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Background: Timely and safe intravenous (IV) fluid resuscitation for major burns may be difficult or impossible during mass casualty burn incidents. Oral/enteral fluid resuscitation may be an alternative., Objectives: To synthesize and assess certainty of evidence on oral/enteral fluid resuscitation as compared to IV or no fluid resuscitation for major burns., Methods: PubMed, EMBASE, CINAHL, and Cochrane Library were searched on 8 September 2023. Primary quantitative studies meeting criteria as assessed by two reviewers were included. Meta-analyses for outcome effects of oral/enteral versus IV and of oral/enteral versus no fluid resuscitation were conducted. Evidence certainty was assessed using GRADE., Results: Seven human and eight animal studies were included. Three human RCTs totalling 100 participants contributed to estimates. Compared to IV fluid resuscitation, oral/enteral fluid resuscitation is associated with a statistically insignificant increased risk of mortality (OR 1.33, 95% CI 0.33-5.36) but the evidence is very uncertain, and no difference in urine output (SMD -0.17, 95% CI -0.65-0.31) with moderate certainty of evidence. Eight controlled animal studies totalling 212 participants contributed to estimates. From these animal studies, enteral fluid resuscitation may increase mortality (OR 36.00, 95% CI 2.72-476.28), worsen creatinine levels (MD 22 mmol/L, 95% CI 15.8-28.2), and increase urine output (MD 1 ml/kg/h, 95% CI 0.55-1.45) compared to IV, but all with very low certainty of evidence. Again, from animal studies, all the evidence is very uncertain, but compared to no fluid resuscitation, enteral resuscitation is associated with a statistically insignificant reduction in mortality (OR 0.29, 95% CI 0.08-1.09), improved creatinine levels (SMD -3.48, 95% CI -4.69 to -2.28), and increased urine output (MD 0.55 ml/kg/h, 95% CI 0.38-0.72)., Conclusions: Current evidence comparing oral/enteral and IV fluid resuscitation for major burns is limited and uncertain. However, where IV fluid resuscitation is unavailable or delayed, oral fluid resuscitation could be considered., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 World Health Organization.)

Background: Patients undergoing surgery for ileostomy creation frequently experience postoperative dehydration and subsequent renal injury. The use of oral rehydration solutions (ORS) has been shown to prevent dehydration, but compliance may be variable., Methods: Semi-structured qualitative interviews were conducted with 17 patients who received a postoperative hydration kit and dehydration education to assess barriers and facilitators to compliance with ORS kit instructions., Results: Qualitative analysis revealed five themes affecting patient adherence to the ORS intervention: (1) patient's perception of the effectiveness of the ORS solution, (2) existing co-morbidities, (3) kit quality and taste of the ORS product, (4) quality of the dehydration education, and (5) social support., Conclusions: Given that patient adherence can greatly affect the success of an ORS intervention, the design of future ORS interventions should emphasize the educational component, the "patient friendliness" of the ORS kit, and ways that social supports can be leveraged to increase adherence., Competing Interests: Declaration of competing interest Dr. Dualeh receives personal fees as a Visual Abstract Editor for the JAMA network. The other authors have no conflicts of interest to declare., (Published by Elsevier Inc.)

Dilip Mahalanabis, an esteemed Indian pediatrician, revolutionized global health through his pioneering work in combatting diarrheal diseases, particularly during the Bangladesh War of Independence in 1971. His development of oral rehydration therapy (ORT) provided a simple, cost-effective solution that significantly reduced mortality rates among cholera patients. Mahalanabis' dedication to equitable healthcare, evidenced by his leadership roles in organizations such as the World Health Organization (WHO), underscores his legacy as a champion for vulnerable populations. ORT's widespread adoption has democratized treatment, empowering communities and drastically reducing mortality rates associated with diarrheal diseases., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Kawalkar et al.)

Background: Enterotoxins produce diarrhea through direct epithelial action and indirectly by activating the enteric nervous system. Calcium-sensing receptor (CaSR) inhibits both actions. The latter has been well documented in vitro but not in vivo . The hypothesis to be tested was that activating CaSR inhibits diarrhea in vivo ., Aim: To determine whether CaSR agonists ameliorate secretory diarrhea evoked by cholera toxin (CTX) in mice., Methods: CTX was given orally to C57BL/6 mice to induce diarrhea. Calcium and calcimimetic R568 were used to activate CaSR. To maximize their local intestinal actions, calcium was administered luminally via oral rehydration solution (ORS), whereas R568 was applied serosally using an intraperitoneal route. To verify that their actions resulted from the intestine, effects were also examined on Cre-lox intestine-specific CaSR knockouts. Diarrhea outcome was measured biochemically by monitoring changes in fecal Cl - or clinically by assessing stool consistency and weight loss., Results: CTX induced secretory diarrhea, as evidenced by increases in fecal Cl - , stool consistency, and weight loss following CTX exposure, but did not alter CaSR, neither in content nor in function. Accordingly, calcium and R568 were each able to ameliorate diarrhea when applied to diseased intestines. Intestinal CaSR involvement is suggested by gene knockout experiments where the anti-diarrheal actions of R568 were lost in intestinal epithelial CaSR knockouts ( villin Cre/Casr flox/flox ) and neuronal CaSR knockouts ( nestin Cre/Casr flox/flox )., Conclusion: Treatment of acute secretory diarrheas remains a global challenge. Despite advances in diarrhea research, few have been made in the realm of diarrhea therapeutics. ORS therapy has remained the standard of care, although it does not halt the losses of intestinal fluid and ions caused by pathogens. There is no cost-effective therapeutic for diarrhea. This and other studies suggest that adding calcium to ORS or using calcimimetics to activate intestinal CaSR might represent a novel approach for treating secretory diarrheal diseases., Competing Interests: Conflict-of-interest statement: All the authors report having no relevant conflicts of interest for this article., (©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.)

