Glucose-based Oral Rehydration Solution Research Articles

Comparative study on Physico-chemical characteristics of different periods of soaked minor millets flour-based diarrheal replacement fluids

Acute diarrhoea is defined as three or more loose bowel movements in 24 hours (WHO, 1995), and is one of the principal causes of morbidity and mortality among the children. World-wide attention in the proper management of diarrheal disease in infants has led to the provision of the WHO/UNICEF glucose-based oral rehydration solution. However, this solution is only available in hospitals and health care centres which are sparsely located in most rural areas of the developing countries. The addition of alternative is the cereal-based oral rehydration solution, which is effective in replacing the lost fluid; contribute to the nutrient intake of the patients, easily available, cheap, and familiar and more acceptable. In this present study attempt to formulate millet-based diarrheal replacement fluids and analyse the physiochemical characteristic of the fluids and correlate the foxtail and kodo millet nutrient, viscosity and Osmolality of the fluids. Among the results, there was a significant difference between unsoaked and soaked samples. The viscosity and osmolality values were reduced in soaked samples. The reduction of viscosity and Osmolality values were influenced by the soaking of millets.It was observed that, between the nutrient and viscosity of foxtail and kodo millet had a significant positive correlation in the viscosity of protein, and fat at 0.01% level. A significant positive correlation found between Osmolality and CHO at 0.01%level. Reduced Osmolality of fluids contains a minimized amount of glucose and minerals had a beneficial effect of the clinical course of diarrhoea and millet is safe for diarrheal replacement fluids. So it can be suggested that soaked millet-based replacement fluids will improve rehydration and reduce stool output due to the reduced Osmolality. Research on millets for formulating potential replacement fluids is indispensable, as it will benefit those in under-developed and developing nations to combat death due to diarrhea.

Can an amino acid-based oral rehydration solution be effective in managing immune therapy-induced diarrhea?

Immune checkpoint inhibitor (ICPi) therapy has transformed the way we treat cancer. However, its immune related adverse events (irAEs) can be debilitating and life threatening. Immune therapy-induced diarrhea (ITID) is one of the most commonly encountered irAEs and can lead to expensive and prolonged hospitalizations. The current standard of care for grade 3 or 4 ITID involves ICPi discontinuation, the initiation of steroids, and infliximab for refractory disease. This treatment regimen reverses the desired anti-tumor effect of ICPis, can lead to side effects, and is cost-ineffective. We report the first case of the successful treatment of grade 3 ITID with steroids and an amino acid-based oral rehydration solution (AA-ORS), enterade. Research suggests that AA-ORS may be used to reduce diarrhea and adequately hydrate patients, in contrast to glucose-based oral rehydration solutions, which have been implicated as a contributing factor to diarrhea in cancer patients. We hypothesize that an AA-ORS may mitigate ITID via safer and more economically viable means than the current standard of care, but more controlled trials are needed to test this hypothesis.

Glucose enhances rotavirus enterotoxin-induced intestinal chloride secretion.

Rotavirus causes severe diarrhea in small children and is typically treated using glucose-containing oral rehydration solutions; however, glucose may have a detrimental impact on these patients, because it increases chloride secretion and presumably water loss. The rotavirus enterotoxin nonstructural protein 4 (NSP4) directly inhibits glucose-mediated sodium absorption. We examined the effects of NSP4 and glucose on sodium and chloride transport in mouse small intestines and Caco-2 cells. Mouse small intestines and Caco-2 cells were incubated with NSP4114-135 in the presence/absence of glucose. Absorption and secretion of sodium and chloride, fluid movement, peak amplitude of intracellular calcium fluorescence, and expression of Ano1 and sodium-glucose cotransporter 1 were assessed. NHE3 activity increased, and chloride secretory activity decreased with age. Net chloride secretion increased, and net sodium absorption decreased in the intestines of 3-week-old mice compared to 8-week-old mice with NSP4. Glucose increased NSP4-stimulated chloride secretion. Glucose increased NSP4-stimulated increase in short-circuit current measurements (I sc) and net chloride secretion. Ano1 cells with siRNA knockdown showed a significant difference in I sc in the presence of NSP4 and glucose without a significant difference in peak calcium fluorescence intracellular when compared to non-silencing (N.S.) cells. The failure of glucose to stimulate significant sodium absorption was likely due to the inhibition of sodium-hydrogen exchange and sodium-glucose cotransport by NSP4. Since glucose enhances intestinal chloride secretion and fails to increase sodium absorption in the presence of NSP4, glucose-based oral rehydration solutions may not be ideal for the management of rotaviral diarrhea.

