The role of oral electrolyte-glucose solutions in hydration for children—international and domestic aspects

Abstract

Focus is currently on the use of the oral route for prevention and treatment of dehydration occurring secondary to diarrhea. Conflicts have arisen regarding how to carry out the oral regimen and these conflicts have slowed progress. Attention in this discussion is directed to the roles of the clinician psychologist and public health worker. Before delineating the existing conflict and proposed resolution the historical development of the current state of knowledge of oral therapy is reviewed. The success with oral therapy for cholera led public health physicians to use the method for nonspecific enteritis in infants all over the developing world. The formulation recommended by World Health Organization (WHO) committees contained less sodium than originally proposed for adults in order to have the practical advantage of single formation and distribution. Such a solution may be and has been used successfully for patients of all ages who have cholera. This soon led to recommending the solution for all diarrheal disease of infants when dehydration had occurred or was threatened. Implementation of the WHO program for oral hydration therapy became stalled in part because the need for a single solution conflicted with the physiology of infancy which calls for use of a lower solute content. In May 1979 a group was called together to see if an accommodation was possible. The compromise reached was to have 2 sets of instructions for a single formulation. The method proposes use of the WHO oral rehydration solution (ORS) formulation but administers the solution by giving 1 feeding of plain water for each 2 of ORS all in equal volume. On the 2nd and subsequent days breast milk and plain water are given in increasing amounts.