Oral fluid therapy in diarrhea and dehydration : current concepts and practical considerations

The recent widespread use of oral fluid therapy (OFT) has significantly reduced diarrhea mortality, showing it to be an effective cure of relatively lower cost and greater convenience than intravenous feeding therapy. This report outlines the major approaches to OFT, ways of implementing these approaches, and issues still unresolved. OFT does not prevent the incidence of diarrhea, but does minimize its effects. It replaces the child"s water and electrolytes, aiding and sustaining the child"s recovery and inhibiting fluid loss at the onset of diarrhea. The ideal OFT solution consists of sodium, potassium, chloride, sodium bicarbonate, and glucose; although glucose or sucrose combined with salt is an effective early diarrhea retardant. The report recommends the usage of a standard mixture of 90 millimoles of sodium per fluid liter; continual feeding despite diarrhea, except in cases of severe dehydration; preparation of the solution with boiled water when possible; the non-use of antibiotics due to their limited effect and potential hazard; and minimal reliance upon packets and kits, because of their expense and logistical problems. The OFT program should be a multitiered system relying on early home treatment of diarrhea with sugar/salt solutions; peripheral health workers to disseminate the solution and to train and monitor families in dosage preparation and administration; a peripheral rehydration center equipped to provide complete oral fluids and intravenous feeding treatments and to reinforce the health workers" training; and a referral center to handle the most serious cases and to oversee the program. Unresolved OFT issues include the ability of families to administer the solution correctly and sanitarily; the possible ineffectiveness of a solution composed solely of sugar and salt; and OFT"s nonapplicability to patients who are vomiting, in severe shock, or have an enzyme deficiency preventing the consumption of sugar. A 44-item bibliography (1948-80) is appended.