Polymer-based oral rehydration solution for treating acute watery diarrhoea.

BackgroundAcute diarrhoea is one of the main causes of morbidity and mortality among children in low‐income countries. Glucose‐based oral rehydration solution (ORS) helps replace fluid and prevent further dehydration from acute diarrhoea. Since 2004, the World Health Organization (WHO) has recommended the osmolarity of less than 270 mOsm/L (ORS ≤ 270) versus greater than 310 mOsm/L formulation (ORS ≥ 310). Polymer‐based ORS (for example, prepared using rice or wheat) slowly releases glucose and may be superior to glucose‐based ORS.ObjectivesTo compare polymer‐based oral rehydration solution (polymer‐based ORS) with glucose‐based oral rehydration solution (glucose‐based ORS) for treating acute watery diarrhoea.Search methodsWe searched the following sources up to 5 September 2016: the Cochrane Infectious Diseases Group (CIDG) Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library 2016, Issue 9), MEDLINE (1966 to 5 September 2016), EMBASE (1974 to 5 September 2016), LILACS (1982 to 5 September 2016), and mRCT (2007 to 5 September 2016). We also contacted researchers, organizations, and pharmaceutical companies, and searched reference lists.Selection criteriaWe included randomized controlled trials (RCTs) of people with acute watery diarrhoea (cholera and non‐cholera associated) that compared polymer‐based and glucose‐based ORS (with identical electrolyte contents).Data collection and analysisTwo review authors independently assessed the search results and risk of bias, and extracted data. In multiple‐treatment arms with two or more treatment groups, we combined outcomes as appropriate and compared collectively with the control group.Main resultsThirty‐five trials that included 4284 participants met the inclusion criteria: 28 trials exclusively included children, five included adults, and two included both adults and children.Polymer‐based ORS versus glucose‐based ORS (osmolarity ≤ 270)Eight trials (752 participants) evaluated this comparison, and seven trials used rice as a polymer source. Polymer‐based ORS may decrease mean stool output in the first 24 hours by 24 mL/kg (mean difference (MD) −24.60 mL/kg, 95% CI −40.69 to −8.51; one trial, 99 participants, low quality evidence). The average duration of diarrhoea may be reduced by eight hours (MD −8.24 hours, 95% CI −13.17 to −3.30; I² statistic = 86%, five trials, 364 participants, low quality evidence) with polymer ORS but results are heterogeneous. Limited trials showed no observed difference in the risk of unscheduled use of intravenous fluid (RR 0.66, 95% CI 0.43 to 1.02; I² statistic = 30%; four trials, 376 participants, very low quality evidence), vomiting (very low quality evidence), and hyponatraemia (very low quality evidence).Polymer‐based ORS versus glucose‐based ORS (osmolarity ≥ 310)Twenty‐seven trials (3532 participants) evaluated this comparison using a variety of polymers. On average, polymer ORS may reduce the total stool output in the first 24 hours by around 65 mL/kg (MD −65.47 mL/kg, 95% CI −83.92 to −47.03; 16 trials, 1483 participants, low quality evidence), and may reduce the duration of diarrhoea by around eight hours (MD −8.57 hours; SD −13.17 to −4.03; 16 trials, 1137 participants, low quality evidence) with substantial heterogeneity. The proportion of participants that required intravenous hydration was low in most trials with fewer in the polymer ORS group (RR 0.75, 95% CI 0.57 to 0.98; 19 trials, 1877 participant, low quality evidence) . Subgroup analysis by type of pathogen suggested an effect on unscheduled intravenous fluid in those infected with mixed pathogens (RR 0.63, 95% CI 0.41 to 0.96; 11 trials, 928 participants, low quality evidence), but not in participants positive for Vibrio cholerae (RR 0.94, 95% CI 0.66 to 1.34; 7 trials, 535 participants, low quality evidence). No difference was observed in the number of patients who developed vomiting (RR 0.91, 95% CI 0.72 to 1.14; 10 trials, 584 participants, very low quality evidence), hyponatraemia (RR 1.82, 95% CI 0.52 to 6.44; 4 trials, 385 participants, very low quality evidence), hypokalaemia (RR 1.29, 95% CI 0.74 to 2.25; 2 trials, 260 participants, low quality evidence), or persistent diarrhoea (RR 1.28, 95% CI 0.68 to 2.41; 2 trials, 885 participants, very low quality evidence).Authors' conclusionsPolymer‐based ORS shows advantages compared to glucose‐based ORS (at ≥ 310 mOsm/L). Comparisons favoured polymer‐based ORS over ORS ≤ 270 but analysis was underpowered.15 April 2019No update plannedOtherThis is not a current research question

