Sucrose in oral therapy for cholera and related diarrhoeas

Abstract

Sucrose was tested as a possible alternative to glucose in oral diarrhoea therapy. Eighteen patients were given oral sucrose plus electrolytes as a maintenance solution. Fifteen of these patients could be maintained using this solution, but three developed massive increases in net fluid losses with increases in plasma specific gravity, necessitating termination of oral therapy. Twelve patients tested all had significant concentrations of stool reducing sugar. The data contrast with the rarity of treatment failures of oral glucose-electrolyte solutions. Glucose, therefore, is preferable to sucrose for oral therapy of diarrhoeal diseases.

PIP: The use of sucrose in oral rehydration therapy solutions in place of glucose was tested in 18 patients, 17 males and 1 female, admitted for treatment of severe dehydration due to diarrhea and vomiting. 13 of these patients were positive for cholera (1 with untyped vibrio), whereas 4 others cultured no recognizable pathogen. Patients received an average 1100 ml of intravenous fluids to keep the intravenous drip open during the oral therapy period, and the intravenous therapy was stopped or slowed during oral (or nasogastric) therapy. Average patient age was 32 years. Oral solutions contained either 48 or 38 gm of sucrose per liter plus (in all solutions) sodium chloride (4.2 gm/liter), sodium bicarbonate (2 gm/liter), and potassium citrate (2.7 gm/liter). Of the 18 patients, 15 could be maintained using this solution, but 3 developed massive increases in net fluid losses with increases in plasma specific gravity, which necessitated terminating the therapy. In these failure cases, plasma specific gravity increased over 1.031. Stool samples of 12 patients tested were found to contain reducing sugar: prehydrolysis 436 mg/100 ml, posthydrolysis 957 mg/100 ml. The breakdown of sucrose by intestinal enzymes or by bacteria accounts for the presence of reducing sugar in the stool. These data contrast with the rarity of treatment failures of oral glucose therapy; therefore, glucose is the preferable component in oral rehydration electrolyte solution therapy.