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. 

The answer is e. (Hardman, p 926.) Diphenoxylate is a piperidine opioid that is related to meperidine. It inhibits peristalsis and, hence, increases the passage time of the intestinal bolus. It is combined with atropine to discourage use as a street drug. Atropine has little effect on peristalsis. Clonidine, bismuth subsalicylate, and rehydration therapy are all useful in some types of diarrhea, but none of them inhibit peristalsis. 

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. 

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 ... 

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... 

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