Burn injuries are a constant threat in war. Aspects of the modern battlefield increase the risk of burn injuries and pose challenges for early treatment. The initial resuscitation of a severely burn-injured patient often exceeds the resources available in front-line medical facilities. This stems mostly from the weight and volume of the intravenous fluids required. One promising solution to this problem is enteral resuscitation with an oral rehydration solution. In addition to being logistically easier to manage, enteral resuscitation may be able to mitigate secondary injuries to the gut related to burn shock and systemic immunoinflammatory activation. This has been previously studied in burn patients, primarily using electrolyte solutions, with promising results. Modern ORS containing sodium, potassium, and glucose in ratios that maximize gut absorption may provide additional benefits as a resuscitation strategy, both in terms of plasma volume expansion and protection of the barrier and immune functions of the gut mucosa. While enteral resuscitation is promising and should be used when other options are not available, further research is needed to refine an optimal implementation strategy.

Objectives: Acute diarrhea in children is generally managed by replacing the lost fluid with oral rehydration solution (ORS). Probiotic supplementation has been reported to reduce the severity of diarrhea. In the present study, we investigated the effect of Weizmannia coagulans ( Bacillus coagulans ) MTCC 5856, along with ORS on acute diarrhea of all causes in non-hospitalized children., Methods: A total of 110 children of ages between 1 and 10 were enrolled in a double-blind placebo-controlled study and were randomly allocated to receive W. coagulans MTCC 5856 (4 × 10 8 spores, N  = 54) + ORS and zinc (Zn) or a placebo ( N  = 56) + ORS and (Zn) for 5 days. The consistency of the stool, mean duration of diarrhea in hours, mean diarrhea frequency per day, and the dehydration status were collected as efficacy endpoints. Safety was evaluated by the occurrence of adverse events., Results: The mean age of the children was 5.55 ± 2.57 years (61 boys and 49 girls). The mean duration of diarrhea was 51.31 ± 20.99 h in the W. coagulans MTCC 5856 group and 62.74 ± 24.51 h in the placebo ( p  = 0.011) group. The frequency of diarrhea was lower in children supplemented with the probiotic, but the difference was not statistically significant. The perceived efficacy score and dehydration status improved significantly in the W. coagulans MTCC 5856 group compared with the placebo group. No adverse events were recorded., Conclusion: The results of the study suggest that W. coagulans MTCC 5856 could be supplemented along with ORS and zinc to reduce the duration of diarrhea in non-hospitalized children., Clinical Trial Registration: ClinicalTrials.gov, identifier CTRI/2022/06/043239., Competing Interests: MM, KN, SA, AM, PP, and LM are employees of Sami-Sabinsa Group Limited. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Majeed, Nagabhushanam, Arumugam, Chadalavada, Seepana, Annamalai, Murali, Prakasan and Mundkur.)

Oral rehydration solution (ORS) or oralit is a sugar and salt-based solution that restores electrolyte balance, counters dehydration and mitigates metabolic acidosis. In Indonesia, particularly during the month of Ramadan, the use of ORS as a form of fasting doping has become increasingly prevalent. This study aimed to analyze the patterns of communication, key influencers, and sentiment within the Twitter network in Indonesia regarding the use of ORS as fasting doping. From March 15 to March 26, 2023, Twitter data was collected using NodeXL software. The dataset was then analyzed using NodeXL and Gephi software to identify key influencers and patterns within the network. To assess attitudes towards the use of ORS as fasting doping expressed in tweets, sentiment analysis was conducted using Azure Machine. The dataset consisted of 13,746 tweets, from which the analysis revealed that Twitter discourse concerning the use of ORS as fasting doping demonstrated a diverse range of individuals. The top five users with the highest betweenness centrality scores were medical doctors, mention and confess (menfess) accounts, and personal accounts. The sentiment analysis of the collected tweets unveiled a relatively high negative sentiment toward the use of ORS for fasting purposes. Notably, the proportion of positive and neutral sentiments were comparable. Our data indicate that ORS use as fasting doping is controversial in Indonesia. Most tweets express concerns about misuse and negative consequences, indicating a need for guidance and regulation from public health authorities. Further research and guidelines are necessary to ensure the safe and appropriate use., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Author(s).)

