the key Gastroenterology 114 197-210... 

Appropriate follow-up care of patients with acute diarrhea is based on successful restoration of fluid losses. The clinical signs and symptoms (see Table 111-1) that led to the diagnosis also can indicate adequate rehydration and should be assessed frequently. Because oral rehydration therapy is now preferred, routine laboratory testing often is unnecessary. Electrolytes should be measured in those receiving parenteral fluids, when oral replacement fails, or when signs of hypernatremia or hypokalemia are present. Follow-up stool samples to ensure complete evacuation of the infecting pathogen may be necessary only... 

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

Clinical Perspective Oral Rehydration Therapy, above, describes one of the most lethal and pervasive examples of cellular fluid imbalance. 

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). 

Oral rehydration therapy (ORT) is a simple and effective way to treat or prevent dehydration and the accompanying electrolyte loss, especially if the dehydration is caused by diarrhea. Oral rehydration therapy was developed in the 1950s for use in developing countries where diarrhea-producing diseases like cholera, combined with unsanitary water and food, cause the death of an estimated 4 million children annually. The threat to children in developed countries is not nearly as great an estimated 500 children die annually from diarrhea in the United States. 

Oral rehydration therapy products are available in numerous forms and flavors. 

---