[Development of a rehydration therapy in diarrheic disease. 1980]

Intravenous rehydration is required only in patients with severe diarrhea due to V. cholerae who are in shock, with absent peripheral pulse and blood pressure; when the shock has been corrected, rehydration can be completed using an oral rehydration solution. The intravenous solution to be used is 5:4: 1 (5g of sodium chloride, 4g of sodium bicarbonate and 1g of potassium chloride per liter) or a comparable commercial alkaline solution. For oral rehydration a solution is used containing 3.5 g sodium chloride, 2.5g sodium bicarbonate, 1.5g potassium chloride and 20g of glucose (or 40g of sucrose) per liter. These fluids are administered in a volume replacing the amount lost before treatment was initiated and the fluids lost in the continuing diarrhea. With this management, a case fatality rate of 50% in the untreated falls to less than 1%. The addition of antibiotics such as tetracycline and furazolidone reduces the duration of diarrhea and the need for continuing fluid balance observation. Intravenous rehydration of severe diarrhea cases with normal saline solution or with 5% glucose solution increases the acidosis with resulting veno-constriction, which favors the pooling of blood in the heart and the pulmonary circulation leading to cardiac overload and then failure and circulatory peripheral collapse. When acidosis is corrected by the sodium bicarbonate solution and with adequate fluid replacement, normal hemodynamics are reestablished and the patient immediately recovers from the collapse. In cases of mild or moderate diarrhea, replacement entirely by oral rehydration of the estimated volume of lost fluid alone is usually sufficient. This management of diarrhea is applicable for diarrhea from any cause, including enterotoxigenic Escherichia coli, Rotavirus, Salmonella and Shigella as well as Vibrio cholerae.