Scientific Rationale for a Change in the Composition of Oral Rehydration Solution

Duggan, Christopher; Fontaine, Olivier; Pierce, Nathaniel F.; Glass, Roger I.; Mahalanabis, Dilip; Alam, Nur; Bhan, Maharaj Kishan; Santosham, Mathuram

doi:10.1001/jama.291.21.2628

Cited by 64 publications

(38 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…195 Large post-marketing surveillance studies involving 50,000 Bangladeshi adults and children have recently been completed, and their results will help inform this debate. 199 The use of probiotics in treating diarrhea has been studied in children as well as adults. A Cochrane review pooled the results of trials involving 1,449 children across a diverse range of settings.…”

Section: Controversies In Managementmentioning

confidence: 99%

Infectious Diarrhea in Developed and Developing Countries

Cheng¹,

McDonald²,

Thielman³

2005

Journal of Clinical Gastroenterology

108

View full text Add to dashboard Cite

Diarrhea from gastrointestinal infection remains a common problem. In industrialized countries, management is aimed at reducing morbidity and defining groups that may benefit from further investigation. Most infectious diarrhea is self-limiting and only requires supportive management. Viral agents are increasingly recognized as causative agents of epidemic and sporadic diarrhea. In developing countries, diarrhea is a major cause of mortality in children. Oral rehydration therapy, guided by a clinical assessment of the degree of dehydration, is cheap, simple, and effective and remains the mainstay of management of infant diarrhea. Controversies focus on the optimal formulation of oral rehydration solution. A vaccine against rotavirus has the potential to save millions of lives worldwide.

show abstract

Section: Controversies In Managementmentioning

confidence: 99%

Infectious Diarrhea in Developed and Developing Countries

Cheng¹,

McDonald²,

Thielman³

2005

Journal of Clinical Gastroenterology

108

View full text Add to dashboard Cite

show abstract

“…This switch was motivated by improved medical outcomes, including reductions in stool output, vomiting, and the need for supplemental intravenous (IV) therapy (Binder et al, 2014;Duggan et al, 2004). The WHO lower-osmolarity ORS has an osmolarity of 245 mOsm/L.…”

Section: Discussionmentioning

confidence: 99%

A low osmolarity rehydration solution that helps chemo patients

Cushing¹,

Joseph²

2018

View full text Add to dashboard Cite

Abstract:Intro: Prior research using oral rehydration solutions (ORS) have focused primarily on diarrhea secondary to infectious diseases such as cholera. We evaluated the efficacy of supplying oral rehydration solution (ORS) to patients undergoing chemotherapy.Method: Patients undergoing one of four chemotherapy treatments (CAF, EC, FOLFIRI, or IFL), in one of eleven hospitals, with HDI scores largely representative of the global population (Range: 0.48-0.89), were divided semirandomly into two groups. Patients in the test group received a low-osmolarity oral rehydration solution powder, and instructed to consume it with water. Patients in the control group did not get the rehydration solution. Return hospital visits were tallied for both groups during the first three months of treatment. Mean return visits per hospital, per treatment, were calculated for each group. A t-test for independent samples was conducted on these data points.Results: Welch's t was used to make corrected group comparisons between the groups. It found a significant difference in monthly return visit rate between the control group (M = 4.35, SD = 0.61) and the test group (M = 0.94, SD = 0.18), t(23.386) = 24.5, p < .001, d = 7.58. The effect size of this difference was remarkably large. Discussion:Patients who had access to the ORS had return visit rates that were less than 25% of those who did not. This reduction in hospital visits demonstrates that the medical use of appropriate ORS can be used as a supplement treatment for chemotherapy patients.

show abstract

“…Before initiation of SGLT1-mediated Na ϩ -glucose cotransport, monolayers were preincubated for 20 min at 37°C in nominally HCO 3 Ϫ -free HBSS with 25 mM mannose and 0.5 mM phloridzin, to inhibit Na ϩ -glucose cotransport. When used, 10 M PD169316 or 5 M Akti1/2 (Calbiochem) were included during this preincubation as well as all subsequent media before cell lysis.…”

