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Issues and Controversies in the Evolution of Oral Rehydration Therapy (ORT)

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eMediNexus    05 June 2021

A new article published in Tropical Medicine and Infectious Disease reported that the initial studies demonstrating the efficacy of oral glucose-electrolytes solutions in reducing or eliminating the need for i.v. therapy for dehydrationcaused by acute watery diarrheas (AWD), were focused on cholera patients. While later research adapted the oral therapy (ORT) methodology for treatment of non-cholera AWDs, including for pediatric patients. These adaptations included the 2:1 regimen – using 2 parts of the original WHO oral rehydration solution (ORS) formulation followed by 1 part additional plain water, and a “low sodium” packet formulation with similar average electrolyte and glucose concentrations, when dissolved in the recommended volume of water. 

Moreover, the programmatic desire for a single ORS packet formulation has led to controversy over use of the “low sodium” formulations to treat cholera patients. This current review concluded that the use of low-sodium ORS to treat cholera patients renders a negative sodium balance, leading to hyponatremia and—in severe cases, particularly in pediatric cholera—to seizures and other complications of sodium depletion. Thus, two separate ORS formulations should be used for cholera therapy and for non-cholera pediatric AWD.

The authors inferred that it is in the long-term public health interest to choose safer and more effective ORS formulation for cholera. Hyponatremic seizures and other neurologic and developmental sequelae are avoidable morbidities. Both, rice and glycine–glucose ORS have advantages in cholera, but for use in packets, glycine, which does not require boiling, may be advantageous, and may have superior shelf life before and after mixing. 

Source: Tropical Medicine and Infectious Disease. 2021 Mar; 6(1): 34.doi: 10.3390/tropicalmed6010034

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