The effects of varying sodium (Na) and carbohydrate (CHO) in oral rehydration solutions (ORS) and sports drinks (SD) for rehydration following exercise are unclear. We compared an ORS and SD for the percent of fluid retained (%FR) following exercise-induced dehydration and hypothesized a more complete rehydration for the ORS (45 mmol Na/L and 2.5% CHO) and that the %FR for the ORS and SD (18 mmol Na/L and 6% CHO) would exceed the water placebo (W). A placebo-controlled, randomized, double-blind clinical trial was conducted. To induce 2.6% body mass loss (BML, p > 0.05 between treatments), 26 athletes performed three 90 min interval training sessions without drinking fluids. Post-exercise, participants replaced 100% of BML and were observed for 3.5 h for the %FR. Mean ± SD for the %FR at 3.5 h was 58.1 ± 12.6% (W), 73.9 ± 10.9% (SD), and 76.9 ± 8.0% (ORS). The %FR for the ORS and SD were similar and greater than the W ( p < 0.05 ANOVA and Tukey HSD). Two-way ANOVA revealed a significant interaction with the ORS having greater suppression of urine production in the first 60 min vs. W (SD did not differ from W). By 3.5 h, the ORS and SD promoted greater rehydration than did W, but the pattern of rehydration early in recovery favored the ORS.

Diarrhea remains a major cause of under-five mortality globally. In 2016, it accounted for 8% of under-five mortality worldwide. Most of these deaths occur in developing countries. Fluid replacement using Oral Rehydration Solution (ORS) or Salt Sugar Solution (SSS), has been the mainstay of diarrhea management. Gaps in knowledge and practice regarding the preparation of these solutions have been identified by various researchers. One challenge encountered by healthcare providers and caregivers of under-five children has been lack of a standard, easy to clean cup for measurement of accurate volume of water for ORS or SSS preparation. Soft drink bottles, which are currently being used, are difficult to clean because of their narrow necks. More so, the size and volume of these bottles change so often that non-numerate caregivers get easily confused. The aim of this paper is to introduce the AMBA CUP, an easy-to-clean cup that can be used to accurately measure one litre of water for SSS or ORS preparation., Competing Interests: The author has no competing interests to declare., (Copyright: © 2023 The Author(s).)

Background: Diarrhoeal disease is a major cause of global infant mortality, and compromises the ability of many countries with respect to achieving sustainable development goals. The WHO's recommendation of Oral Rehydration Solution (ORS) and zinc in the management of this disease, may not be readily available. Consideration and assessment of cultural practices in its management has been an area of increased interest over the last decade. Aim: This study aims to systematically evaluate efficacy of the consumption of traditional fermented foods as functional products for the treatment and management of diarrhoea. Methods: Following PRISMA guidelines, a systematic review was conducted of electronic databases (Cochrane Library, Ovid Medline and Pubmed) databases with no restrictions on language and publication date for RCTs that investigated the effect of consumption of fermented foods on the treatment of diarrhoea in children under five years of age. Results: Seven RCTs were included. Meta-analysis showed that compared to control, consumption of fermented foods significantly reduced mean duration of diarrhoea, -0.61 days; (95% CI, -1.04, -0.18); length of hospitalization, -0.35 days (95% CI, -0.69, -0.02); but not mean daily frequency of stool -2.00 (95% CI,-7.03, 3.04). Conclusion: Limited available evidence suggests that consumption of fermented foods may help reduce duration and severity of symptoms as a treatment of diarrhoea. More high quality research needs to be undertaken to investigate the efficacy of fermented food as an effective alternative to ORS as a potential WHO recommendation for management of diarrhoeal disease.

The burdens associated with acute gastroenteritis involve billions of dollars in expenses, coupled with significant morbidity and mortality globally. To reduce these burdens, health officials and policymakers require up-to-date data (health and economic) to request and allocate resources in guiding the development and implementation of preventative strategies. In 2021, the estimate for one case of acute gastroenteritis was calculated using multiple sources of data: the 2009 national health burden survey on acute gastroenteritis; a 2021 telephone survey of five major private hospitals; a 2021 telephone survey of 30 private pharmacies; and the 2021 Minimum Wages Act of Trinidad and Tobago. For each case of illness, an average cost of $1614 TTD ($238 USD) was estimated. For residents who sought private health care, the average GP visit cost was $500-$700 TTD ($73-$103 USD), while costs for medication prescribed ranged between $327 and $1166 TTD ($48-$172 USD). Productivity losses amounted to almost $21.7 million TTD ($3.2 million USD) for residents who took time off from work or required caregiving services. The overall annual cost was estimated to be $204 million TTD ($30.1 million USD) and, therefore, warrants measures by health officials to reduce the economic and social burdens of acute gastroenteritis in Trinidad and Tobago., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background Diarrheal illness remains one of the most common causes of death among children specifically those who live in developing countries. Appropriate mothers' knowledge and practice regarding acute diarrhea illness in children can considerably reduce diarrhea-related morbidity and mortality. So, the aim of this study was to evaluate mothers' knowledge and practice regarding acute diarrheal illness in children. Method This cross-sectional study was conducted in a tertiary hospital in Riyadh, Saudi Arabia using a newly developed questionnaire that was distributed to King Abdullah Specialist Children. The calculated sample size was 375. Results A total of 375 mothers were included in this study and the majority of them (99%) were Saudis. More than half of the participants (61%) were university graduates. The majority (96.5%) chose previous experience as the main source of information about diarrhea while (40%) chose physician. Most of the mothers (69.6%) believed that teething is the leading cause of diarrheal illness in children. Regarding the treatment, fluid was recognized to be the major treatment for diarrhea as chosen by the mothers. Around (42.7%) of the respondents thought intravenous fluid is more effective than oral rehydration solution (ORS) in treating dehydration associated with diarrheal episodes. ORS was the main type of fluid (74.1%) which was selected by the mothers to be given during the diarrheal episode. Conclusion Mothers showed good knowledge and practice overall in regard to acute diarrheal illness in children. However, this study revealed some misconceptions among the caregivers which necessitates more educational sessions to be conducted in the community and during the hospital visit., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Alrafiaah et al.)