Glucose stimulates calcium-activated chloride secretion in small intestinal cells

The sodium-coupled glucose transporter-1 (SGLT1)-based oral rehydration solution (ORS) used in the management of acute diarrhea does not substantially reduce stool output, despite the fact that glucose stimulates the absorption of sodium and water. To explain this phenomenon, we investigated the possibility that glucose might also stimulate anion secretion. Transepithelial electrical measurements and isotope flux measurements in Ussing chambers were used to study the effect of glucose on active chloride and fluid secretion in mouse small intestinal cells and human Caco-2 cells. Confocal fluorescence laser microscopy and immunohistochemistry measured intracellular changes in calcium, sodium-glucose linked transporter, and calcium-activated chloride channel (anoctamin 1) expression. In addition to enhancing active sodium absorption, glucose increased intracellular calcium and stimulated electrogenic chloride secretion. Calcium imaging studies showed increased intracellular calcium when intestinal cells were exposed to glucose. Niflumic acid, but not glibenclamide, inhibited glucose-stimulated chloride secretion in mouse small intestines and in Caco-2 cells. Glucose-stimulated chloride secretion was not seen in ileal tissues incubated with the intracellular calcium chelater BAPTA-AM and the sodium-potassium-2 chloride cotransporter 1 (NKCC1) blocker bumetanide. These observations establish that glucose not only stimulates active Na absorption, a well-established phenomenon, but also induces a Ca-activated chloride secretion. This may explain the failure of glucose-based ORS to markedly reduce stool output in acute diarrhea. These results have immediate potential to improve the treatment outcomes for acute and/or chronic diarrheal diseases by replacing glucose with compounds that do not stimulate chloride secretion.

Oral rehydration salt solution for treating cholera: ≤ 270 mOsm/L solutions vs ≥ 310 mOsm/L solutions.

Oral rehydration solution (ORS) is used to treat the dehydration caused by diarrhoeal diseases, including cholera. ORS formulations with an osmolarity (a measure of solute concentration) of ≤ 270 mOsm/L (ORS ≤ 270) are safe and more effective than ORS formulations with an osmolarity of ≥ 310 mOsm/L (ORS ≥ 310) for treating non-cholera diarrhoea. As cholera causes rapid electrolyte loss, it is important to know if these benefits are similar for people suffering from cholera. To compare the safety and efficacy of ORS ≤270 with ORS ≥ 310 for treating dehydration due to cholera. We searched the Cochrane Infectious Disease Group Specialized Register (April 2011), CENTRAL (The Cochrane Library Issue 4, 2011), MEDLINE (1966 to April 2011), EMBASE (1974 to April 2011), and LILACS (1982 to April 2011). We also contacted organizations and searched reference lists. Randomized controlled trials comparing ORS ≤ 270 with ORS ≥ 310 for treating adults and children with acute diarrhoea due to cholera. Two reviewers independently applied eligibility criteria, assessed trial quality, and extracted data. We pooled dichotomous data using risk ratio (RR), pooled continuous data using mean difference (MD) or the standardized mean difference (SMD), and presented the results with 95% confidence intervals (CI). For glucose-based ORS, seven trials (718 participants) met the inclusion criteria. Biochemical hyponatraemia (blood sodium levels < 130 mmol/L) was more common with ORS ≤ 270 (RR 1.67, CI 1.09 to 2.57; 465 participants, four trials), while a higher level of severe biochemical hyponatraemia (blood sodium levels < 125 mmol/L) in the same group was not significant (RR 1.58, CI 0.62 to 4.04; 465 participants, four trials). No instances of symptomatic hyponatraemia or death were noted in the trials that intended to record them. We found no statistically significant difference in the need for unscheduled intravenous infusion. Analyses separating children and adults showed no obvious trends.Two trials also examined rice-based ORS. In the ORS ≤ 270 group, duration of diarrhoea was shorter (MD -11.42 hours, CI -13.80 to -9.04; 102 participants, two trials). In people with cholera, ORS ≤ 270 is associated with biochemical hyponatraemia when compared with ORS ≥ 310, but there are no differences in terms of other outcomes. Although this risk does not appear to be associated with any serious consequences, the total patient experience in existing trials is small. Under wider practice conditions, especially where patient monitoring is difficult, caution is warranted.

