Oral Glucose-electrolyte Solution Research Articles

Oral rehydration on infants and children in the Dr. Hasan Sadikin General Hospital, Bandung.

Fifty-nine out of one hundred and fifty-jour patients with gastroenteritis and dehydration admitted between April and September 1975 to the Department of Child Health, Dr. Hasan Sadikin General Hospital, were treated with oral glucose electrolyte solution and studied.Twenty-nine patients (group I) were treated with P.3.M. formula and thirty patients (group II) with Hirschhorn formula. In both groups no significant differences were noted in grades of volume depletion which ranged between 5 to 10%, with a peak incidence of 8%. Rehydration was excellent in 41 (69.6%), good in 14 (23.7%) and poor in 4 patients (6.7%). No significant differences were found between both groups. The mean weight gain after rehydration was 4.5% (of the initial weight) in group I and 4.49% in group II (no significant differences). In the study of Hirchhorn et al. (1975) the mean weight gain was about 3%. Fifty-four patients (91.5%) had a recognized pathogen in their stool. In general, the result of oral rehydration in this study was satisfactory; statistically the treatment with both oral glucose electrolyte solutions gave the same good results.

Diarrhoeal Disease of Children in Indonesia

Diarrhoeal disease in infants and children up till now is still becoming a major problem with its high morbidity and mortality. There are too many factors which can play a role in causing this disease. But by giving Oral-glucose electrolyte Solution as soon as possible the case fatality rate can be reduced as low as possible. Whereas decreasing the morbidity still needs a very long time, since it has very multi-complex factors i.e. socio-economic condition, environmental and personal hygiene and sanitation, life style of people, belief, etc. The study on epidemiology, the influence of improvement of environmental sanitation and socio-anthropology is still very few, besides there is no satisfactory vaccin produced to prevent this disease. Meanwhile the worse of the case is that there is a tendency of decreasing breast-feeding in the big cities and to substiotute it with bottle-feeding.

Effects of oral rehydration on tissue perfusion, organ function and survival rate in rats with 40% blood volume loss hemorrhagic shock

Objective To investigate the effects of oral glucose-electrolyte solution (GES) on resuscitation of hemorrhagic shock induced by 40% blood volume loss in rats. Methods SD rats were randomly divided into three groups; oral GES without hemorrhagic shock (GES group, n = 16) , hemorrhage shock without fluid resuscitation (HS group, n = 20) and hemorrhagic shock resuscitated with oral GES (HS + GES group, n = 20). About 40% of total blood volume was bled from carotid artery of rats to produce a model of hemorrhagic shock. GES with a volume of three times of blood loss was given three times intragastrically at 0.5, 1 and 6 hours after hemorrhage. Mean arterial pressure (MAP) was measured constantly. Blood flow in liver, kidney, stomach and small intestines, and parameters like hemato-crit, plasma osmotic pressure, alanine aminotransferase (ALT) , creatinine (Cr) and diamine oxidase (DAO) were determined 24 hours after hemorrhage. Survival rates of the rats in three groups were calculated 24 hours after hemorrhage. Results MAPs of HS + GES group were 9. 7% and 10. 9% higher than those of HS group 4 and 24 hours after hemorrhage (P < 0. 05). The blood flow of liver, stomach and small intestines in HS + GES group were 18.6% , 88.4% and 22.0% respectively, higher than those in HS group(P <0.05 or P <0.01) 24 hours after hemorrhage. The hematocrit level of HS + GES group was significantly lower than that of HS group, while the levels of ALT, Cr and DAO in HS + GES group were significantly lower than those in HS group (P <0.01). The survival rate of rats in HS + GES group was 80% , which was significantly higher than 30% in HS group (P <0.01). Conclusions Oral rehydration can significantly improve MAP and tissue perfusion, maintain blood volume and plasma osmotic pressure, alleviate organ damage and hence promote the survival rates of rats with hemorrhagic shock. Key words: Shock, hemorrhagic; Fluid therapy; Tissue perfusion

Oral fluid therapy of cholera among Bangladesh refugees. 1973.