Background: To verify the hydration effects of oral rehydration solution (ORS) on athletes by comparing the degrees of fluid absorption and plasma volume changes following beverage consumption, including ORS., Methods: Thirty-one participants visited the testing laboratory 4 times at 1-week intervals to consume 1 L of beverage (e.g., water, ORS, and two sports drinks [SpD]) for 30 min on each visit. The urine output was measured 4 times at 1 h, 2 h, 3 h, and 4 h after beverage consumption. A blood sample was collected 3 times at 1 h, 2 h, and 3 h after beverage consumption. Body weight was measured once in 4 h after beverage consumption., Results: Body weight change was smaller for ORS than for water, SpD1, and SpD2 (p < 0.05). Cumulative urine output in 4 h was lower for ORS, SpD1, and SpD2 than for water (p < 0.05), and it was lower for ORS than for SpD2 (p < 0.05). BHI in 4 h was higher for ORS, SpD1, and SpD2 than for water (p < 0.05), and it was higher for ORS than for SpD2 (p < 0.05). There was no significant difference in PVC for different beverages at all test times, i.e.., 1 h, 2 h, and 3 h., Conclusions: We evaluated the hydration effects of the consumption of beverages, such as water, SpD, and ORS in athletes. ORS and SpD were more effective than water. A comparison between ORS and SpD showed that the result could vary depending on the type of SpD., (© 2022. The Author(s).)

This review focuses on the innate beneficial effects of sodium pyruvate-based fluids, including pyruvate in intravenous solutions, oral rehydration solutions, and peritoneal dialysis solutions, on shock resuscitation with various animal models relative to current commercial fluids over the last two decades. Due to its superior pharmacological properties, pyruvate effectively sustains cytosolic glycolytic pathways and mitochondrial oxidative phosphorylation by restoration of redox potentials and reactivation of pyruvate dehydrogenase in hypoxia, even anoxia, and diabetes, reversing the Warburg effect and diabetic glucometabolic aberration. Pyruvate has been demonstrated to protect against multiorgan dysfunction and metabolic disturbance in numerous preclinical studies with various pathogenic injuries. The unique features of pyruvate potential clinical benefits encompass to efficiently correct lethal lactic acidosis via metabolically rapid consumption of intracellular [H + ] and robustly protect multiorgan metabolism and function, particularly visceral organs in addition to the heart and brain, significantly prolonging survival in various animal models. Pyruvate protection of red blood cell function and preservation of the partial pressure of arterial oxygen should be highly concerned in further studies. Pyruvate is much advantageous over existing anions such as acetate, bicarbonate, chloride, and lactate in commercial fluids. Pyruvate-based fluids act as a therapeutic agent without causing iatrogenic resuscitation injury in addition to being a volume expander, indicating a potential novel generation of resuscitation fluids, including crystalloids and colloids. Pyruvate-based fluids have an enormous potential appeal for clinicians who face the ongoing fluid debate to readily select as the first resuscitation fluid. Clinical trials with pyruvate-based fluids in shock resuscitation are urgently warranted., Competing Interests: Author FQZ was employed by Fresenius Medical Care., (Copyright © 2022 Zhou.)

