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  • Title: Oral rehydration solutions.
    Journal: Med Lett Drugs Ther; 1983 Feb 18; 25(629):19-20. PubMed ID: 6823225.
    Abstract:
    In the US oral glucose electrolyte solutions have been marketed for over 30 years for the treatment of infantile diarrhea. Recently, oral solutions have been widely used instead of intravenous fluids for treatment of dehydration from diarrhea, especially in developing countries, where diarrhea is a major cause of death in infants and young children and facilities for intravenous fluid replacement are limited or unavailable. The high concentrations of glucose and other carbohydrates in older preparations may make the diarrhea worse. The use of 2-2 1/2% glucose, as in "Infalyte, Pedialyte R.S." and the World Health Organization (WHO) solution avoids the osmotic effect of unabsorbed glucose, makes the taste tolerable, and promotes coupled absorption of sodium from the intestine. Replacement solutions for fluid loss due to diarrhea should also contain about 20 mEq/L of potassium because diarrhea invariably results in a substantial loss of potassium. Although homemade mixtures of glucose electrolyte solutions and commercial powders that require dilution are less costly than ready to use commercial solutions, errors in mixing or diluting occur often and can have serious consequences. For rehydration after volume depletion, the sodium concentration of the replacement fluid should be between 50-90 mEq/L, regardless of the cause of the diarrhea, patient's age, or the serum sodium concentration. For early treatment of diarrhea to prevent dehydration or for maintenance of hydration after parenteral fluid replacement, 90 mEq/L of sodium is acceptable for adults and children, but may not be appropriate for infants who have a higher insensible water loss. When diarrhea in infants is not caused by cholera, some consultants prefer to use more dilute fluids that contain 50-60 mEq/L of sodium. When circulatory insufficiency (10-15% weight loss), severe vomiting, inability to drink, or severe gastric distention is present, parenteral fluid replacement is indicated. With 5-8% acute weight loss, oral rehydration alone is often successful. Infants should be offered frequent small amounts of rehydration solution, aiming for an intake of about 150 ml/kg in the 1st 24 hours, 1/2 in the 1st 8 hours, if possible.
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