As soon as diarrhoea begins, treatment using home remedies to prevent dehydration must be started. Magic Bullet: The History of Oral Rehydration Sodium potassium pump pdf 39 pages 7.
Oral rehydration therapy with an inexpensive glucose and electrolyte solution as promoted by the World Health Organization has reduced substantially the number of deaths from dehydration due to diarrhea. In addition, recent research suggests that these solutions have advantages over conventional therapy. Yet, oral rehydration therapy has not been used extensively in developed countries. Acute gastroenteritis is one of the most common illnesses affecting infants and children in Canada and the world.
The average child under age 5 experiences 2. 1 Treatment from resulting dehydration accounts for an estimated 200,000 hospitalizations per year in the U. 2 with comparable rates occurring in Canada. Worldwide as many as 4,000,000 children per year die as a result of gastroenteritis and resulting malnutrition.
1,3 In spite of its efficacy, ORT has not been used extensively in developed countries. Recent research, summarized in this report, suggests that the use of oral rehydration solutions have advantages over conventional therapy. Oral rehydration takes advantage of glucose-coupled sodium transport,4 a process for sodium absorption which remains relatively intact in infective diarrheas due to viruses or to enteropathogenic bacteria, whether invasive or enterotoxigenic. Glucose enhances sodium, and secondarily, water transport across the mucosa of the upper intestine. 5 For optimal absorption, the composition of the rehydration solution is critical. For practical purposes in Canada, rehydration can be accomplished using solutions with higher sodium, i.
Oral rehydration and maintenance solutions presently in use, although effective in rehydration, do not decrease stool volume because of the relatively high osmolarity of the glucose which they contain. The challenge, therefore, is to provide adequate glucose to the sodium pump without increasing the osmolarity of the rehydration solution. Defined short-chained glucose polymers from rice may also be safe and effective in the treatment of acute diarrhea. A clinical study with solutions containing rice-syrup solids confirmed their efficacy in the rehydration of infants with acute diarrhea. Amino acids have also been suggested as additives to ORS. Nevertheless, these are not currently recommended by WHO.
Along with improved oral rehydration solutions have come advances in the field of early refeeding. Fasting has been shown to prolong diarrhea. This may be due to undernutrition of the bowel mucosa which delays the replacement of mucosal cells destroyed by the infection. Although there is general agreement that breast-feeding should continue in spite of diarrhea,14 early refeeding with a lactose-containing formula is usually well tolerated. Fluid therapy should include the following three elements: rehydration, replacement of ongoing losses, and maintenance. Fluid therapy is based on an assessment of the degree of dehydration present.
No dehydration – If diarrhea is present, but urinary output is normal, the normal diet and breast-feeding may continue at home with fluid intake dictated by thirst. Mild – If symptoms and signs are limited to decreased urinary output and increased thirst, mild dehydration is suspected. Assessment and treatment under close supervision are indicated. Early refeeding with the child’s customary formula at the usual concentration is recommended. If dehydration is corrected, therapy for ongoing losses and maintenance are continued as outlined above. Severe – If, in addition to signs of moderate dehydration, there is rapid breathing, lethargy, coma, a rapid thready pulse or “tenting” of the skin lasting more than 2 seconds, severe dehydration and shock are present.
Vomiting is not a contraindication to ORT. ORS should be given slowly but steadily to minimize vomiting. Fluids may be administered by nasogastric tube if required. The child’s clinical condition should be frequently assessed. A child should never be kept on ORS fluid alone for more than 24 hours.
Early refeeding should begin within 6 hours. A full diet should be reinstituted within 24 to 48 hours, if possible. As ORS can be administered easily by a properly instructed parent, and because dehydration can be corrected quickly, it lends itself well for use in an outpatient department or nursing station. At the end of 4 hours, the child can either be sent home on maintenance therapy or, if dehydration persists, be observed for further therapy.