IMPROVED ORAL REHYDRATION THERAPY

P15 WHO recommended glucose based oral rehydration therapy containing 90 mmol sodium per liter provides an effective treatment for correction of dehydration. But this does not reduce the stool volume or frequency of diarrhea. Besides, there has been concern about high sodium content (90 mmol/L) for children with non-cholera diarrhea. Several carefully planned studies have been carried out throughout the world replacing glucose as well as changing electrolytes. One of the earliest studies at International Center for Diarrhoeal disease Research, Bangladesh replaced 20 gm of glucose with 50 gm of rice flour keeping the electrolytes unchanged demonstrated improved results in adult and pediatric patients with cholera. The rice based ORS reduced the stool volume by 30-40%, ORS intake by 29-38% and vomiting by 50-60%. The improved efficacy is attributed to cereal starch, slowly releasing, glucose into the lumen without raising the osmolality of the intestinal lumen. Further studies have been carried out with neutral aminoacid and peptides both in cholera and non cholera patients, The results are conflicting. Recently a multicenter study carried out with reduced osmolarity ORS containing 60 mmol instead of 90 mmol of sodium per liter instead, improved results in terms of reduction in stool output, ORS consumption and duration of diarrhoea. Community based studies with cereal ORS demonstrated nutritional benefit in addition to reduction in duration of diarrhoea. Further research is necessary specially keeping in mind the anthropological practice of the community.