Oral rehydration therapy in the second decade of the twenty-first century.

Henry J Binder,B S Ramakrishna,Graeme P Young,Ian Brown

doi:10.1007/s11894-014-0376-2

Henry J Binder, B S Ramakrishna + Show 2 more

Open Access

https://doi.org/10.1007/s11894-014-0376-2

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Abstract

Oral rehydration solution (ORS) was established as the cornerstone of therapy for dehydration secondary to acute infectious diarrhea approximately 40 years ago. The efficacy of ORS is based on the ability of glucose to stimulate Na and fluid absorption in the small intestine via a cyclic AMP-independent process. Despite the establishment that ORS is the primary reason for the substantial reduction in morbidity and mortality from diarrhea in children in developing countries, the use of ORS has lagged for many reasons. This review highlights efforts to establish a major reformulation of ORS following the demonstration that short-chain fatty acids (SCFA) stimulate colonic Na and fluid absorption by a cyclic AMP-independent mechanism. The addition of high-amylose maize starch (HAMS), a microbially-fermentable (or ‘resistant’) starch, to ORS results in delivery of non-absorbed carbohydrate to the colon where it is fermented to SCFA. To date, three randomized controlled trials with a HAMS-ORS in south India have demonstrated a substantial decrease in diarrhea duration in both adults and children hospitalized for acute diarrhea. Significant efforts are now underway to establish this dual-action, modified HAMS-hypoosmolar ORS solution as the standard ORS for the treatment of dehydration from acute diarrhea.

Highlights

Oral rehydration solution (ORS) was originally developed in the early 1970s to correct the substantial dehydration that occurs as a result of severe diarrhea, especially acute infectious diarrhea [1, 2, 3]
Oral rehydration therapy (ORT) has been developed over the past 40 years and has been established as the standard of therapy for the treatment of the dehydration and metabolic acidosis associated with acute diarrhea
The use of ORS has been attributed as the primary reason for the substantial reduction in morbidity and mortality of acute infectious diarrhea

Summary

Introduction

Oral rehydration solution (ORS) was originally developed in the early 1970s to correct the substantial dehydration that occurs as a result of severe diarrhea, especially acute infectious diarrhea [1, 2, 3]. The initial scientific observations that were critical to the subsequent development of ORS were the establishment that glucose absorption in the mammalian small intestine required luminal Na, and that Na absorption was markedly enhanced by the presence of luminal glucose (as well as luminal amino acids) [4].

Results

Conclusion