Cochrane review: Polymer‐based oral rehydration solution for treating acute watery diarrhoea

AbstractBackgroundAcute diarrhoea is one of the principal causes of morbidity and mortality among children in low‐income countries. Glucose‐based ORS helps replace fluid and prevent further dehydration from acute diarrhoea. Since 2004, the World Health Organization has recommended the osmolarity &lt; 270 mOsm/L (ORS ≤ 270 ) over the &gt; 310 mOsm/L formulation (ORS ≥ 310). Glucose polymer‐based ORS (eg prepared using rice or wheat) slowly releases glucose and may be superior.ObjectivesTo compare polymer‐based ORS with glucose‐based ORS for treating acute watery diarrhoea.Search strategyIn September 2008, we searched the Cochrane Infectious Diseases Group Specialized Register, CENTRAL (The Cochrane Library2008, Issue 3), MEDLINE, EMBASE, LILACS, andmRCT. We also contacted researchers, organizations, and pharmaceutical companies, and searched reference lists.Selection criteriaRandomized controlled trials of people with acute watery diarrhoea (cholera and non‐cholera associated) comparing polymer‐based and glucose‐based ORS (with identical electrolyte contents).Data collection and analysisTwo authors independently assessed the search results and risk of bias, and extracted data. In multiple treatment arms with two or more treatment groups, we combined outcomes as appropriate and compared collectively with the control group.Main resultsThirty‐four trials involving 4214 participants met the inclusion criteria: 27 in children, five in adults and two in both. Twelve trials used adequate methods to conceal allocation. Most compared polymer‐based ORS with ORS ≥ 310. There were fewer unscheduled intravenous infusions in the polymer‐based ORS group compared with glucose‐based ORS (ORS ≥ 310 and ≤ 270 groups combined) (RR 0.75, 95% CI 0.59 to 0.95; 2235 participants, 19 trials). Adults positive forVibrio choleraehad a shorter duration of diarrhoea with polymer‐based ORS than with ORS ≤ 270 (MD ‐7.11 hours, SD ‐11.91 to ‐2.32; 228 participants, 4 trials). Wheat‐based ORS resulted in lower total stool output in the first 24 hours compared with ORS ≤ 270 (MD ‐119.85 g/kg, SD ‐114.73 to ‐124.97; 129 participants, 2 trials). Adverse effects were similar for polymer‐based ORS and glucose‐based ORS.Authors' conclusionsPolymer‐based ORS shows some advantages compared to ORS ≥ 310 for treating all‐cause diarrhoea, and in diarrhoea caused by cholera. Comparisons favoured the polymer‐based ORS over ORS ≤ 270, but the analysis was underpowered. If specialists consider a potential role for polymer‐based ORS, further trials against the current standard (ORS ≤ 270) will be required.Plain Language SummaryPolymer‐based oral rehydration solution (ORS) ORS for acute diarrhoeaAcute diarrhoea is a common cause of death and illness in developing countries. Oral rehydration solutions (ORS) have had a massive impact worldwide in reducing the number of deaths related to diarrhoea.Most ORS is in the form of a sugar–salt solution, but over the years people have tried adding a variety of compounds ('glucose polymers') such as whole rice, wheat, sorghum, and maize. The aim is to slowly release glucose into the gut and improve the absorption of the water and salt in the solution. This review updates and expands on a 1998 Cochrane Review of rice‐based ORS, and assesses the available evidence on the use of polymer‐based ORS (both rice and non‐rice based) in comparison with the glucose‐based ORS.The original ORS was based on glucose and had an osmolarity of ≥ 310 mOsm/L (ORS ≥ 310). Glucose‐based ORS with a lower osmolarity was later introduced in attempts to improve efficacy, and is considered better at reducing the amount and duration of diarrhoea.Thirty‐four trials involving 4214 participants met the inclusion criteria: 27 in children; five in adults; and two in both. Most trials compared polymer‐based ORS with a sugar–salt ORS with a particular strength (ORS ≥ 310), which is slightly more salty than the currently agreed best formula (≤ 270 mOsm/L). The trials' methodological quality was variable.Fewer people in the polymer‐based ORS group needed a drip to be rehydrated compared with those in the glucose‐based ORS group. Adverse events were similar for polymer‐based ORS and glucose‐based ORS.The authors conclude that polymer‐based ORS show some advantages compared to glucose‐based ORS for treating diarrhoea of any cause and in diarrhoea caused by cholera. Limited evidence favoured the polymer‐based ORS over ORS ≤ 270. Further trials should compare the efficiency of ORS ≤ 270 with a polymer‐based ORS.

