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PubMed2000

Intravenous versus oral rehydration during a brief period: responses to subsequent exercise in the heat.

PURPOSE: The purpose of this study was to assess whether a brief period (20 min) of intravenous (i.v.) fluid rehydration versus oral rehydration differentially affects cardiovascular, thermoregulatory, and performance factors during exhaustive exercise in the heat. METHODS: Following dehydration (-4% of body weight), eight nonacclimated highly trained cyclists (age = 23.5 +/- 1.2 yr; VO2peak = 61.4 +/- 0.8 mL x kg x min(-1); body fat = 13.5 +/- 0.6%) rehydrated and then cycled at 70% VO2peak to exhaustion in 37 degrees C. Rehydration (randomized, cross-over design) included: 1) CONTROL (no fluid), 2) DRINK (oral rehydration, 0.45% NaCl) equal to 50% of prior dehydration, and 3) IV (intravenous rehydration, 0.45% NaCl), equal to 50% of prior dehydration. Thus, in the DRINK and IV treatments subjects began exercise (EX) at -2% of body weight. RESULTS: Exercise time to exhaustion was not different (P = 0.07) between DRINK (34.9 +/- 4 min) and IV (29.5 +/- 3.5 min), but both were significantly (P < 0.05) longer than CONTROL (18.9 +/- 2.7 min). Plasma volume was better (P < 0.05) restored during IV than CONTROL and DRINK at pre-exercise and 5 min EX, but different (P < 0.05) from only CONTROL at 15 min EX. Plasma lactate during DRINK was lower (P < 0.05) than IV at 15 min EX and postexercise. Heart rate during CONTROL was greater (P < 0.05) than DRINK and IV from 0-8 min EX, and greater (P < 0.05) than DRINK from 10-14 min EX. Rectal temperature during DRINK was less (P < 0.05) than IV from 0-24 min EX. Mean weighted skin temperature during DRINK was less (P < 0.05) than IV from 4-12 min EX. CONCLUSIONS: Thus, despite no statistically significant performance differences between DRINK and IV, it appears that certain physiological parameters were better maintained in the DRINK trial, and the trend toward performance differences may be important to elite athletes.

Administration, Oral↗
PubMed1995

Cereal-based oral rehydration solutions in Sudanese children with diarrhoea: a comparative clinical trial of rice-based and sorghum-based oral rehydration solutions.

A randomized controlled study was carried out at the Children's Emergency Hospital, Khartoum to evaluate the acceptability, safety and efficacy of (rice or sorghum) cereal-based oral rehydration solutions (ORS) relative to that of the standard WHO ORS formulation in children with acute diarrhoea. Ninety-six children whose ages ranged from 6 to 40 months were enrolled in the study. Thirty-two of them were allocated to the rice-based ORS group, 34 to the sorghum-based ORS group and 30 to the control group. Cereal-based ORS solutions were found to shorten the duration of diarrhoea and to reduce both the stool volume and the frequency of diarrhoea and vomiting as well as the mean total ORS intake. These effects were more marked with the sorghum-based ORS than with the rice-based ORS. By the end of day 3, 50% of patients in the rice ORS group and 67.6% in the sorghum ORS group had recovered compared with 40% from the standard ORS group.

Child, Preschool↗
PubMed1989

[The detoxication and rehydration effect of oral rehydration therapy in acute intestinal infection].

As many as 120 patients with food toxinfections were treated by intravenous injections of kvartasol solution and the oral solutions glucosolan and rehydron. The data obtained allow the conclusion that rehydration therapy is not only not inferior to intravenous treatment but also favours the quickest recovery of the disturbed parameters of homeostasis including most rapid elimination of intoxication. Rehydron solution should be regarded as the most effective one.

Acetates↗
PubMed1986

Oral rehydration in China.

Oral rehydration with salt and sugar solution for diarrhea seems to have been widely used in China for more than 20 years. Surveys in five rural counties in widely distributed provinces have revealed that over 90 per cent of barefoot doctors and county doctors have been using a simple salt and sugar solution. Thirty-four per cent of mothers also said they used the oral solution. By contrast, most urban hospitals, especially teaching hospitals, continued to rely on intravenous (I-V) fluids. It had been previously observed that China has had high morbidity but low mortality from diarrheal diseases. Part of the explanation undoubtedly is the relatively good nutritional status of children and the widespread use of liquid traditional medicines. The finding that barefoot doctors have been using oral rehydration also may help explain the low mortality.

Administration, Oral↗
PubMed2000

Rice-based oral rehydration solution for treating diarrhoea.

