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Oral rehydration therapy.


 In this lecture presented to the 30th Congress of the Turkish National Pediatric Society in 1986, the author describes how oral rehydration therapy (ORT) has demonstrated its efficacy and been adopted even by physicians in the developed world. The traditional approach of clear liquids by mouth is an imprecise and inappropriate means of rehydration. During the 1st 8-24 hours after intestinal water losses, a solution containing sodium and potassium chloride, bicarbonate, and glucose is necessary to meet deficits; other sources of liquid such as breast milk and rice water can be offered to satisfy thirst after rehydration has been achieved. Studies in the US have repeatedly confirmed the benefit and cost-effectiveness of ORT. Also successful has been the use of oral electrolyte solutions at the onset of diarrhea before dehydration becomes a problem. An appropriate sodium and potassium concentration, with 2% glucose, facilitates absorption across the intestinal mucosa without an increase in the intraluminal osmotic load. Calories need to be provided within 24 hours after the initiation of ORT, especially in malnourished infants. Clean water is essential if infection is to be overcome. Finally, it is stressed that medications to slow intestinal motility are not indicated since diarrhea helps to eliminate offending organisms and their toxins.
