Abstract

PIP: Oral rehydration therapy (ORT) prevents severe morbidity and death from mild to moderate dehydration from acute diarrhea for all ages and all etiologies. WHO advises ORT fluid to contain 3.5 g sodium chloride, 3.5 g potassium chloride, 2.5 g sodium bicarbonate or 2.9 g trisodium citrate dihydrate, and 20 g glucose all dissolved in 1 1 of water. This fluid does not reduce stool volume or frequency and does not curtail duration thus it is not always acceptable. Improved ORT is needed, however. The glucose concentration cannot be increased above the present 2% since an increased concentration would intensify diarrhea and dehydration. Researchers are working on an improved solution (Super ORS) which would rehydrate the body and actively bring on reabsorption of endogenous secretions in the intestine. Thus this improved ORS would reduce stool volume, shorten duration of diarrhea, and allow early introduction of feeding. Even though some studies demonstrate that fortified ORS with the amino acid glycine decreases stool volume by 49-70% and duration of diarrhea 28-30%, other studies indicate that it induces excess sodium concentrations in the blood. 1 study demonstrates that in comparison with the standard ORS, ORS fortified with the amino acid L-alanine reduced the severity of symptoms and the need for fluid in patients afflicted with cholera and enterotoxigenic Escherichia coli. Further studies reveal that rice powder based ORS (50-80 g/l) reduces stool volume 24-49% and duration of duration 30%. The advantage of using rice is that when it hydrolyzes glucose, amino acids, and oligopeptides emerge. Each 1 of these chemicals facilitate sodium absorption through separate pathways. Disadvantages include the fuel must be used to cook the rice, rice based ORS ferments within 8-24 hours making it useless, and the rice or pop rice needs to be ground.