There have been ongoing debates about resuscitation fluids because each of the current fluids has its own disadvantages. The debates essentially reflect an embarrassing clinical status quo that all fluids are not quite ideal in most clinical settings. Therefore, a novel fluid that overcomes the limitations of most fluids is necessary for most patients, particularly diabetic and older patients. Pyruvate is a natural potent antioxidant/nitrosative and anti-inflammatory agent. Exogenous pyruvate as an alkalizer can increase cellular hypoxia and anoxia tolerance with the preservation of classic glycolytic pathways and the reactivation of pyruvate dehydrogenase activity to promote oxidative metabolism and reverse the Warburg effect, robustly preventing and treating hypoxic lactic acidosis, which is one of the fatal complications in critically ill patients. In animal studies and clinical reports, pyruvate has been shown to play a protective role in multi-organ functions, especially the heart, brain, kidney, and intestine, demonstrating a great potential to improve patient survival. Pyruvate-enriched fluids including crystalloids and colloids and oral rehydration solution (ORS) may be ideal due to the unique beneficial properties of pyruvate relative to anions in contemporary existing fluids, such as acetate, bicarbonate, chloride, citrate, lactate, and even malate. Preclinical studies have demonstrated that pyruvate-enriched saline is superior to 0.9% sodium chloride. Moreover, pyruvate-enriched Ringer's solution is advantageous over lactated Ringer's solution. Furthermore, pyruvate as a carrier in colloids, such as hydroxyethyl starch 130/0.4, is more beneficial than its commercial counterparts. Similarly, pyruvate-enriched ORS is more favorable than WHO-ORS in organ protection and shock resuscitation. It is critical that pay attention first to improving abnormal saline with pyruvate for ICU patients. Many clinical trials with a high dose of intravenous or oral pyruvate were conducted over the past half century, and results indicated its effectiveness and safety in humans. The long-term instability of pyruvate aqueous solutions and para-pyruvate cytotoxicity is not a barrier to the pharmaceutical manufacturing of pyruvate-enriched fluids for ICU patients. Clinical trials with sodium pyruvate-enriched solutions are urgently warranted., Competing Interests: The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Zhou.)

Introduction: diarrhoea is the second leading cause of morbidity and mortality in young children. The aim was to assess maternal knowledge, hygienic practices and home management (HM) of diarrhoea with oral rehyrdation therapy (ORT) and oral zinc in children aged 6-23 months in western Nigeria. Predictors of good knowledge and practice were also assessed., Methods: this was a community based analytic cross-sectional study. Multistage sampling was used to select mothers of children 6-23 months of age. Data were collected using pre-tested, interviewer administered questionnaires and analyzed using SPSS version 20. Bivariate analysis and multiple logistic regression for predictor variables were done. Level of significance was set at 0.05., Results: three hundred and seventy one (371) respondents were interviewed (mean age 30.4 ± 5.02 years). 305 (82.2%) had good knowledge of diarrhoeal diseases, 208(56.1%) had good knowledge of home management of childhood diarrhoea, 274 (73.9%) had good maternal hygienic practices and 161 (61.2%) of the 263 mothers who had managed diarrhoea in their children, had good practice. Only 34 (12.9%) of them used zinc tablets and 11 (32.4%) did not complete the full course. Maternal age 30-39 years predicted good knowledge (AOR 3.19 CI 2-6.05). Predictors of good home management practices were: maternal age 30-39 years (AOR 2.78 CI 1.44-5.37), >40 years (AOR 5.55 CI 1.54-20.01) and younger age of the index child, 6-11 months (AOR 4.83 CI 2.29-10.18)., Conclusion: mothers had poor knowledge of the role of zinc supplementation in childhood diarrhoea and use of zinc tablets for diarrhoea was very low. Community based health education should be carried out., Competing Interests: The authors declare no competing interests., (Copyright: Ifeoma Peace Okafor et al.)

Background: Patients with a jejunostomy or high output stoma may need a glucose-sodium oral rehydration solution drink to maintain hydration. These solutions are unpalatable and a new flavoured pre-packaged solution was developed., Methods: After 8 h of fasting, 27 patients took 500 mL of the modified World Health Organization (WHO) cholera solution or Glucodrate® (Vitaflo) on two occasions in a cross-over random order and urine and stomal output was collected for 6 h., Results: There was a small but significant difference in net sodium absorption in favour of the modified WHO cholera solution (10 ± 28 mmol modified WHO cholera solution vs. -1 ± 26 mmol Glucodrate®, p = 0.01). However the Glucodrate® was more palatable, with 24 patients (89%) preferring it to the modified WHO cholera solution (p < 0.005)., Conclusions: Glucodrate® is a more palatable solution than the modified WHO cholera solution and is almost as effective and so can be used when patients find the modified WHO cholera solution unpalatable., (© 2021 The British Dietetic Association.)

