sodium-bicarbonate and Cholera

On the basis of human perfusion studies it has been speculated that bicarbonate ions in oral rehydration salt solutions (ORS) to treat diarrhoea are more efficiently absorbed from the small bowel. We evaluated the role of bicarbonate in ORS by using a reduced purging rate in cholera as a proxy indicator for absorption efficiency in cholera-like severe diarrhoea.. In a double-blind randomized trial 60 patients received standard ORS containing bicarbonate or an identical solution except that sodium bicarbonate was replaced by an equimolar amount of sodium chloride (sodium, 90 mmol/l; potassium, 20 mmol/l; chloride, 80 mmol/l; bicarbonate, 30 mmol/l; glucose, 111 mmol/l; and osmolality, 331 mmol/l) after initial intravenous rehydration to correct initial dehydration and shock and until diarrhoea ceased.. Five patients receiving standard ORS and eight receiving bicarbonate-free ORS required unscheduled intravenous therapy for recurrence of severe dehydration in spite of receiving ORS solution. ORS intake and purging rate, in ml/kg body weight/day, both including and excluding stool output during unscheduled intravenous therapy are closely similar in the two treatment groups.. The results indicate that bicarbonate-containing ORS solution does not have any clinically significant effect on the absorption efficiency of ORS, either beneficial or adverse, and its use is relevant only for correction of metabolic acidosis of diarrhoeal dehydration.

Topics: Administration, Oral; Adult; Cholera; Double-Blind Method; Fluid Therapy; Humans; Intestinal Absorption; Rehydration Solutions; Sodium Bicarbonate

Topics: Adolescent; Adult; Bicarbonates; Child; Cholera; Citrates; Citric Acid; Diarrhea; Double-Blind Method; Escherichia coli Infections; Fluid Therapy; Humans; Male; Middle Aged; Rehydration Solutions; Sodium; Sodium Bicarbonate; Time Factors

This study investigated the therapeutic effectiveness of oral rehydration salt (ORS) solutions containing trisodium citrate (ORS-citrate) in place of sodium bicarbonate (ORS-bicarbonate). 74 children with cholera and 34 infants and children under 2 years of age with infantile diarrhea, all of whom had moderate to severe dehydration, were randomly assigned to 1 of the 2 treatment solution groups. Children with severe dehydration were 1st rehydrated with intravenous fluid followed by maintenance therapy with ORS solution (bicarbonate or citrate), while those with moderate dehydration received either ORS-bicarbonate or ORS-citrate during both the initial and the maintenance phases of therapy. Treatment effectiveness was assessed by comparing the success rates, stool output, ORS intake, gain in body weight, changes in erythrocyte volume fraction and plasma specific gravity, correction of acidosis, and maintenance of electrolyte balance. Of the children with cholera, 92% of those who received ORS-citrate and 86% of those who received ORS-bicarbonate were successfully treated. Of the children under 2 years of age with infantile diarrhea, 100% of those who received ORS-citrate and 94% of those who received ORS-bicarbonate were treated successfully. The results indicated that treatment with ORS-citrate is as successful as that with ORS-bicarbonate in terms of its ability to rehydrate, correct the acidosis, and maintain electrolyte concentrations. Thus, trisodium citrate dihydrate, which has the a advantage of a longer shelf-life in hot and humid climates, can effectively replace sodium bicarbonate in the standard ORS solution if used as an adjunct to standard hydration and antibiotic therapy in children with severe cholera or as the only treatment in children with infantile diarrhea assocated with less severe dehydration.

Topics: Bicarbonates; Child; Child, Preschool; Cholera; Citrates; Citric Acid; Diarrhea, Infantile; Electrolytes; Fluid Therapy; Humans; Infant; Sodium; Sodium Bicarbonate; Solutions

Glucose-based oral rehydration salt (ORS) is an appropriate and cost-effective tool to treat diarrhoeal dehydration. In patients with a high purging rate, particularly due to cholera, rice-based ORS has been shown to substantially reduce stool output compared to glucose ORS. However, it is not used in the hospitals or diarrhoea treatment centres largely because of the non-availability of a ready-to-use inexpensive packaged product and because of the problem of cooking. In a large diarrhoea treatment centre in Bangladesh (with an annual ORS consumption of approximately 140,000 litres), we have maintained in-house production of rice ORS and used it routinely for more than 600,000 patients over the last nine years. Semi-literate health workers cook rice ORS and supervise mothers in its use. Rice ORS is less costly (US $0.15 per patient treated compared with US $0.37 for glucose ORS) and is well accepted. It is an attractive alternative to glucose ORS in many fixed facility treatment centres in countries where rice is a staple and cholera is endemic. The process of its in-house preparation and use is described in this report which may assist hospitals wishing to use rice ORS in treating diarrhoea patients. Availability of a low cost ready-to-use rice ORS packet (which needs no cooking) with adequate shelf-life will increase its use at fixed facilities.

Topics: Bangladesh; Cholera; Citrates; Citric Acid; Costs and Cost Analysis; Diarrhea; Flour; Fluid Therapy; Humans; Oryza; Potassium Chloride; Quality Control; Rehydration Solutions; Sodium Bicarbonate; Sodium Chloride