Potency of Oral Rehydration Solution in Inducing Fluid Absorption is Related to Glucose Concentration

Vittoria Buccigrossi,Eugenia Bruzzese,Carla Russo,Andrea Lo Vecchio,Valentina Cioffi,Sara Terranova,Antonella Marano,Alfredo Guarino

doi:10.1038/s41598-020-64818-3

Abstract

Oral rehydration solutions (ORSs) is the key treatment of acute diarrhea in children, as it restores the electrolyte balance by stimulating the intestinal sodium/glucose transporter SGLT1 to induce fluid absorption. The World Health Organization (WHO) and The European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) proposed ORSs with different chemical compositions. The main agent of childhood acute gastroenteritis is rotavirus (RV). We evaluate the effects of ORS with different concentration of glucose and sodium on RV induced secretion. Ussing chambers technique was used for electophysiology experiments to evaluate ion fluid flux. ESPGHAN ORS (sodium 60 mmol/L and glucose 111 mmol/L) induced a more potent proabsorptive effect in Caco-2 cells than WHO ORS, and this effect depended on the sodium/glucose ratio. Titration experiments showed that RV-induced fluid secretion can be reverted to a proabsorptive direction when sodium and glucose concentration fall in specific ranges, specifically 45–60 mEq/L and 80–110 mM respectively. The results were confirmed by testing commercial ORSs. These findings indicated that ORS proabsorptive potency depends on sodium and glucose concentrations. Optimal ORS composition should be tailored to reduce RV-induced ion secretion by also considering palatability. These in vitro data should be confirmed by clinical trials.

Highlights

Diarrhea is already an important cause of death primarily in children younger than 5 years
The specific aim of this study was to investigate the effects of Oral rehydration solutions (ORSs) with different concentration of glucose and sodium in in-vitro model of ion secretion induced by Rotavirus (RV), the most frequent cause of acute gastroenteritis in children This model reflects the chloride secretion induced by the virus on intestinal epithelial cells through the measure ofelectrical parameters generated in a polar epithelium mounted in Ussing chambers
Short circuit current (Isc expressed in μA/cm2) and area under the curve (AUC) measured in Ussing chambers were evaluated as parameter of the secretory/absorptive response and indicating the potency of the effect, respectively

Summary

Introduction

Diarrhea is already an important cause of death primarily in children younger than 5 years. 1,3 million deaths are caused by diarrheal diseases among all ages, with the main impact on children younger than 5 years[3,4]. The first ORS composition was jointly proposed by the United Nations Children’s Fund (UNICEF) and the World Health Organization (WHO). This formula was based on glucose/salt solution to counteract dehydration during diarrhea independently by the etiology and the age of patients[8]. This ORS is designed to counteract cholera diarrhea, because the latter was the major cause of death. The efficacy of ORS composition depends on several factors, and our research try to find an optimal compromise between taste and fluid absorption

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