Oral rehydration solutions

Oral rehydration solutions are the principle treatment of severe diarrhea in developing countries. The standard World Health Organization (WHO) solution contains 90 mmol/l sodium, 20 mmol/l potassium, 80 mmol/l chloride, 30 mmol/l citrate, and 111 mmol/l (20 g/l) glucose. In controlled trials oral rehydration solutions with a sodium content of 50 mmol/l are as effective as those with a greater sodium content but cause less edema and hypernatremia. Commercially available solutions contain varying amounts of sodium when made up according to manufacturers' directions, for example Pedialyte (Ross, Canada and United States; Abbott, Italy) 45 mmol/l, Gastrolyte (Rhone-Poulenc Rorer, Australia) 60 mmol/l, or Rehydralyte (Ross, United States) 75 mmol/l.

The WHO recommends a carbohydrate content of approximately 2 per cent for oral rehydration solutions. The American Academy of Pediatrics recommends a maximum of 2.5 per cent. Contraindications to the use of oral rehydration solution are shock, persistent vomiting, and impaired consciousness.

The glucose and sodium contents of oral rehydration solutions enhance water absorption at the brush border of the ileal mucosa, thus reducing the volume of diarrhea. When glucose and sodium are present in appropriate ratios, they enhance each other's transport across the brush border, with the movement of solute being associated with the iso-osmotic movement of water.

In children, the use of oral rehydration solution is associated with up to 97 per cent successful rehydration. There is only limited experience of its use in adults developing diarrhea during intensive care (G§I|a.gh§I...and...phe|an 1992). Use of an oral rehydration solution maintained hydration and was associated with hemodynamic and metabolic stability and improvement in renal function, but the effect on diarrhea volume was unclear.

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