Green banana-supplemented diet in the home management of acute and prolonged diarrhoea in children: a community-based trial in rural Bangladesh

To determine the effectiveness of green banana in the home management of acute (<7 days) or prolonged (≥ 7 days) diarrhoea at the community level. A cluster randomized field trial was conducted among 2968 Bangladeshi rural children 6-36 months old. Wards (villages) were randomly assigned to either a standard care group or a standard care plus green banana group where mothers were instructed to add cooked green banana to the diets of diarrhoeal children. Through a village-based surveillance system, diarrhoeal morbidity data (severity, duration, compliance) were collected for 14 days. Treatment effects were determined by analysing cumulative probability of cure by testing Cox proportional hazards models and relative risk (RR). The cumulative probability of cure was significantly (P < 0.001) different in children receiving GB for both acute [hazard ratio (HR) = 0.63 (95% CI: 0.56-0.67)] and prolonged diarrhoea [HR = 0.38 (95% CI: 0.26-0.59)]. The recovery rates of children with acute diarrhoea receiving GB (vs. control) were significantly more by day 3: 79.9%vs. 53.3% [(RR) = 0.47, 95% CI: 0.41-0.55], (P < 0.001) and day 7: 96.6%vs. 89.1% (RR = 0.32; 0.22-0.46), (P < 0.001). Children with prolonged diarrhoea receiving green banana had significantly higher recovery rates by day 10: 79.8%vs. 51.9% (RR = 0.42; 0.23-0.73), (P < 0.001) and day 14: 93.6%vs. 67.2% (RR = 0.22; 0.08-0.54), (P < 0.001). A green banana-supplemented diet hastened recovery of acute and prolonged childhood diarrhoea managed at home in rural Bangladesh.

Safety and Efficacy of a Premixed, Rice‐Based Oral Rehydration Solution

ABSTRACTThe authors compared the safety and efficacy of a ready‐to‐use, premixed, rice‐based oral rehydration solution (R‐ORS) with a glucose‐based oral rehydration solution (G‐ORS), each containing 75 mmol/L sodium, in Mexican children with acute diarrhea for less than 5 days.MethodsOne hundred eighty‐nine boys 3 to 24 months old admitted to the hospital with acute diarrhea and signs of dehydration were randomly assigned to receive either G‐ORS or R‐ORS. Intake and output were measured every 3 hours.ResultsIn the group treated with R‐ORS, significantly fewer patients required supplemental intravenous fluids during the rehydration phase compared to the G‐ORS group (1%v 8.7%; P &lt; 0.01). Mean stool output, percent weight gain, ORS intake, urine output, and number of patients who vomited during rehydration were similar in the two groups. The mean total stool output after the first 24 hours of maintenance phase was significantly lower in the R‐ORS group than in the G‐ORS group.ConclusionsThe authors found rice‐based ORS to be safe, and its use reduced the rate of intravenous fluid therapy in comparison with the use of a glucose‐based ORS.

Evaluation of oral hypo-osmolar glucose-based and rice-based oral rehydration solutions in the treatment of cholera in children

Evaluation of oral hypo-osmolar glucose-based and rice-based oral rehydration solutions in the treatment of cholera in children

Amylase-Treated Rice Flour Oral Rehydration Solution with Enhanced Energy Density. Ii. in Vivo Studies of Tolerance, Energy Intake, and Rehydration Efficacy in the Initial Treatment of Dehydrated Diarrhoeic Children