Section: Methodsmentioning

confidence: 99%

“…One critical example involves coordinated Na ϩ and glucose absorption by villus enterocytes (1,2). This process may, in part, explain why inclusion of Na ϩ and glucose in oral rehydration solutions used to treat life-threatening diarrheal disease augments therapeutic efficacy (3,4). In mechanistic terms, Na ϩ -glucose cotransport mediated by SGLT1 leads to activation of the apical Na ϩ -H ϩ antiporter NHE3.…”

mentioning

confidence: 99%

MAPKAPK-2 Is a Critical Signaling Intermediate in NHE3 Activation Following Na+-Glucose Cotransport

Wang

Graham

et al. 2006

Journal of Biological Chemistry

View full text Add to dashboard Cite

Villus enterocyte nutrient absorption occurs via precisely orchestrated interactions among multiple transporters. For example, transport by the apical Na ؉ -glucose cotransporter, SGLT1, triggers translocation of NHE3, Na ؉ -H ؉ antiporter isoform 3, to the plasma membrane. This translocation requires activation of p38 mitogen-activated protein kinase (MAPK), Akt2, and ezrin. Akt2 directly phosphorylates ezrin, but the precise role of p38 MAPK in this process remains to be defined. Sequence analysis suggested that p38 MAPK could not directly phosphorylate Akt2. We hypothesized that MAPKAPK-2 might link p38 MAPK and Akt2 activation. MAPKAPK-2 was phosphorylated after initiation of Na ؉ -glucose cotransport with kinetics that paralleled activation of p38 MAPK, Akt2, and ezrin. MAPKAPK-2, Akt2, and ezrin phosphorylation were all attenuated by p38 MAPK inhibition but were unaffected by dominant negative ezrin expression. Akt2 inhibition blocked ezrin but not p38 MAPK or MAPKAPK-2 phosphorylation, suggesting that MAPKAPK-2 could be an intermediate in p38 MAPK-dependent Akt2 activation. Consistent with this, MAP-KAPK-2 could phosphorylate an Akt2-derived peptide in vitro. siRNA-mediated MAPKAPK-2 knockdown inhibited phosphorylation of Akt2 and ezrin but not p38 MAPK. MAPKAPK-2 knockdown also blocked NHE3 translocation. Thus, MAP-KAPK-2 controls Akt2 phosphorylation. In so doing, MAP-KAPK-2 links p38 MAPK to Akt2, ezrin, and NHE3 activation after SGLT1-mediated transport.Intestinal nutrient absorption occurs via precisely orchestrated regulation of multiple transporters. One critical example involves coordinated Na ϩ and glucose absorption by villus enterocytes (1, 2). This process may, in part, explain why inclusion of Na ϩ and glucose in oral rehydration solutions used to treat life-threatening diarrheal disease augments therapeutic efficacy (3, 4). In mechanistic terms, Na ϩ -glucose cotransport mediated by SGLT1 leads to activation of the apical Na ϩ -H ϩ antiporter NHE3. This generates a favorable osmotic gradient that drives transepithelial water absorption (5, 6). Coordination of SGLT1 and NHE3 involves a complex signal transduction pathway where activation of p38 mitogen-activated protein kinase (MAPK) 2 leads to Akt2 activation, ezrin phosphorylation, and NHE3 translocation to the brush border (1,7,8).Although it is clear that p38 MAPK is critical to this process (1), the mechanisms by which p38 MAPK activates Akt2 are unknown. Available data suggest that p38 MAPK cannot activate Akt2 directly. We therefore considered p38 MAPK effectors as potential signaling intermediates in this process.A large number of kinases have been reported to be p38 MAPK effectors, including Mnk1, Mnk2, PRAK, MEF2, ATF-2, Stat1, and MAPK-activated protein kinase-2 (MAPKAPK-2) (9, 10). These, in turn, act on additional substrates, including CREB and HSP27 (11-17). Among these effectors, two recent reports suggest that MAPKAPK-2, a serine/threonine protein kinase, may link p38 MAPK and Akt. These studies showed that recombinant MAPKAPK...

show abstract

Scientific Rationale for a Change in the Composition of Oral Rehydration Solution

Cited by 64 publications

References 36 publications

Infectious Diarrhea in Developed and Developing Countries

Infectious Diarrhea in Developed and Developing Countries

A low osmolarity rehydration solution that helps chemo patients

MAPKAPK-2 Is a Critical Signaling Intermediate in NHE3 Activation Following Na+-Glucose Cotransport

Contact Info

Product

Resources

About