In 1971 a crucial field trial of oral glucose-electrolyte solutions in the treatment of cholera was carried out in Bongaon India when the disease appeared in a population of war refugees. A total of 3703 patients including severe cases treated initially with limited supplies of parenteral fluids and mild to moderately severe cases treated with oral therapy alone were admitted to the Bongaon treatment center; the overall case/fatality ratio was 3.6%. A special demonstration unit provided treatment for 1190 of these patients with a case/fatality ratio of 1%. Advantages of the oral solution included local availability of ingredients minimal cost of preparation and transport ease of administration safety in the hands of inexperienced personnel after only brief instructions early accessibility of treatment and reasonable effectiveness especially when used very early in the course of the disease prior to extreme dehydration shock and acidosis. In severe cases considerable sparing of intravenous fluids resulted from the adjunct use of the oral solution.

Rice-based formulas for rapid refeeding of infants with acute diarrhoea. A field trial

Two infant formulas based on a high protein rice flour (HPRF) and a control soy formula were studied in the early feeding of 56 infants, 3 to 6 months of age, with acute diarrhoea1 disease (n = 20, 17 and 19, respectively). A double blind, randomised study design was used. An oral glucose electrolyte solution was offered on days 1-2 along with formula; full formula feedings were reached by day 3 and continued to day 60. HPRF formulas were well accepted and tolerated. Differences in clinical course and weight gain among the experimental and control groups were not significant. Mean duration of liquid stools was 3.5 and 3.8 days for HPRF-fed infants and 3.3 days for those on the soy protein formula; faeces were well formed by days 8.2, 9.9 and 7.7, respectively (not statistically different). Infants maintained normal weight and height gain to day 60. Formulas based on HPRF are acceptable in the nutritional management of acute infantile diarrhoea.

Gesundheitsprobleme in Verbindung Mit Der Oralen Rehydratations-Therapie Und Der Zwangsfütterung Beim Jungen Kalb

PROBLEMS WITH ORAL REHYDRATION THERAPY AND FORCE-FEEDING IN THE YOUNG CALF&#x0D; The introduction of oral glucose-electrolyte solutions (ORS) in the rehydration therapy in calf diarrhea is believed to be one of the most important advances in veterinary medicine in the past decades. However, own experiences and investigations with several hundred neonatal calves suffering from diarrhea or other diseases show that the use of such solutions - including so-called 'diet-drinks' - implies various risks, which have to be considered.&#x0D; Article in German, English summary in PDF.

Economic Barriers to the Use of Oral Rehydration Therapy

Diarrheal dehydration is a highly prevalent condition among young children and is readily prevented and treated with oral rehydration therapy. We report a death due to hypernatremic dehydration caused by rotavirus diarrhea of a 9-month-old infant whose mother attempted to purchase oral glucose-electrolyte solution in a pharmacy but was unable to afford it. While efforts such as the National ORT Project should help to promote the proper at-home treatment of this condition, we conclude that oral rehydration therapy will not be used optimally by the parents of children living in poverty until the economic barriers to its use are removed.

Economic barriers to the use of oral rehydration therapy. A case report

Diarrheal dehydration is a highly prevalent condition among young children and is readily prevented and treated with oral rehydration therapy. We report a death due to hypernatremic dehydration caused by rotavirus diarrhea of a 9-month-old infant whose mother attempted to purchase oral glucose-electrolyte solution in a pharmacy but was unable to afford it. While efforts such as the National ORT Project should help to promote the proper at-home treatment of this condition, we conclude that oral rehydration therapy will not be used optimally by the parents of children living in poverty until the economic barriers to its use are removed. (<i>JAMA</i>. 1991;265:1724-1725)

Hypernatremic diarrheal dehydration treated with oral glucose-electrolyte solution containing 90 or 75 mEq/L of sodium.

