Use of Oral Fluid Therapy and Posttreatment Feeding Following Enteritis in Children in a Developed Country

Abstract

The 1982-1983 report by the United Nations Children's Fund (UNICEF) on the State of the World's Children recommended widespread implementation of oral rehydration as one of the four strategies projected to save the lives of 20,000 children each day.1 In the developing countries, oral rehydration has been shown to be an effective, simple, and inexpensive therapy for dehydration caused by severe enteritis in infants.2-8 The modern concepts of oral fluid therapy for diarrheal diseases evolved in part from the clinical observation that orally administered glucose-electrolyte solutions can replace diarrheal fluid losses in cholera. Previous laboratory investigation had demonstrated the presence of a cotransport system of sodium with glucose or other actively transported small organic molecules in the small intestine in animals and in man. Clinical studies suggest that this sodium-glucose cotransport system remains intact not only when the pathophysiologic agent is an enterotoxin, such as that elaborated by Vibrio cholerae or enterotoxigenic strains of Escherichia coli, but also with inflammatioion such as that associated with rotavirus, Campylobacter jejuni, E coli, and Yersinia enterocolitica.4-8 These observations have provided a physiologic rationale for an appropriately efficient ratio of sodium to glucose in formulating solutions to be used in the developing countries for oral therapy in the treatment of infants with life-threatening diarrheal dehydration. The question we address in this commentary is that of the appropriate implementation of oral hydration therapy in a developed country. Pediatricians and others concerned with the health of children in this country are not usually confronted with the problem of obtaining uncontaminated water nor with the management of large numbers of severely malnourished young infants with multiple health problems.