Total parenteral nutrition (TPN) is widely used as a substitute for intestinal water and electrolyte losses and to replenish nutrients in patients with short bowel syndromes (SBS), as well as diarrheal diseases. However, TPN can cause certain serious complications like central line infections, which can be associated with sepsis, and increased hepatic enzymes. Additionally, TPN therapy requires co-administration of supplemental intravenous fluids and electrolytes to replenish intestinal fluid losses and recurrent volume depletion, which can be accomplished by oral rehydration therapy (ORT). 

Oral Rehydration Therapy (ORT) works on the principle of coupled transport of sodium and glucose. It is even effective in high output diarrhoeas like cholera. It is considered superior to intravenous infusion in conscious patients who are able to drink, to avoid the complications of central lines with associated hazards of insertion and central-line–associated bloodstream infections (CLABSI). 

ORT is known to be safer and convenient in patients with short bowel syndromes but is underutilized currently. A case reports its utility and usage in a patient with an ileostomy who was able to transition off TPN to a combination of enteral feeding and a rice hydrolysate oral rehydration therapy (ORT) (Ceralyte).

The researchers also considered ORT as a less troublesome, safer, and inexpensive alternative to intravenous therapies.

The case explains the condition of a 27-year-old, female with cerebral palsy, spina bifida, paraplegia, and chronic intestinal dysmotility with colon paralysis (Ogilvie’s syndrome), who required diverting colostomy. She suffered a high output loss of water and electrolytes following ileostomy and was successfully weaned from total parenteral nutrition and intravenous fluid and electrolyte replacement to a rice-based oral rehydration therapy (ORT) allowing her early discharge in the care of her parents.

Thus the researchers rendered ORT to be effective in the context of modern high-technology settings, as well as in resource-poor situations.

Long-term use of TPN elevates the risk of pancreatic atrophy, gall stones, impaired renal and hepatic function, and is also known to be associated with overfeeding, hyperglycemia, sepsis, and intestinal atrophy. Contrary, ORT escapes the pain of needles, the complications of central line insertion and infections, and is less expensive. Additionally, it can be administered at home by family members without any technical assistance.

Source: Wright SM, Noon MJ, Greenough WB 3rd. Oral Rehydration Therapy and Feeding Replaces Total Parenteral Nutrition: A Clinical Vignette. J Gen Intern Med. 2016;31(2):255-257. doi:10.1007/s11606-015-3396-1