Can acetate replace bicarbonate in oral rehydration solution for infantile diarrhoea?

Patra, F. C.; Mahalanabis, Dilip; Jalan, K. N.; A, Sen; Banerjee, Parthajit

doi:10.1136/adc.57.8.625

Cited by 22 publications

(11 citation statements)

References 6 publications

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“…Ac has been directly tested in field studies with a rate of clinical success not inferior to that obtained with the WHO recommended OHS (28). The Ac solution appeared remarkable in its capacity to allow for considerable absorption of both sodium and potassium, even at moderate electrolyte concentrations (Figs.…”

Section: Discussionmentioning

confidence: 99%

Osmolality and Solute Concentration—Their Relationship with Oral Hydration Solution Effectiveness: An Experimental Assessment

Wapnir

Lifshitz

1985

Pediatr Res

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ABSTRACT. The role of electrolyte, carbohydrate, and base composition, a s well a s osmolality, of oral hydration solutions (OHS), was investigated using a nonabsorbable marker and tritiated water in an in vivo intestinal perfusion system in rats. The O H S tested were the World Health Organization recommended formula, containing 90 mEq/ liter sodium and 11 1 m M glucose, which was taken a s the reference solution; five variants of this solution with different sodium and glucose concentrations; and two solutions without sodium, i.e. isotonic glucose and deionized water. Also tested were one solution with acetate in lieu of bicarbonate, and two commercial preparations where citrate substituted for bicarbonate. The best water absorption rates were obtained with World Health Organization-type O H S characterized by a combination of low osmolality and moderate sodium and glucose content. Hypotonic O H S (190, 220, and 155 mosmol/kg) in which the sodium:glucose ratios were 60:30, 60:60, and 3055, respectively, produced mean jejunal water transport rates of 3.46, 3.20, and 2.91 pl/min/cm, respectively, whereas the standard World Health Organization O H S (330 mosmol/kg) resulted in a rate of 1.36 pl/min/cm ( p < 0.001). Similar good water absorption was achieved when Ac was the base (270 mosmol/kg and 60:111 sodium:glucose ratio) and with one of the commercial solutions (245 mosmol/kg and 50:111 sodium:glucose ratio). The reference World Health Organization O H S allowed for sodium absorption, a s did the O H S with sodium:glucose ratios of 90:45,60:30,60:60, and acetate-containing 60:111. Sodium a t a concentration of 30 mEq/liter or less resulted in the efflux of this electrolyte. High glucose concentration and lower osmolality exacerbated this effect. The results obtained in this investigation may assist in better evaluating O H S and in selecting modified formulae geared to specific hydration needs and possible replacement of water and sodium losses. (Pediatr Res 19: 894-898,1985 OHS, the cost factor, and other considerations (1-4). The most important points involved in the formulation of OHS have been sodium and carbohydrate concentrations and osmolality. The rationale for the amount of sodium, potassium, and chloride provided in the OHS has been related to the degree of potential electrolyte losses during the illness (5, 6).Several field and experimental studies have tested the suitability of the OHS proposed by the WHO, containing 90 mEq/liter sodium, or of a variant with a lower sodium content (7-10). It is generally accepted that both can accomplish rehydration, with the WHO formula also allowing for the replenishment of sodium. The amount of glucose added (20 g/liter or 1 1 1 mM) has been considered optimum.Earlier reports had provided conflicting information on the stoichiometry of sodium:glucose cotransport and the fluxes of electrolytes and water, either from in vitro (1 1-14) or from in vivo studies, including animal experimentation (15, 16) and clinical trials (I 6, 17).We previously evaluated the rela...

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Section: Discussionmentioning

confidence: 99%

Osmolality and Solute Concentration—Their Relationship with Oral Hydration Solution Effectiveness: An Experimental Assessment

Wapnir

Lifshitz

1985

Pediatr Res

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“…Neverthe less, these findings provide a rationale for including acetate and possible citrate in hu man ORS, especially in view of their estab lished efficacy in correcting acidosis associ ated with acute diarrhoea [8,13]. Further more, these anions do not react with glucose to form furfural compounds and this should ensure a longer shelf-life when compared to bicarbonate-containing prepacked formula tions.…”

Section: Discussionmentioning

confidence: 99%

“…Firstly, bicar- Table II. Jejunal water and sodium absorption (mean ± SEMI from isotonic solutions of saline and acetate (n = 5) and saline and citrate (n = 6) bonate reacts with glucose to form furfural compounds which reduces the shelf-life of pre packed ORS [8], Secondly, such ORS does not always reduce the magnitude and duration of diarrhoea and may actually increase stool out put by 15-20% when compared to intrave nously treated patients [9], The present study demonstrates that both acetate (50 mmol/1) and citrate (5 mmol/1) enhance net absorption of water and sodium from the human jejunum in vivo. In an ear lier study, Schmitt et al [10], using a triple lumen tube, failed to demonstrate enhance ment of water absorption from the human jejunum by 50 mmol/1 of acetate.…”

Section: Discussionmentioning

confidence: 99%

Acetate and Citrate Stimulate Water and Sodium Absorption in the Human Jejunum

et al. 1986

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“…Unfortunately, under hot and humid conditions, this new preparation also absorbs moisture, discolours and cakes. Attempts to improve stability have been suggested but not evaluated (Patra et al 1982;Islam 1985). There is, therefore, a need to understand the moisture sorption characteristics of the ORS ingredients to improve stability.…”

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confidence: 99%

Formulation Studies of Tableted Oral Rehydration Salt Mixtures

Ombaka

Alkan

Groves

1989

Journal of Pharmacy and Pharmacology

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Dehydration following non-specific diarrhoea may be prevented by oral administration of a simple glucose/salt mixture. A solution tablet of this mixture would have advantages of stability under environmental exposure and transport if the costs could be held within reasonable limits. The moisture adsorption and compression characteristics of Oral Rehydration Salts (ORS) ingredients have been studied. Combinations of ingredients resulted in a moisture adsorption higher than that of the individual components. This may be explained in terms of critical relative humidity, RHo, and environmental relative humidity RHi. Preparation of a stable ORS solution tablet therefore requires protection of moisture adsorbing components from the environment. The present UNICEF ORS mixture compacted easily by direct compression but gave fragile tablets, which were hygroscopic. This can be reduced by film coating the electrolyte component as granules with a resin (Eudragit L), or by simulating direct compression of the glucose as a compression-coating around the precompressed electrolytes. The packaging of compression-coated solution tablets in inexpensive polyethylene bags may lengthen the shelf-life and make the preparation less costly than the currently supplied ORS powders packed in laminated aluminium sachets. The increased dissolution lag time for the compacted tablet is a disadvantage that can be overcome by instructions to crush the product immediately before use.

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Can acetate replace bicarbonate in oral rehydration solution for infantile diarrhoea?

Cited by 22 publications

References 6 publications

Osmolality and Solute Concentration—Their Relationship with Oral Hydration Solution Effectiveness: An Experimental Assessment

Osmolality and Solute Concentration—Their Relationship with Oral Hydration Solution Effectiveness: An Experimental Assessment

Acetate and Citrate Stimulate Water and Sodium Absorption in the Human Jejunum

Formulation Studies of Tableted Oral Rehydration Salt Mixtures

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