Of 33 infants with hypernatremic dehydration (serum Na+ of greater than or equal to 150 mEq/L) 7 were excluded, 6 because severe alteration of the level of consciousness or shock precluded oral rehydration and 1 because he was given glucose-electrolyte solution plus water. We studied the remaining 27 infants. Twenty (group A) were treated with the World Health Organization-recommended oral rehydration solution (90 mEq/L Na+) and seven (group B) were treated with Pedialyte-RS (Abbott Laboratories Ltd.; 75 mEq/L Na+). The rehydrating solutions were administered in a volume equivalent to twice the clinically estimated fluid deficit. Initial serum sodium was 156.7 +/- 0.9 mEq/L for group A and 155.8 +/- 1.8 mEq/L for group B (mean +/- SEM). The mean time to achieve rehydration was 14.3 and 16.6 h for groups A and B, respectively. Twenty-four hours after commencing oral rehydration, serum Na+ had decreased to 144.8 +/- 1.8 mEq/L for group A and 144.5 +/- 0.9 mEq/L for group B. In two patients in group A, the serum Na+, which, had not decreased to less than 150 mEq/L at 24 h, did so at 48 h. Only in one case (group A) did the serum Na+ increase. This patient had high stool output and failed to become rehydrated after 24 h of unsuccessful oral rehydration. None of the patients had seizures or persistent CNS dysfunction. We conclude that the slow administration of oral rehydration solutions containing either 90 or 75 mEq/L Na+ is a safe and effective treatment of hypernatremic dehydration.

Effect of continued oral feeding on clinical and nutritional outcomes of acute diarrhea in children

One hundred twenty-eight nonmalnourished male patients between 3 and 36 months of age were randomly assigned to receive one of four lactose-free dietary treatments to determine the effect of dietary therapy on the severity and nutritional outcome of diarrheal illness. Group 1 received a formula diet composed of casein, sucrose, dextrin with maltose (Dextri-Maltose), and vegetable oil to provide 110 kcal/kg body weight/d (CSO-110). Group 2 received CSO to provide 55 kcal/kg/d (CSO-55) for 2 days and then CSO-110. Group 3 received only oral glucose-electrolyte solution (GES) for 2 days, CSO-55 for the next 2 days, and then CSO-110. Group 4 received the same diets as Group 3 except that only intravenous GES was used for the first 2 days. The GES maintenance solutions provided 24 to 30 kcal/kg/d. Therapeutic success rates were similar among dietary groups, ranging from 90% to 97%. Fecal excretion was initially lower in group 4 (P less than 0.05) but was similar initially among groups treated orally and among all four groups beginning on day 3. Net apparent absorption of nitrogen, fat, carbohydrate, and total energy; retention of nitrogen; and increments in body weight, arm circumference, and skin-fold thickness were positively related to the amounts of dietary energy consumed. Thus continued oral feeding with the CSO diets during the early phase of therapy yielded improved nutritional results.

Alanine enhances jejunal sodium absorption in the presence of glucose: studies in piglet viral diarrhea.

We measured the response of jejunal sodium (Na) absorption to neutral amino acid (L-alanine) and to dipeptides (L-alanyl-L-alanine, glycylsarcosine) in normal piglets and in piglets with acute viral diarrhea after experimental infection with transmissible gastroenteritis (TGE) virus. In the TGE jejunum villi were blunted, crypts were deepened, and the epithelium was composed of relatively undifferentiated cells with reduced disaccharidase, decreased sodium-potassium-stimulated ATPase, and elevated thymidine kinase activities. The response of Na absorption to a maximal concentration of L-alanine (20 mM) or D-glucose (30 mM) was significantly blunted in TGE jejunum in Ussing chambers. However, the addition of L-alanine together with D-glucose caused a significantly greater increment of Na absorption than either L-alanine or D-glucose alone in control and TGE tissue. The effect of Na absorption of the dipeptide L-alanyl-L-alanine (10 mM), which was rapidly hydrolyzed by control and TGE mucosa, was similar to that of L-alanine (20 mM), while glycylsarcosine, a poorly hydrolyzed dipeptide, did not change net Na absorption in the jejunum. Our data support the concept of separate carrier systems for neutral amino acid and hexose in the crypt-type intestinal epithelium characterizing viral enteritis. We speculate that a sodium-cotransporting amino acid, if added to oral glucose-electrolyte solutions, could benefit oral rehydration therapy in acute viral diarrhea; neither of the dipeptides tested here can be expected to enhance absorption to any greater extent than its constituent amino acids.