Background: Muscle cramp is a painful, involuntary muscle contraction, and that occurs during or following exercise is referred to as exercise-associated muscle cramp (EAMC). The causes of EAMC are likely to be multifactorial, but dehydration and electrolytes deficits are considered to be factors. This study tested the hypothesis that post-exercise muscle cramp susceptibility would be increased with spring water ingestion, but reduced with oral rehydration solution (ORS) ingestion during exercise., Methods: Ten men performed downhill running (DHR) in the heat (35-36 °C) for 40-60 min to reduce 1.5-2% of their body mass in two conditions (spring water vs ORS) in a cross-over design. The body mass was measured at 20 min and every 10 min thereafter during DHR, and 30 min post-DHR. The participants ingested either spring water or ORS for the body mass loss in each period. The two conditions were counter-balanced among the participants and separated by a week. Calf muscle cramp susceptibility was assessed by a threshold frequency (TF) of an electrical train stimulation to induce cramp before, immediately after, 30 and 65 min post-DHR. Blood samples were taken before, immediately after and 65 min after DHR to measure serum sodium, potassium, magnesium and chroride concentrations, hematocrit (Hct), hemoglobin (Hb), and serum osmolarity. Changes in these varaibles over time were compared between conditions by two-way repeated measures of analysis of variance., Results: The average (±SD) baseline TF (25.6 ± 0.7 Hz) was the same between conditions. TF decreased 3.8 ± 2.7 to 4.5 ± 1.7 Hz from the baseline value immediately to 65 min post-DHR for the spring water condition, but increased 6.5 ± 4.9 to 13.6 ± 6.0 Hz in the same time period for the ORS condition (P < 0.05). Hct and Hb did not change significantly (P > 0.05) for both conditions, but osmolarity decreased (P < 0.05) only for the spring water condition. Serum sodium and chloride concentrations decreased (< 2%) at immediately post-DHR for the spring water condition only (P < 0.05)., Conclusions: These results suggest that ORS intake during exercise decreased muscle cramp susceptibility. It was concluded that ingesting ORS appeared to be effective for preventing EAMC.

Background: Oral rehydration is the main treatment of acute diarrhea in children. This study was undertaken to evaluate the efficacy and safety of xyloglucan and gelose (agar-agar) plus oral rehydration solution (ORS) compared with placebo and ORS for reduction of acute diarrhea symptoms in children., Methods: In a randomized, double-blind, placebo-controlled trial, children with acute gastroenteritis received xyloglucan/gelose plus ORS (n = 50) or placebo plus ORS (n = 50) for 5 days. Demographic, clinical, anthropometric and laboratory parameters were recorded and analyzed., Results: Xyloglucan/gelose plus ORS reduced the total number of type 7 and 6 stools on the Bristol Stool Form scale ( p = 0.040 and p = 0.015, respectively, compared to placebo plus ORS), and had a rapid onset of action, evident 6 hours post-treatment. Xyloglucan/gelose plus ORS also improved associated clinical symptoms (apathy, vomiting, flatulence, and blood in stool). compared with placebo plus ORS. Except for a generalized rash of unknown causality in a patient receiving placebo plus ORS, all other adverse events (dehydration, n = 7, cough, n = 1, exacerbation of vomiting, n = 1) were deemed unrelated to study medication., Conclusions: Xyloglucan/gelose plus ORS was effective and safe in treating acute diarrhea in children.

Background: Oral rehydration solution (ORS) is an evidence-based intervention to reduce diarrhoea-related morbidity and mortality, but consistently low rates of ORS use have been documented in Nigeria., Aim: To identify barriers to the optimal use of ORS for childhood diarrhoea in Nigeria and recommend appropriate interventions to improve uptake of ORS at community and facility levels., Methods: A quantitative cross-sectional survey of 400 mothers with children under 5 years of age was conducted in Nigeria to explore reasons for suboptimal utilization of ORS for childhood diarrhoea. An interviewer-administered questionnaire was used for data collection. Data were analysed using the statistical software SPSS version 21.0®., Results: Sixty-one (15.3%) of the respondents were unaware of ORS. Of the 339 that were aware, their source of information was mainly hospital/health workers (81.1%). Among mothers that affirmed they could prepare ORS, only 64 (22.1%) prepared it correctly. Level of education significantly influenced awareness of ORS as well as its correct preparation. Nineteen mothers (5.6%) had difficulty getting ORS when needed, whereas 13 (3.8%) reported that it was difficult for them to remember how to prepare ORS. Four in ten children took ORS reluctantly or refused it outrightly. No cultural taboo concerning the use of ORS was reported., Conclusion: There is still a wide gap in the awareness of ORS and many caregivers prepared the solution incorrectly. We recommend that the method of preparation of ORS be clearly indicated on the sachets, and production of commercial 1-L water packages for ORS preparation be encouraged. Lay summaryOral rehydration solution (ORS) is an evidence-based intervention to reduce diarrhoea-related morbidity and mortality, but consistently low rates of ORS use have been documented in Nigeria. A quantitative cross-sectional study was carried out among 400 mothers to identify barriers to the optimal use of ORS for childhood diarrhoea and recommend appropriate interventions. Sixty-one (15.3%) of the respondents were unaware of ORS. Among mothers that affirmed they could prepare ORS, only 64 (22.1%) prepared it correctly. Level of education significantly influenced awareness of ORS as well as its correct preparation. Some mothers had difficulty getting ORS when needed, while some found it difficult to remember how to prepare it. Four in ten children took ORS reluctantly or refused it outrightly. No cultural taboo concerning the use of ORS was reported. The study showed that there is still a wide gap in the awareness of ORS and many caregivers prepared the solution incorrectly. Hence, we recommend that the method of preparation of ORS be clearly indicated on the sachets, and production of commercial 1-L water packages for ORS preparation be encouraged., (© The Author(s) [2020]. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Background: Oral rehydration solution (ORS) is a simple intervention that can prevent childhood deaths from severe diarrhea and dehydration. In a previous study, we mapped the use of ORS treatment subnationally and found that ORS coverage increased over time, while the use of home-made alternatives or recommended home fluids (RHF) decreased, in many countries. These patterns were particularly striking within Senegal, Mali, and Sierra Leone. It was unclear, however, whether ORS replaced RHF in these locations or if children were left untreated, and if these patterns were associated with health policy changes., Methods: We used a Bayesian geostatistical model and data from household surveys to map the percentage of children with diarrhea that received (1) any ORS, (2) only RHF, or (3) no oral rehydration treatment between 2000 and 2018. This approach allowed examination of whether RHF was replaced with ORS before and after interventions, policies, and external events that may have impacted healthcare access., Results: We found that RHF was replaced with ORS in most Sierra Leone districts, except those most impacted by the Ebola outbreak. In addition, RHF was replaced in northern but not in southern Mali, and RHF was not replaced anywhere in Senegal. In Senegal, there was no statistical evidence that a national policy promoting ORS use was associated with increases in coverage. In Sierra Leone, ORS coverage increased following a national policy change that abolished health costs for children., Conclusions: Children in parts of Mali and Senegal have been left behind during ORS scale-up. Improved messaging on effective diarrhea treatment and/or increased ORS access such as through reducing treatment costs may be needed to prevent child deaths in these areas.

