J Korean Med Assoc.  2012 Jun;55(6):525-531. 10.5124/jkma.2012.55.6.525.

Clinical application of oral rehydration solution

• Lee JH

• KMID: 2015650
• DOI: http://doi.org/10.5124/jkma.2012.55.6.525

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.

Keyword

Oral rehydration solution; Acute diarrhea; Child

MeSH Terms

Bicarbonates
Child
Diarrhea
Electrolytes
Fluid Therapy
Glucose
Humans
Intestinal Diseases
Potassium Chloride
Sodium Chloride
Zinc
Bicarbonates
Electrolytes
Glucose
Potassium Chloride
Sodium Chloride
Zinc

Reference

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.