RELATIONSHIP BETWEEN GLUCOSE AND SODIUM IN ORAL REHYDRATION SOLUTIONS (ORS); STUDIES IN A MODEL OF SECRETORY DIARRHOEA

Glucose sodium co-transport remains intact in enterotoxin - mediated diarrhoea, hence the rationale for rehydration with oral glucose electrolyte solutions. Using a technique of in situ perfusion in whole rat small intestine after exposure to cholera toxin (75μg for 2 hours) we evaluated the ability of seven different ORS (Glucose 111 or 202 m mol/l, sodium 35-90 m mol/l, osmolality 270-320 mOsm/kg, ratio of glucose: sodium concentration 1.2-5.8), to reverse net water secretion to absorption. Water absorption (+) in μl/min/g of dry wt intestine occurred with all ORS but was greater from ORS with a glucose: sodium ratio of 1.9 than from ORS with ratios of 1.2 and 5.8 ( + 98.6 ± 16 vs + 37.8 ± 8 vs 2.2 ± 7 respectively; p < 0.01). Hypotonic ORS (270 mOsm/kg were superior in promoting water absorption than ORS with osmalities of 312 and 330 mOsm/kg. Water absorption was less from the two ORS with glucose 202 m mol/l. (+ 2.2 ± 7 and 19.4 ± 4) than from the five ORS with glucose 111 m mol/l. (range + 37.8 ± 8 to + 101.9 ± 12; p < 0.01). ORS with 60 m mol/l of sodium were superior to those with 35 or 90 m mol/l. Efficacy of ORS in this model of secretory diarrhoea depends not only on glucose and sodium concentration but on the glucose: sodium ratio and osmolality. These studies may guide development of new, more effective ORS.

Safe Oral Rehydration of Hypertonic Dehydration

Summary: Eighteen infants with severe hypernatremic dehydration secondary to acute gastroenteritis were rehydrated during the 1st day with an oral glucose electrolyte solution containing 60 mmol sodium/L at a mean rate of 120 ml/kg/24 h. These 18 children were safely treated with oral therapy alone. No convulsions were observed during treatment. The mean decrease in natremia was 0.32 mmol/L/h, which compared favorably with the mean fall in natremia of 26 other infants in similar initial conditions who were treated intravenously. The present study lends additional support to the opinion that a slow decrease in plasma sodium (<0.5 mmol/L/h) helps to avoid seizures during treatment. As no other untoward effects were observed, this study also confirms that oral solutions given at a slow rate can effectively replace intravenous fluids in the majority of such children.

Safe Oral Rehydration of Hypertonic Dehydration

Summary:Eighteen infants with severe hypernatremic dehydration secondary to acute gastroenteritis were rehydrated during the 1st day with an oral glucose electrolyte solution containing 60 mmol sodium/L at a mean rate of 120 ml/kg/24 h. These 18 children were safely treated with oral therapy alone. No convulsions were observed during treatment. The mean decrease in natremia was 0.32 mmol/L/h, which compared favorably with the mean fall in natremia of 26 other infants in similar initial conditions who were treated intravenously. The present study lends additional support to the opinion that a slow decrease in plasma sodium (&lt;0.5 mmol/L/h) helps to avoid seizures during treatment. As no other untoward effects were observed, this study also confirms that oral solutions given at a slow rate can effectively replace intravenous fluids in the majority of such children.

Safe Oral Rehydration of Hypertonic Dehydration

Eighteen infants with severe hypernatremic dehydration secondary to acute gastroenteritis were rehydrated during the 1st day with an oral glucose electrolyte solution containing 60 mmol sodium/L at a mean rate of 120 ml/kg/24 h. These 18 children were safely treated with oral therapy alone. No convulsions were observed during treatment. The mean decrease in natremia was 0.32 mmol/L/h, which compared favorably with the mean fall in natremia of 26 other infants in similar initial conditions who were treated intravenously. The present study lends additional support to the opinion that a slow decrease in plasma sodium (less than 0.5 mmol/L/h) helps to avoid seizures during treatment. As no other untoward effects were observed, this study also confirms that oral solutions given at a slow rate can effectively replace intravenous fluids in the majority of such children.

