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Issues and Controversies in the Evolution of Oral Rehydration Therapy (ORT)

The original studies demonstrating the efficacy of oral glucose-electrolytes solutions in reducing or eliminating the need for intravenous therapy to correct dehydration caused by acute watery diarrheas (AWD) were focused chiefly on cholera patients. Later research adapted the oral therapy (ORT) met...

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Autor principal: Nalin, David
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8005945/
https://www.ncbi.nlm.nih.gov/pubmed/33809275
http://dx.doi.org/10.3390/tropicalmed6010034
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author Nalin, David
author_facet Nalin, David
author_sort Nalin, David
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description The original studies demonstrating the efficacy of oral glucose-electrolytes solutions in reducing or eliminating the need for intravenous therapy to correct dehydration caused by acute watery diarrheas (AWD) were focused chiefly on cholera patients. Later research adapted the oral therapy (ORT) methodology for treatment of non-cholera AWDs including for pediatric patients. These adaptations included the 2:1 regimen using 2 parts of the original WHO oral rehydration solution (ORS) formulation followed by 1 part additional plain water, and a “low sodium” packet formulation with similar average electrolyte and glucose concentrations when dissolved in the recommended volume of water. The programmatic desire for a single ORS packet formulation has led to controversy over use of the “low sodium” formulations to treat cholera patients. This is the subject of the current review, with the conclusion that use of the low-sodium ORS to treat cholera patients leads to negative sodium balance, leading to hyponatremia and, in severe cases, particularly in pediatric cholera, to seizures and other complications of sodium depletion. Therefore it is recommended that two separate ORS packet formulations be used, one for cholera therapy and the other for non-cholera pediatric AWD.
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spelling pubmed-80059452021-03-30 Issues and Controversies in the Evolution of Oral Rehydration Therapy (ORT) Nalin, David Trop Med Infect Dis Review The original studies demonstrating the efficacy of oral glucose-electrolytes solutions in reducing or eliminating the need for intravenous therapy to correct dehydration caused by acute watery diarrheas (AWD) were focused chiefly on cholera patients. Later research adapted the oral therapy (ORT) methodology for treatment of non-cholera AWDs including for pediatric patients. These adaptations included the 2:1 regimen using 2 parts of the original WHO oral rehydration solution (ORS) formulation followed by 1 part additional plain water, and a “low sodium” packet formulation with similar average electrolyte and glucose concentrations when dissolved in the recommended volume of water. The programmatic desire for a single ORS packet formulation has led to controversy over use of the “low sodium” formulations to treat cholera patients. This is the subject of the current review, with the conclusion that use of the low-sodium ORS to treat cholera patients leads to negative sodium balance, leading to hyponatremia and, in severe cases, particularly in pediatric cholera, to seizures and other complications of sodium depletion. Therefore it is recommended that two separate ORS packet formulations be used, one for cholera therapy and the other for non-cholera pediatric AWD. MDPI 2021-03-12 /pmc/articles/PMC8005945/ /pubmed/33809275 http://dx.doi.org/10.3390/tropicalmed6010034 Text en © 2021 by the author. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) ).
spellingShingle Review
Nalin, David
Issues and Controversies in the Evolution of Oral Rehydration Therapy (ORT)
title Issues and Controversies in the Evolution of Oral Rehydration Therapy (ORT)
title_full Issues and Controversies in the Evolution of Oral Rehydration Therapy (ORT)
title_fullStr Issues and Controversies in the Evolution of Oral Rehydration Therapy (ORT)
title_full_unstemmed Issues and Controversies in the Evolution of Oral Rehydration Therapy (ORT)
title_short Issues and Controversies in the Evolution of Oral Rehydration Therapy (ORT)
title_sort issues and controversies in the evolution of oral rehydration therapy (ort)
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8005945/
https://www.ncbi.nlm.nih.gov/pubmed/33809275
http://dx.doi.org/10.3390/tropicalmed6010034
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