BACKGROUND: Oral rehydration therapy is used to treat dehydration caused by diarrhoea. However the rehydration solution does not reduce stool loss or length of illness. A solution able to do this may lessen the use of ineffective diarrhoea treatments as well as improve morbidity and mortality related to diarrhoea. OBJECTIVES: The objective of this review was to assess the effects of rice-based oral rehydration salts solution compared with glucose-based oral rehydration salts solution on reduction of stool output and duration of diarrhoea in patients with acute watery diarrhoea. SEARCH STRATEGY: We searched the Cochrane Infectious Diseases Group trials register, the Cochrane Controlled Trials Register, Medline, Embase, Lilacs and the reference lists of relevant articles. We also contacted researchers in the field. SELECTION CRITERIA: Randomized trials comparing standard World Health Organization oral rehydration solution with an experimental oral rehydration salts solution in which glucose (20 grams per litre) was replaced by 50-80 grams per litre of rice powder, with the electrolytes remaining unchanged. DATA COLLECTION AND ANALYSIS: Data were extracted independently by a statistician and a clinician. MAIN RESULTS: Twenty-two trials were included. Concealment of allocation was adequate in 15 of these trials. Irrespective of age, people with cholera who were given rice oral rehydration salts solution had substantially lower rates of stool loss than those given oral rehydration salts solution in the first 24 hours. Mean stool outputs in the first 24 hours were lower by 67 millilitres/kg of body weight (weighted mean difference -67.4, 95% confidence interval -94.3 to -41.0) in children, and by 51 millilitres/kg of body weight (weighted mean difference -51.1, 95% confidence interval -65.9 to -36.3) in adults. The rate of stool loss in infants and children with acute non-cholera diarrhoea was reduced by only four millilitres/kg of body weight (weighted mean difference -4.3, 95% confidence interval -9.3 to 0.8). REVIEWER'S CONCLUSIONS: Rice-based oral rehydration appears to be effective in reducing stool output in people with cholera. This effect was not apparent in infants and children with non-cholera diarrhoea.

Adult↗
PubMed2001

Perceptual responses in the heat after brief intravenous versus oral rehydration.

PURPOSE: The purpose of the study was to compare the effects of a brief period (20 min) of intravenous (IV) fluid rehydration and oral (ORAL) rehydration on ratings of perceived exertion (RPE), thirst, and thermal sensation (TS) during exercise in the heat. METHODS: After dehydration (-4% of body weight), eight nonacclimated highly trained cyclists (age = 24 +/- 1 yr; VO2 = 61.4 +/- 0.8 mL.kg.min-1) performed three experimental trials. Rehydration (randomized, cross-over design) included: 1) ORAL (0.45% NaCl) equal to 50% of prior dehydration; 2) IV (0.45% NaCl) equal to 50% of prior dehydration; and 3) a control (CON), no fluid trial. Subjects then cycled at 74% VO2peak until volitional exhaustion in a hot environment (37 degrees C). RESULTS: Central (C-), local (L-), and overall-RPE (O-RPE) were significantly higher in CON compared to ORAL and IV at minutes 5 and 15 of exercise. C-RPE responses at minute 5 of exercise were lower (P < 0.05) during ORAL compared with IV, and C-RPE and O-RPE responses at minute 15 were lower (P < 0.05) during ORAL compared with IV. TS responses during CON were higher (P < 0.05) than ORAL and IV at minute 5, and TS was higher (P < 0.05) during IV versus ORAL at minute 15. TS were significantly correlated with all RPE responses at minute 15 in all trials. Thirst ratings were lower (P < 0.05) during ORAL compared with CON and IV at minutes 0, 5, and 15. CONCLUSION: It was concluded that ORAL resulted in lower RPE, thirst, and TS compared with CON and IV during exercise in the heat.

Administration, Oral↗
PubMed1991

Comparison of rat and human intestinal perfusion models for assessing efficacy of oral rehydration solutions.

The optimal composition for oral rehydration solutions remains controversial. Animal models have been used to assess the efficacy of new formulations but the relevance of these studies to the handling of oral rehydration solutions in human intestine during diarrhoeal disease states remains uncertain. Using steady state perfusion techniques we have compared water and solute transport from a variety of oral rehydration solutions in both the entire rat small intestine and in the human jejunum. Overall the pattern of water, sodium and glucose absorption was similar from the three oral rehydration solutions tested, indicating close parallelism between the two models despite the species and methodological differences. Although the relationship between the findings of these studies to the handling of oral rehydration solution in diarrhoeal disease states remains uncertain, we believe they do support the view that animal models may have a part to play in the preliminary screening of oral rehydration solutions before clinical trial.

Adult↗
PubMedDate not supplied

Evaluation of oral rehydration therapy in Matiguas, Nicaragua.

