Oral therapy for acute diarrhoea.

Abstract

There are 3 mainand related problems that must be considered in managing acute watery diarrheas -- the treatment of fluid loss and related metabolic disturbances nutritional management and drug therapy but the prime objective in the treamtment of patients with acute diarrhea is to replace lost fluids. The importance of the intact sodium ion glucose absorption system in the toxigenic diarrheas is that it provides a mechanism for hydration via the intestine despite the enterotoxin induced fluid secretion into the gut lumen. This is the basic for oral rehydration therapy (ORT) which is being promoted vigorously by the World Health Organization (WHO) and has been adopted with considerable success in dozens of developing countries. The current question is whether this medical advance can be transferred from the developing to the developed countries. There is good evidence that the time is right for this change. The rehydration solution recommended by WHO has the following composition: sodium 90 mmol/L; potassium 20 mmol/L; chloride 80 mmol/L; bicarbonate 30 mmol/L; and glucose 111 mmol/L and can be made by dissolving 3.5 gm of sodium chloride 2.5 gm of sodium bicarbonate 1.5 gm of potassium chloride and 20 gm of glucose (or 40 gm of sucrose) in 1 liter of water. Experience in field trials has shown that most patients with mild to moderate dehydration can be managed effectively by oral therapy based on the above mentioned electrolyte solution. It must be recongnized that more seriously dehydrated patients will require initially more rapid intravenous rehydration followed by oral rehydration to replace continuing fluid losses. It is important also to appreciate that once a person becomes dehydrated replacement therapy should cover both the rehydration pase and the maintenance phase. The aim of ORT is to avoid unnecessary intravenous therapy and its attendant risks. It must supply maintenance fluid requirements and replace fluids lost in watery stools. ORT can work even in patients who are vomiting provided that small volumes of fluid are given frequently but special care must be taken in children under age 2 and particularly in infants under 6 months of age in whom dehydration tends to be rapid. In general terms the WHO formulation has proven satisfactory as a basis for ORT in patients with acute diarrheas and some commercially available products closely resemble this formulation. The WHO formulation perhaps with a lower sodium content could be used as a safe guide for oral therapy for patients with acute diarrhea in Australia.