Revisiting the need for innovative oral hydration technologies

Oral rehydration therapy (ORT) is an important component of fluid management in people with dysregulated fluid intake, renal disorders, and inflammatory gastrointestinal diseases. During intense exercise or periods of compromised intestinal water absorption, regulated intake of an oral rehydration solution (ORS) promotes water uptake and replenishes depleted micronutrients. The primary components of ORS formulation are sodium and glucose, which are co-transported across the apical membrane of ileal and jejunal epithelia to create an osmotic gradient favorable to water uptake. ORS designed for specific conditions are formulated with additional sugars, starches, micronutrients, and proteins to enhance water uptake and counteract solute loss. Despite its efficacy in preventing mortality in children with watery diarrhea, and its demonstratable benefits over intravenous fluid replacement in clinical applications, there is a lack of recent published developments in ORS technology. Recent developments have been driven by the sports nutrition industry, particularly in targeted delivery of carbohydrates. These proprietary developments have potential applications in ORS formulation to improve chronic disease outcomes and enhance acute fluid retention during clinical crises. This review aims to summarize recent literature investigating ORS formulation and application with a focus on chronic disease and exercise rehydration, as well as demonstrate the opportunity for development of new rehydration technologies for both general fluid maintenance and clinical fluid replacement therapy.