Treatment of 242 neonates with dehydrating diarrhea with an oral glucose-electrolyte solution: Pizarro D, Posada G, Mata L J Pediatr 102:153–156 Jan 1983

Treatment of 242 neonates with dehydrating diarrhea with an oral glucose-electrolyte solution: Pizarro D, Posada G, Mata L J Pediatr 102:153–156 Jan 1983

Treatment of 242 neonates with dehydrating diarrhea with an oral glucose-electrolyte solution

Two hundred thirty-four of 242 neonates (96.7%) with a mean dehydration of 5.1% body weight were rehydrated with a glucose-electrolyte solution given orally in an average time of 7 44 hours. Eight (3.3%) neonates required intravenous fluid therapy. Emesis was not an obstacle for complete oral rehydration. Hypernatremia, hyponatremia, and acidosis present on admission were corrected within a few hours. Oral rehydration is an entirely satisfactory choice for treatment of uncomplicated dehydration in neonates.

Oral Rehydration Therapy of Infantile Diarrhea

Although oral glucose-electrolyte solutions containing 90 mmol of sodium per liter have been widely used in the treatment of acute diarrhea among under-nourished children in the developing world, they have rarely been studied in well-nourished children. We therefore conducted a controlled randomized study among well-nourished children three months to two years who were hospitalized with acute diarrhea (52 in the United States, and 94 in Panama), to compare the efficacy of this solution with that of one containing 50 mmol of sodium per liter and with standard intravenous therapy. Oral rehydration with both solutions according to protocol was successful in 97 of 98 children (one required unscheduled intravenous therapy), and in 87 (89 per cent) no intravenous therapy was required. All of six children admitted with hypernatremia were successfully treated with oral therapy alone. We conclude that glucose-electrolyte oral solutions containing either 50 or 90 mmol of sodium per liter are effective and safe in the treatment of well-nourished children hospitalized with acute diarrhea, and that they may completely replace the intravenous fluids in the majority of such children.

Chlorpromazine-HCL in acute infantile diarrhoea (a brief clinical observation).

A total of 78 patients aged between 2 months aruJ 3 years suffuing from acute watery diarrhoea underwent investigation. Fifty-seven patients rectived chlorpromazinne-HCl 1 mg/kg BW/day in addition to oral glucose electrolyte solzuion. Twenty-one patimts were given a combination of chlorwomazine-HCL ( 1 mgjkg BW /day) wu/ antibiotics in additio11 to oral glucose electrolyte solution. In the first group diarrhoea stopped within 3 days in 70.4% and within 7 days in 85.2% of the treated patients. In the secoruJ group almost similar results were observed: resp. 70% and 85%. Three patients in the first group (5.3%) and 1 patient in the second group (4.8%) received i.v.f.d. because of the worsening of the diarrhoea. Side-effects observed during the study, were irritability irt one patient, heavy sedation in 2 patients and uncoordinated movements in one patient.

Nonantibiotic-associated enterocolitis caused by Clostridium difficile in an infant

THE ROLE of toxin-producing strains of Clostridium dijficile in the pathogenesis of pseudomernbranou s colitis has been firmly established, l:' In both adults and children this disease is generally observed in the setting of recent antibiotic exposure. 1-~ Several reports have appeared describing adults with pseudomembranous colitis without prior antibiotic therapy? .~ ~ This report describes an infant with severe enterocolitis associated with C. difficile toxin in the stools and in whom there was no prior antibiotic exposure. CASE REPORT A 4-month-old female infant was admitted to Hartford Hospital because of bloody diarrhea. She had been born after an uneventful term pregnancy and delivery. Feedings had consisted solely of breast milk for the first three months. The mother had been taking no medication. At three months of age a cow milk formula (Enfamil, Mead Johnson & Company) was introduced, and the patient developed watery diarrhea within several days. Treatment with an oral glucose-electrolyte solution (Pedialyte, Ross Laboratories) and then a soy formula (ProSobee, Mead Johnson & Company) was followed quickly by return of the stools to normal. Re-introduction of the cow milk formula at age 31/2 months was attempted, and the patient rapidly developed diarrhea which prompted admission to a local hospital.