The treatment of acute diarrhea in children. An historical and physiological perspective

Abstract

This review examines the historical, physiological, clinical, and epidemiological evidence to support a method of therapy for children's diarrhea that may be recommended for general acceptance. The understanding and use of fluid and nutritional therapy of acute diarrhea in childhood have progressed over the years to a point where acute mortality can be reduced to nearly zero. At the same time, the ill effects on electrolyte balance and nutrition may be reduced to a minimum. Through use of an oral glucose electrolyte solution with a carefully designed composition, physiologically correct treatment may now be so simplified and inexpensive as to be readily available to the remote, under-served areas of the world where most of the morbidity exists; and be useful as well to more sophisticated settings. The method of therapy recommended in this paper has several important departures from traditional teaching. It advocates rapid restoration of extracellular fluid with a polyelectrolyte solution containing sodium, base and potassium; use of an oral glucose electrolyte solution for repletion of those not in shock and for maintenance; use of a single oral glucose electrolyte solution for all age groups, regardless of diagnosis, and quite early feeding with tolerated foods. Sodium loads given are generally higher than advocated by standard pediatric teaching. The origins of that teaching and support for the newer approach come from a detailed analysis of current knowledge in the epidemiological, clinical, and physiological aspects of diarrheal illness.

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

“…33-36). Alternate water and OHS administration, as well as OHS with lower sodium and glucose concentrations have had their advocates (3,4,37,38). This recommendation, in clinical practice, would result in a situation comparable to the OHS that produced in our experiments maximum net water absorption with little or no sodium losses.…”

Oral Rehydration Therapy for Diarrhea: An Example of Reverse Transfer of Technology

“…4 -7 Subsequently, in the 1970s many clinical studies were conducted in developing countries to document the safety and efficacy of ORT. 8 As a result, ORT was adopted by the World Health Organization (WHO) in 1978 as its principal strategy for preventing diarrheal deaths. This strategy was quickly adopted by several international agencies including UNICEF and USAID and national programs throughout the developing world.…”

“…This strategy was quickly adopted by several international agencies including UNICEF and USAID and national programs throughout the developing world. 8 As a result, millions of children were saved. 9 Despite the remarkable success of ORT in developing countries, US pediatricians were reluctant to use ORT among children primarily because of their concern about hypernatremia.…”

Mineral Excretion during Acute, Dehydrating Diarrhea Treated with Oral Rehydration Therapy

“…Infectious diarrheal disease has long been a major cause of childhood morbidity and mortality (1,2). With the advent of effective ORT (3,4), exploiting the sodium-coupled absorption mechanism for glucose (5), the management of the dehydration associated with diarrhea has improved, and mortality can be dramatically reduced (6).…”