In a companion paper we described the feasibility of liquefying high concentrations of rice flour with amylase to produce enhanced oral rehydration solutions (ORS) with suitably lower viscosities to remain drinkable. This offers a means of orally rehydrating patients, while eliminating much or all of the caloric deficit imposed by conventional, dilute, glucose-based ORS. To explore whether humans would tolerate these solutions, 63 dehydrated diarrhoeic children were randomly assigned to one of three four-hour oral treatments: ORS with 5% rice flour, 10% rice flour incubated with -amylase, or 15% rice flour incubated with -amylase. The sodium and potassium concentrations of the solution as well as the osmolality and viscosity were within the desired ranges. On average, the children consumed 70 ± 26%, 90 ± 28%, and 80 ± 45% of the respective ORS, equivalent to intakes of 8 ± 4, 23 ± 9, and 33 ± 18 kcal/kg/4 hours, respectively. The mean increases in weight in four hours were 1.1%, 2.7%, and 1.6%, respectively. The concept of enhanced energy content of ORS based on amylasetreated rice flour appears to be ready for exploration in clinical field trials.

Use of a Single Solution for Oral Rehydration and Maintenance Therapy of Infants With Diarrhea and Mild to Moderate Dehydration

To compare the efficacy of two commonly used solutions in the rehydration of infants with mild to moderate dehydration caused by acute diarrhea in the United States. Double-blind, parallel-group, randomized study performed at Children's Hospital Medical Center. Sixty infant boys (< or = 2 years old), with mild (< or = 5%) or moderate (6 to 9%) dehydration caused by acute diarrhea of less than 1 week's duration were included in the study. Infants were randomly assigned to receive treatment with either a glucose-based oral rehydration solution (ORS) (Pedialyte, Ross Laboratories, Columbus, OH) or a rice syrup solids-based ORS (Infalyte, Mead Johnson Nutritional Group, Evansville, IN). After rehydration was achieved, patients entered a maintenance phase during which, in addition to a maintenance ORS, breast milk or a soy-based formula was offered; infants older than 1 year were also given a lactose-free diet. Rehydration was judged clinically. Infants remained on a metabolic bed during the study in to separate and quantitate urine and stool output. Therefore, in addition to clinical outcome, we compared intake, output and apparent absorption and retention of fluid, sodium, and potassium between groups. All patients were successfully rehydrated using an ORS without the use of intravenous fluids. No differences were detected between treatment groups in time to rehydration, percentage of weight gain after rehydration, consumption of ORS to achieve rehydration, or stool output. However, the apparent sodium absorption (net intake less fecal output) was greater in the Infalyte group than the Pedialyte group during the first 24 hours. The two maintenance oral electrolyte solutions (Pedialyte and Infalyte) most commonly used in the United States are effective as rehydration solutions for infants with mild to moderate dehydration. We speculate that a strategy for oral rehydration therapy in the United States, based on the use of a single solution during the rehydration and maintenance phase, might gain additional acceptance by practicing pediatricians and family physicians.

A Randomized Community Trial of Prepackaged and Homemade Oral Rehydration Therapies

To compare the effectiveness of prepackaged oral rehydration solutions with homemade cereal-based oral rehydration therapy in the treatment of acute childhood diarrhea in children younger than 5 years. In Ethiopia, approximately 40% of all mortality in children younger than 5 years, or over 200,000 annual deaths, is attributable to acute childhood diarrhea. Less than 15% of the episodes of acute childhood diarrhea are treated with oral rehydration solutions. Two hundred ninety-one children younger than 5 years with acute childhood diarrhea. A randomized field trial comparing the effectiveness of an entirely homemade cereal-based oral rehydration therapy (HC-ORT, n = 103) with two alternative prepackaged salt solutions, a glucose-based oral rehydration solution (G-ORS, n = 98) and a cereal-based oral rehydration solution (C-ORS, n = 90), in the treatment of mild to moderate acute childhood diarrhea in children younger than 5 years. Subjects in the HC-ORT group demonstrated equivalent or better weight gain than those in the C-ORS or G-ORS groups at 24, 48, 72, and 96 hours following the onset of treatment. The beneficial weight-gain effect of HC-ORT was most pronounced in infants younger than 12 months, following adjustment for demographic and baseline clinical characteristics. Compliance with ORT use through 96 hours was significantly better among caretakers of children receiving HC-ORT. Minor errors in the preparation of these oral rehydration regimens occurred more frequently among caretakers preparing either of the cereal-based ones. That HC-ORT is an effective, culturally more acceptable alternative to G-ORS or C-ORS. The implementation of well-monitored, community-based HC-ORT programs in less developed countries is recommended.

