What are the solutions for oral rehydration used in gastroenteritis treatment?

Updated: Feb 10, 2017
  • Author: Arthur Diskin, MD; Chief Editor: Steven C Dronen, MD, FAAEM  more...
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Answer

Consider the following:

  • The World Health Organization solution is 90 mEq/L Na+, 20 mEq/L K+, 80 mEq/L Cl-, 20 g/L glucose; osmolarity is 310; CHO:Na = 1.2:1; administer 250 mL (approximately 8 oz) every 15 minutes until fluid balance is clinically restored, then 1.5 L of oral fluid per liter of stool.

  • Other oral rehydration products include Naturalyte, Cera Lyte, Rehydralyte, and Pedialyte.

  • Oral rehydration may not decrease the duration or volume of diarrhea.

  • Small amounts of oral fluids may be given repeatedly while the patient is still vomiting.

  • Oral rehydration has been largely responsible for the tremendous decrease in the death rate in underdeveloped countries from infectious diarrhea, including cholera.

  • The glucose/sodium transport mechanism remains intact despite enterotoxigenic illness. Coupled transport is one of several mechanisms of sodium and water absorption in the bowel. It is the direct entry of sodium and water across the cell at the intestinal brush border membrane via the linking (coupling) of 1 organic molecule, such as glucose, to 1 sodium molecule. This is the principle upon which ORT is based. Optimally, therefore, the ratio of carbohydrate to sodium should approach 1:1. Glucose is necessary to stimulate the absorption of water and electrolytes by the small intestines.

  • The solution must be iso-osmolar or hypo-osmolar to avoid an increased osmotic load in the small intestines contributing to an osmotic diarrheal effect, pulling fluid into the lumen.

  • Studies have shown oral and IV rehydration to be equivalent therapies in patients who can tolerate the oral fluid.

  • Although standard glucose-electrolyte solutions achieve and maintain rehydration, they may not reduce stool volume or duration of diarrheal illness, affecting compliance.

  • Newer solutions with complex carbohydrates and short chain polypeptides of cereals and legumes are now available to provide additional organic cotransport molecules with no increase in osmolarity. These appear to offer the advantage of decreased stool volumes and shortened duration of illness.


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