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Year : 1994  |  Volume : 38  |  Issue : 2  |  Page : 44-9

Usefulness of ORT in certain special situations of diarrhoeal diseases.

Division of Clinical Medicine, National Institute of Cholera and Enteric Diseases, Calcutta

Correspondence Address:
P Dutta
Division of Clinical Medicine, National Institute of Cholera and Enteric Diseases, Calcutta

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Source of Support: None, Conflict of Interest: None

PMID: 7835995

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Diarrhea is one of the most common causes of morbidity and mortality in infants and children less than 5 years old in developing countries. Diarrheal diseases are a major cause of childhood malnutrition. Toxin-producing bacteria are responsible for many acute diarrheas. Oral rehydration solution (ORS) treats dehydration caused by acute diarrheal episodes. WHO promotes the use of a single oral rehydration formula which contains 3.5 g sodium chloride, 2.5 g sodium bicarbonate or 2.9 g trisodium citrate dihydrate, 1.5 g potassium chloride, and 20 g glucose to 1 liter of water. This ORS formula can safely be used for all age groups and all etiologies of diarrhea. ORS replaces the lost fluid and electrolytes and maintains fluid and electrolytes. Pediatricians in most developed countries do not accept this ORS formula in cases of rotavirus-caused diarrhea because rotavirus blunts some absorptive villi and reduces the activity of lactase and other disaccharidase, resulting in reduced absorption. Yet, the unaffected villus cells may absorb enough water and electrolytes to be effective. In cases of vomiting, ORS should be administered in small amounts and slowly. Some health workers are concerned that 90 mmol/l sodium in the WHO formula causes hypernatremia in neonates and young infants who have low sodium levels in their stools. Specialists suggest ORS with 30-60 mmol/l or additional water administered in a 2:1 ratio for these young infants. Hypernatremia is also a concern for malnourished children, but studies show that WHO's ORS is safe and effective in treating malnourished children. Bottle fed children are more vulnerable to hypernatremia than breast fed children. Hypernatremia has neurological effects. Hyponatremia is more common in developing countries than developed countries. It also has neurological effects. In severe dehydration cases, intravenous fluid or ORS delivered via a nasogastric tube should be given immediately.

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