Short-chain glucose polymer and anthracene-9-carboxylic acid inhibit water and electrolyte secretion induced by dibutyryl cyclic AMP in the small intestine

Glucose-stimulated sodium absorption is the rationale for treatment with glucose-based oral rehydration solution in diarrhea. Concurrent treatment with pharmacological inhibitors, which specifically block chloride secretion, may be a useful adjunct to oral fluid therapy. To examine this hypothesis, the authors determined the intestinal water and ion transport rates in rat small intestine during the secretory phase induced by perfusion with N6-2′-0-dibutyryl adenosine 3′,5′-cyclic monophosphate (dbcAMP), 1.0 mmol/L. A marker (polyethylene glycol 4000) dilution technique was used to evaluate the antisecretory effects of a defined short-chain glucose polymer, d-glucose, and a chloride channel blocker, anthracene-9-carboxylic acid (A-9-C). The results showed that dbcAMP induced small intestinal water and chloride ion secretion rapidly and reliably. The 2.5% concentration of rice short glucose polymer (G2, 22.7%; G3, 28.2%; G4, 14.0%; G5, 16.6%; G6, 11.6%; G7–9, 6.9%) is a better carbohydrate than the 2.5% concentration of d-glucose in reversing secretion of water, chloride, and sodium ions induced by dbcAMP. The combination of A-9-C and the glucose polymer can reverse dbcAMP-induced intestinal secretion and produces significantly (P < 0.05) better antisecretory effect on water, sodium, and chloride ions than d-glucose with A-9-C.

Cereal-based oral rehydration therapy. I. Clinical studies

Studies of "improved" oral rehydration solutions, in which glucose polymers (starch) derived from rice or other cereals were added to improve cotransport of sodium and to promote sodium and water absorption, have been reported. These solutions were administered to decrease diarrhea volume and duration, reduce vomiting, and replace volume loss in stools. In clinical trials of children and adults with high-output diarrhea, such as in cases of cholera, the use of cereal-based oral rehydration solutions (ORS) compared with glucose-based ORS produced significant (20% to 53%) reductions in stool volumes. In one study the duration of diarrhea was shortened by 30%. In noncholera diarrhea in children, cereal-based ORS was as effective as glucose-based ORS. Although the amino acid transport systems were intact in patients with cholera, the addition of glycine to glucose-based or rice-based ORS did not reduce stool volume or duration of diarrhea. The exception was alanine, which reduced stool output and ORS requirements. More research is needed to determine the optimal mix of starch, amino acids, oligopeptides, and proteins that would utilize the absorptive active transport systems maximally to reduce fluid losses and duration of diarrhea.

Improved water and sodium absorption from oral rehydration solutions based on rice syrup in a rat model of osmotic diarrhea

Rice syrup solids, rice protein, and casein hydrolysate were added to experimental oral rehydration solutions in various combinations and tested in a rat intestinal perfusion system. Chronic osmotic diarrhea was induced in juvenile rats by supplying the cathartic agents, magnesium citrate and phenolphthalein, in their drinking water for 1 week. The experimental oral rehydration solutions were compared with standard oral rehydration solutions containing 20 gm/L or 30 gm/L of glucose and with each other to determine if there were significant differences in net water, sodium, or potassium absorption. An oral rehydration solution containing 30 gm/L of rice syrup solids had a net water absorption rate significantly higher than that of the standard 20 gm/L glucose-based oral rehydration solution (2.1 +/- 0.62 versus 1.5 +/- 0.48 microliters/[min x cm], p less than 0.05). Casein hydrolysate did not significantly affect net water absorption. However, combinations of 30 gm/L rice syrup solids and 5 gm/L casein hydrolysate significantly increased (p less than 0.05) net sodium and potassium absorption compared with the 20 gm/L glucose-based oral rehydration solution but not versus rice syrup solids alone. Oral rehydration solutions containing 30 gm/L rice syrup solids plus 5 gm/L rice protein, and 30 gm/L rice syrup solids plus 5 gm/L casein hydrolysate, had net water absorption rates significantly higher than the rate of a 30 gm/L glucose-based oral rehydration solution (2.5 +/- 0.36 and 2.4 +/- 0.38, respectively, versus 0.87 +/- 0.40 microliters/[min x cm], p less than 0.05). Rice protein and casein hydrolysate, however, did not significantly affect net water, sodium, or potassium absorption when added to rice protein glucose-based oral rehydration solutions. An inverse correlation between osmolality and net water absorption was observed (r = -0.653, p less than 0.02). The data suggest that substitution of rice syrup solids for glucose in oral rehydration solutions will improve water absorption and that rice syrup solids in combination with protein hydrolysates may, in addition, promote better sodium and potassium uptake.