Use of oral rehydration salts is an effective tool to decrease deaths due to diarrheal dehydration. Following concerted educational efforts to introduce oral rehydration therapy, Nicaragua reported a significant decrease in deaths of young children from diarrhea and dehydration over a 5-year period. Further decline in the mortality rate has not occurred, however, and factors that would affect usage and impact are poorly understood. A health survey was administered in 155 randomly selected homes in Matiguas, Nicaragua, in July 1990. Caretakers of children were asked about their knowledge, attitudes, and practices in treating diarrhea in children younger than age 5. They were also asked to demonstrate their knowledge of mixing World Health Organization oral rehydration salts packets. Ninety percent of the respondents said they used oral rehydration therapy. The major reason quoted for not using it was dislike of the taste. Of the three-quarters willing to mix the oral rehydration salts, 62 percent prepared the solution correctly and 38 percent incorrectly. Knowledge about diarrhea and the role of oral rehydration therapy was high in this population, and those with this knowledge were more likely to use it. Respondents who learned to mix the oral rehydration salts at the health center had more years of education and were more likely to mix the salts correctly. In this study, there is a positive association between contact with the health center and correct use of the rehydration salts. The relationship of this association with morbidity and mortality needs further research.

Adolescent↗
PubMed1994

A randomized community trial of prepackaged and homemade oral rehydration therapies.

OBJECTIVE: 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. BACKGROUND: 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. SUBJECTS: Two hundred ninety-one children younger than 5 years with acute childhood diarrhea. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Acute Disease↗
PubMed2005

Acute diarrhea's recommendations on oral rehydration therapy and feeding.

Oral rehydration therapy and feeding for patients with diarrhea recommended by physicians who had attended the short course "Practical Approach to Common GI Problems" were compared with The Royal College of Pediatricians of Thailand Expert Committee on Gastrointestinal System's (RCPedT) Recommendations. A questionnaire was sent to physicians who had attended the short course. Physicians recommended a variety of oral rehydration solutions (ORS) which were different from RCPedT's recommendations. 42.6% of physicians recommended WHO/ORS, 54.1% recommended commercial ORS and 3.3% recommended any form of ORS. The other form of ORS, 59.0% of physicians recommended was carbonated drinks (nonphysiologic ORS) and 40.9% recommended home mixing of ORS. 55.7% of respondents recommended ORT for mild or moderate dehydration and 29.5% for mild or no dehydration only 14.8% of the physicians followed the guidelines. Although RCPedT WHO and American Academy of Pediatrics (AAP) Committee on Nutrition stated that vomiting was not a contraindication to successful use of ORT but vomiting was the most common reason (86.9%) given by respondents for failure of ORT and vomiting was the reason for starvation as well (11.5%). Early feeding of appropriate food 80.3% of respondents followed the guidelines but only 50.7% of respondents recommended breast feeding for children younger than 1 year old.

Acute Disease↗
PubMed1991

[The theoretical and practical aspects of oral rehydration in diarrhea in infants and small children. II. Oral hydration in acute diarrhea in infants and children].

In the first part are shown historical data of oral rehydration, the therapeutical objects, the water and electrolyte requirements in the acute diarrheal disease. After an appraisal of the dehydration state, solutions and methods of oral rehydration in the acute diarrheal disease (ADD) are presented. In the final part are shown the complications, the limits of the oral rehydration in ADD, as well as the conclusions.

Acute Disease↗
PubMed1990

[Oral rehydration at a third-level service].

Oral rehydration therapy (ORT) has been shown to be useful in decreasing mortality, reducing treatment costs and diminishing the frequency of complications in children under the age of five with acute diarrhea. The current concept of ORT includes not only the increase in the intake of fluids and the administering of oral solution in order to prevent or treat dehydration, but also the continuance of everyday feeding, the teaching of the child's mother to detect signs of dehydration and other alarming changes, as well as the non-administering of medication, especially those considered as anti-diarrheal or anti-vomiting, and limiting the use of antimicrobials, only to be used in special cases. The theoretical know-how of these concepts has been seen to be insufficient in order to increase the use of community-wide Oral Rehydration Therapy, being this the main purpose for the establishment of the Oral Rehydration Ward in teaching hospitals of second and third level, where the majority of its' personnel must come into contact with and share the responsibility of treating children with diarrhea. Within these wards students obtain information, ability and assurance in the effective actual management of children with diarrhea, including the correction of the state of dehydration through the administering of oral solutions. Another complementary benefit from the coming about of this ward is the decrease in the need to hospitalize the majority of the patient with diarrhea therefore reducing costs and any related complications. Oral rehydration therapy; diarrhea; dehydration; oral solutions.

Child, Preschool↗
PubMed1992

Water and solute absorption from a new hypotonic oral rehydration solution: evaluation in human and animal perfusion models.

