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Salt and water homeostasis during oral rehydration therapy
Insights
Oral rehydration therapy effectively corrects sodium deficits in infants with acute diarrhea. Higher sodium concentration solutions (ORS90) achieve faster repletion than lower concentration ones (ORS40).
Area of Science:
- Pediatrics
- Gastroenterology
- Clinical Nutrition
Background:
- Acute diarrhea is a common pediatric illness, often leading to dehydration and electrolyte imbalances.
- Oral rehydration therapy (ORT) is the standard treatment for dehydration due to diarrhea.
- The optimal sodium concentration in ORT solutions for infants requires further investigation.
Purpose of the Study:
- To compare the efficacy of two oral rehydration solutions with different sodium concentrations (90 mmol Na/L vs. 40 mmol Na/L) in correcting sodium balance in infants with acute diarrhea.
- To assess the impact of these solutions on urinary and stool output and electrolyte balance.
Main Methods:
- A randomized controlled trial involving 22 well-nourished Turkish infants (2-13 months) with acute diarrhea.
- Infants received either a 90 mmol Na/L (ORS90) or 40 mmol Na/L (ORS40) oral rehydration solution.
- Sodium balance, urinary and stool output, fractional sodium excretion, and urinary electrolyte quotients were monitored.
Main Results:
- Both ORS90 and ORS40 effectively corrected sodium deficits, with clinical improvement in all infants.
- Sodium balance was more positive and corrected faster with ORS90 (12-18 hours) compared to ORS40 (24-36 hours).
- Transient hypernatremia occurred in a few infants on ORS90, and transient hyponatremia in a few on ORS40.
Conclusions:
- Oral rehydration therapy is clinically effective for acute diarrhea in infants.
- Higher sodium concentration ORT (ORS90) leads to more rapid correction of sodium deficits compared to lower concentrations (ORS40).
- Careful monitoring for minor electrolyte disturbances is warranted with both solution types.
Abstract:
Changes in sodium balance and urinary and stool output during orally administered rehydration therapy were studied in 22 well-nourished Turkish infants, aged 2 to 13 months, with acute diarrhea mainly of viral origin. The infants randomly received a rehydration solution containing either 90 mmol Na/L (ORS90) or 40 mmol Na/L (ORS40). Slight transient hypernatremia was noted in a few infants receiving ORS90, and slight transient hyponatremia in a few infants receiving ORS40. In both groups, sodium balance increased most rapidly during the first 12 hours of rehydration, and then more slowly because of increased urinary as well as stool sodium output. Sodium balance was always more positive after ORS90 than after ORS40, but the difference did not change much from 12 to 36 hours after therapy was started. Changes in fractional sodium excretion, urinary K/Na quotient, and urinary aldosterone-creatinine quotient were used as indexes of changes in sodium balance. All values were interpreted to indicate that the sodium deficit on admission was corrected within 12 to 18 hours after ORS90 and, in most cases, after 24 to 36 hours after ORS40. Both groups of infants responded well to orally administered rehydration therapy from the clinical viewpoint.