Background: More than 3 million children under 5 years in developing countries die from dehydration due to diarrhea, a preventable and treatable disease. We conducted a comparative analysis of two Demographic Health Survey (DHS) cycles to examine changes in ORS coverage in Zimbabwe, Zambia and Malawi. These surveys are cross-sectional conducted on a representative sample of the non-institutionalized individuals., Methods: The sample is drawn using a stratified two-stage cluster sampling design with census enumeration areas, typically, selected first as primary sampling units (PSUs) and then a fixed number of households from each PSU. We examined national and sub-regional prevalence of ORS use during a recent episode of diarrhea (within 2 weeks of survey) using DHSs for 2007-2010 (1st Period), and 2013-2016 (2nd Period). Weighted proportions of ORS were obtained and multivariable- design-adjusted logistic regression analysis was used to obtain Odds Ratios (aORs) and 95% confidence intervals (CIs) and weighted proportions of ORS coverage., Results: Crude ORS coverage increased from 21.0% (95% CI: 17.4-24.9) in 1st Period to 40.5% (36.5-44.6) in 2nd Period in Zimbabwe; increased from 60.8% (56.1-65.3) to 64.7% (61.8-67.5) in Zambia; and decreased from 72.3% (68.4-75.9) to 64.6% (60.9-68.1) in Malawi. The rates of change in coverage among provinces in Zimbabwe ranged from 10.3% over the three cycles (approximately 10 years) in Midlands to 44.2% in Matabeleland South; in Zambia from - 9.5% in Eastern Province to 24.4% in Luapula; and in Malawi from - 16.5% in the Northern Province to - 3.2% in Southern Province. The aORs for ORS use was 3.95(2.66-5.86) for Zimbabwe, 2.83 (2.35-3.40) for Zambia, and, 0.71(0.59-0.87) for Malawi., Conclusion: ORS coverage increased in Zimbabwe, stagnated in Zambia, but declined in Malawi. Monitoring national and province-level trends of ORS use illuminates geographic inequalities and helps identify priority areas for targeting resource allocation.. Provision of safe drinking-water, adequate sanitation and hygiene will help reduce the causes and the incidence of diarrhea. Health policies to strengthen access to appropriate treatments such as vaccines for rotavirus and cholera and promoting use of ORS to reduce the burden of diarrhea should be developed and implemented.

Background: Infants under 6 months (U6M) contribute a significant proportion of the burden and mortality of severe malnutrition globally. Evidence of underlying aetiology in this population is sparse, but it is known that the group includes ex-preterm and low birthweight (LBW) infants. They represent a unique population given their dependence on breastmilk or a safe, secure alternative. Nutrition agencies and health providers struggle to make programming decisions on which interventions should be provided to this group based upon the 2013 WHO Guidelines for the 'Management of Severe Acute Malnutrition in Infants and Young Children' since there are no published interventional trial data focussed on this population. Interim guidance for this group might be informed by evidence of safety and efficacy in adjacent population groups., Methodology: A narrative literature review was performed of systematic reviews, meta-analyses and randomised controlled trials of antimicrobial and micronutrient interventions (antibiotics, deworming, vitamin A, vitamin D, iron, zinc, folic acid and oral rehydration solution (ORS) for malnutrition) across the population groups of low birthweight/preterm infants, infants under 6 months, infants and children over 6 months with acute malnutrition or through supplementation to breastfeeding mothers. Outcomes of interest were safety and efficacy, in terms of mortality and morbidity., Results: Ninety-four articles were identified for inclusion within this review. None of these studied interventions exclusively in severely malnourished infants U6M. 64% reported on the safety of studied interventions. Significant heterogeneity was identified in definitions of study populations, interventions provided, and outcomes studied. The evidence for efficacy and safety across population groups is reviewed and presented for the interventions listed., Conclusions: The direct evidence base for medical interventions for severely malnourished infants U6M is sparse. Our review identifies a specific need for accurate micronutrient profiling and interventional studies of micronutrients and oral fluid management of diarrhoea amongst infants U6M meeting anthropometric criteria for severe malnutrition. Indirect evidence presented in this review may help shape interim policy and programming decisions as well as the future research agenda for the management of infants U6M identified as malnourished., Competing Interests: Marie McGrath is employed by the Emergency Nutrition Network. Timothy Campion-Smith is employed by Oxford University Hospitals and was employed by Emergency Nutrition Network as a consultant to undertake this review., (©2020 Campion-Smith et al.)