Cereal-based oral rehydration therapy. II. Strategic issues for its implementation in national diarrheal disease control programs

Field studies in Bangladesh demonstrated that after proper training, village mothers were able to prepare and use rice-based, salt-enriched oral rehydration solutions containing safe concentrations of sodium, and were capable of achieving significantly fewer treatment failures and a reduction in the duration of diarrhea than with glucose-based oral rehydration solutions (ORS). An additional longitudinal study showed that improved growth and weight gain occurred with the consistent use of ORS; the effect was greater when rice-based ORS were used. In addition, the following possible limitations and benefits of cereal-based oral rehydration therapy, which are relevant to the strategies for its implementation in national diarrheal disease control programs, are discussed: safety, osmolarity, hypernatremia, spoiling, effectiveness, rehydration ability, reduction in diarrhea volume and duration, nutritional effects, effect on food intake, acceptance and usage by care givers, training of health workers, self-reliance of families, effect on other child survival activities, costs, potential problems in changing to cereal-based ORS, and the role of industrial production in packaged cereal-based ORS.

L-glutamine stimulates jejunal sodium and chloride absorption in pig rotavirus enteritis

Rotavirus enteritis is the leading cause of diarrhea in infants worldwide. A research priority of the World Health Organization is to develop oral rehydration solutions containing amino acids or other additives that will stimulate intestinal absorption more efficiently than the current glucose-based oral rehydration solutions. Glutamine is the principal metabolic fuel of the small bowel and a putative stimulator of mucosal repair. This report describes the transport response to mucosal l-glutamine following intestinal injury caused by porcine rotavirus. Peak symptoms and mucosal damage were observed 2–7 days after oral rotavirus inoculation. In vitro transport studies of the maximally injured region, the midjejunum (80% reduction in lactase), surprisingly, showed transport responses to l-glutamine (30 mmol/L) Sand l-alanine (30 mmol/L) that were similar qualitatively and quantitatively to those observed in control tissue. Subsequent application of mucosal d-glucose (30 mmol/L) caused additional stimulation of electrogenic Na+ transport, but the response to glucose was blunted (P < 0.05) in the infected tissues. Glutamine and alanine enhanced Na+ absorption to a similar degree (2–2.5 μEq · cm−2 · h−1), but glutamine stimulated equal amounts of electrogenic and electroneutral NaC1 absorption, whereas alanine had no significant effect on net Cl− flux. Glutamine is a potentially useful substrate for investigation in oral rehydration solutions for infant diarrhea.

A comparison of rice-based oral rehydration solution and “early feeding” for the treatment of acute diarrhea in infants

To compare the use of rice-based oral rehydration solution (R-ORS), with the introduction of food immediately after rehydration ("early feeding"), using standard glucose-based oral rehydration solution (G-ORS) in the management of acute diarrhea, we conducted a four-cell randomized, controlled trial among 200 hospitalized Egyptian infants between 3 and 18 months of age. During the rehydration phase (first 4 hours), three groups were given G-ORS and a fourth group was given R-ORS. During the subsequent maintenance phase, the control group was given a soy-based, lactose-free formula (G-ORS + SF), a second group (G-ORS + RF) was given a rice-based formula, and a third group (G-ORS + rice) was given boiled rice. The fourth group (R-ORS + SF) continued to receive R-ORS for the first 24 hours of the maintenance period, followed by a soy-based lactose-free formula. During the first and second 24 hours of the maintenance period, infants in the three treatment groups had a lower mean stool output in comparison with the control group (p = 0.006 and 0.03, respectively). The mean total stool output in the R-ORS + SF group was significantly lower than in the control group (p = 0.02). There were no statistically significant differences among the four groups in the mean duration of diarrhea. We conclude that (1) infants who were given R-ORS had reduced total stool output (by 35%) compared with the control group and (2) feeding of boiled rice or a rice-based formula immediately after rehydration therapy was as efficacious as treatment with R-ORS alone for 24 hours, followed by feeding with a soy-based, lactose-free formula.

AN IMPROVED ORAL REHYDRATION SOLUTION.

Although glucose-based oral rehydration solution effectively treats the dehydration brought on by diarrhea, it does not reduce the volume or frequency