Does oral rehydration therapy alter food consumption and absorption of nutrients in children with cholera?

Abstract

In order to estimate consumption of food and absorption of nutrients, a metabolic balance study was conducted in 47 children between 1 and 5 years old, suffering from acute cholera. Twenty-two of the children were treated by intravenous solution (IV) only and 25 others by oral rehydration along with intravenous solution (ORS/IV) when necessary. After initial rehydration a nonabsorbable charcoal marker was fed to the patients followed by a typical Bangladeshi home food of known composition offered ad libitum. Appearance of the first marker in the faeces was taken as zero hour (0 h); at 72 h a second marker was fed. Faeces, urine and vomitus were collected up to the appearance of the second marker. Intake of IV fluid, ORS and any other fluid or food were recorded accurately. Samples of faeces, urine and vomitus were analysed for energy, fat and nitrogen. Consumption of nutrients and absorption in both groups were calculated. There was no significant difference in the intake or absorption of energy or carbohydrate between the two groups. The consumption of fat and protein was slightly, but significantly, lower in the ORS/IV group during the acute stage of diarrhoea than in the IV group. Absorption of nitrogen was significantly lower in the ORS/IV group, but absorption of fat was not significantly impaired. Vomiting was significantly higher in the ORS/IV group. The differences in the consumption and absorption of nutrients between the two groups were transient and came to the same level within 2 weeks after recovery.

PIP: Between May 1983-March 1984, the International Centre for Diarrhoeal Disease Research, Bangladesh conducted a metabolic balance study involving 47 children with acute cholera between 1-5 years old. Researchers randomly assigned 22 children to the intravenous (IV) solution treatment group. The children received it continuously until the diarrhea stopped. The remaining 25 were treated with oral rehydration solution (ORS) and IV fluid as needed. Health staff attempted to maintain hydration in the ORS/IV group with ORS alone, but IV therapy was reinstated if a child vomited excessively or the child exhibited signs of severe dehydration. Within 6-8 hours after admission and initial rehydration, the children took a nonabsorbable charcoal marker before taking in any food. The appearance of the 1st marker in the stool was called 0 hour and all stools, urine and vomitus between the 0-72 hours were collected. At 72 hours, the children ingested a 2nd marker. The ORS/IV group consumed 40% of the fluid orally. Vomiting within this group was significantly higher than the IV group (p.001). Intake of protein on day 2 and intake of both fat and protein on day 3 were significantly higher in the IV group (p.05, p.01). Daily intake and absorption of energy or carbohydrates in both of the groups, however, were similar. No significant differences in the total consumption of nutrients after recovery existed. Nitrogen absorption was significantly higher in the IV group than the ORS/IV group (p.05). This study demonstrates that an adequate amount of food is consumed and utilized by patients with acute diarrhea while receiving ORS and therefore there is no justification for withholding food during the acute stage of diarrhea.