Controversy continues regarding the optimal composition of glucose electrolyte oral rehydration solutions for the treatment of acute diarrhoea. Four perfusion models (normal human jejunum, normal rat small intestine, cholera toxin treated secreting rat small intestine and rotavirus infected rat small intestine) have been developed and used to compare the efficacy of a hypotonic oral rehydration solution with standard United Kingdom British National formulary and developing world oral rehydration solutions (WHO). Despite obvious physiological and pathophysiological differences between these models there was general congruence in the water and solute absorption profiles of the different oral rehydration solutions. Hypotonic oral rehydration solution promoted significantly greater water absorption than other oral rehydration solutions in all rat models (p < 0.001) but apparently increased water absorption failed to achieve significance in human jejunum. British National Formulary-oral rehydration solution was unable to reverse net water secretion in both rotavirus and cholera toxin models. Net sodium absorption from hypotonic and WHO-oral rehydration solutions was significantly greater than from the low sodium British National Formulary-oral rehydration solutions (p < 0.001) except in the rotavirus model when absorption was similar to hypotonic-oral rehydration solutions. These findings show that there is agreement in the apparent efficacy of oral rehydration solutions in these animal and human perfusion models, and that improved water absorption with adequate sodium absorption may be achieved by reducing oral rehydration solution osmolality.

Adolescent↗
PubMed1990

Glycine, glycyl-glycine and maltodextrin based oral rehydration solution. Assessment of efficacy and safety in comparison to standard ORS.

We evaluated the efficacy and safety of an oral rehydration solution containing glycyl-glycine, glycine, and maltodextrin (GGG-ORS), in comparison to the glucose based ORS (standard ORS). The osmolality of the GGG-ORS (305 mOsm/l) and standard ORS (311 mOsm/l) was similar. Ninety-two children presenting with acute gastroenteritis and moderate dehydration, aged 3 months to 3 years, were randomly assigned to receive standard ORS or GGG-ORS. All the patients were successfully rehydrated orally. The two groups were comparable for baseline characteristics including the microbial etiology. Rotavirus (49%, 36%), ETEC (11%, 18%) or a combination of rotavirus and ETEC (15%, 9%) were the main stool pathogens isolated. There was no significant difference in the mean stool output or duration of diarrhoea between the two groups. Patients in the GGG-ORS group had higher urine output (p less than 0.01) and weight gain (p less than 0.05) in the initial 6 hours when feeding was withheld, but no such differences were observed beyond this period. Hypernatremia did not develop in any patient during the study. We conclude that glycine and glycyl-glycine supplemented oral rehydration solution does not have any therapeutic advantage in the treatment of acute gastroenteritis with moderate dehydration caused predominantly by rotavirus.

Acute Disease↗
PubMed2000

Amylase-resistant starch plus oral rehydration solution for cholera.

BACKGROUND: Although standard glucose-based oral rehydration therapy corrects the dehydration caused by cholera, it does not reduce the diarrhea. Short-chain fatty acids, which are produced in the colon from nonabsorbed carbohydrates, enhance sodium absorption. We conducted a study to determine the effects of an orally administered, nonabsorbed starch (i.e., one resistant to digestion by amylase) on fecal fluid loss and the duration of diarrhea in patients with cholera. METHODS: We randomly assigned 48 adolescents and adults with cholera to treatment with standard oral rehydration therapy (16 patients), standard therapy and 50 g of rice flour per liter of oral rehydration solution (16 patients), or standard therapy and 50 g of high-amylose maize starch, an amylase-resistant starch, per liter of oral rehydration solution (16 patients). The primary end points were fecal weight (for every 12-hour period during the first 48 hours after enrollment) and the length of time to the first formed stool. RESULTS: The mean (+/-SD) fecal weights in the periods 12 to 24 hours, 24 to 36 hours, and 36 to 48 hours after enrollment were significantly lower in the resistant-starch group (2206+/-1158 g, 1810+/-1018 g, and 985+/-668 g) than in the standard-therapy group (3251+/-766 g, 2621+/-1149 g, and 2498+/-1080 g; P=0.01, P= 0.04, and P=0.001, respectively). From 36 to 48 hours after enrollment, fecal weight was also significantly lower with the resistant-starch therapy than with the rice-flour therapy (985+/-668 g vs. 1790+/-866 g, P=0.01). The mean duration of diarrhea was significantly shorter with the resistant-starch therapy (56.7+/-18.6 hours) than with standard therapy alone (90.9+/-29.8 hours, P=0.001) or the rice-flour therapy (70.8+/-20.2 hours, P=0.05). Fecal excretion of starch was higher with the resistant-starch therapy (32.6+/-30.4) than with the standard therapy (11.7+/-4.1 g, P=0.002) or the rice-flour therapy (15.1+/-8.4 g, P=0.01). CONCLUSIONS: The addition of a resistant starch to oral rehydration solution reduces fecal fluid loss and shortens the duration of diarrhea in adolescents and adults with cholera.

Adolescent↗