Background: Radiotherapy inadvertently affects gastrointestinal (GI) epithelial cells, causing intestinal barrier disruption and increased permeability., Objective: We examined the effect of amino acid-based oral rehydration solution (AA-ORS) on radiation-induced changes of intestinal barrier function and epithelial tight junctions (TJs) in a randomized experimental study using a total-body irradiation (TBI) mouse model., Methods: Eight-week-old male Swiss mice received a single-dose TBI (0, 1, 3, or 5 Gy), and subsequent gastric gavage with AA-ORS (threonine, valine, serine, tyrosine, and aspartic acid) or saline for 2 or 6 d. Intestinal barrier function of mouse ileum was characterized by electrophysiological analysis of conductance, anion selectivity, and paracellular permeability [fluorescein isothiocyanate (FITC)-dextran]. Ultrastructural changes of TJs were evaluated by transmission electron microscopy. Membrane protein and mRNA expression of claudin-1, -2, -3, -5, and -7, occludin, and E-cadherin were analyzed with western blot, qPCR, and immunohistochemistry. Nonparametric tests were used to compare treatment-dose differences for each time point., Results: Saline-treated mice had a higher conductance at doses as low as 3 Gy, and as early as 2 d post-TBI compared with 0 Gy (P < 0.001). Paracellular permeability and dilution potential were increased 6 d after 5 Gy TBI (P < 0.001). Conductance decreased with AA-ORS after 2 d in 3-Gy and 5-Gy mice (P < 0.05 and P < 0.001), and on day 6 after 5 Gy TBI (P < 0.001). Anion selectivity and FITC permeability decreased from 0.73 ± 0.02 to 0.61 ± 0.03 pCl/pNa (P < 0.01) and from 2.7 ± 0.1 × 105 to 2.1 ± 0.1 × 105 RFU (P < 0.001) in 5-Gy mice treated with AA-ORS for 6 d compared with saline. Irradiation-induced ultrastructural changes of TJs characterized by decreased electron density and gap formation improved with AA-ORS. Reduced claudin-1, -3, and -7 membrane expression after TBI recovered with AA-ORS within 6 d, whereas claudin-2 decreased indicating restitution of TJ proteins., Conclusions: Radiation-induced functional and structural disruption of the intestinal barrier in mice is reversed by AA-ORS rendering AA-ORS a potential treatment option in prospective clinical trials in patients with gastrointestinal barrier dysfunction., (Copyright © The Author(s) 2020.)

The aim of the study was to determine the abomasal emptying rate (AER) of calves suffering from naturally occurring diarrhoea compared with that of healthy calves. Furthermore, the effects of an oral rehydration solution (ORS) mixed into milk replacer on the AER were determined. Acetaminophen absorption test (APAT) was performed to estimate the AER. Sixty Holstein-Frisian calves (age < 14 days) were included in the study and divided into groups as follows: healthy calves (H; n = 16), healthy calves fed with ORS (HORS; n = 14), diarrhoeic calves (D; n = 15) and diarrhoeic calves fed with ORS (DORS; n = 15). For the APAT, the calves were fed 2 L of milk replacer containing 50 mg acetaminophen (AP)/kg body weight. Venous blood samples were collected before and after milk replacer and AP intake in 30-60 min intervals for 12 hr. During the APAT, no significant differences in median maximum acetaminophen concentration (C max ) were observed among all groups. Time to reach maximum acetaminophen concentration (T max ) in DORS (median 390 min, 25/75 quartiles: 300/480 min) was significantly higher compared with that in H (median: 270 min 25/75 quartiles: 210/315 min) and HORS (median: 300 min (25/75 quartiles: 240/360 min). Non-linear regression revealed that the calculated abomasal half-life (AP t 1/2 ) tended to be delayed in DORS (median: 652 min, 25/75 quartiles: 445/795 min, p = .10). The area under the AP curve values (AUC) from 0 to 120 min and 0 to 240 min of the observation period were significantly higher in H than D and DORS. In conclusion, significant differences in the AER indices reflected delayed abomasal emptying in diarrhoeic calves. Furthermore, the hypertonic ORS tended to have an additive delaying impact on the AER, which needs attention for the feeding management of diarrhoeic calves., (© 2020 The Authors. Journal of Animal Physiology and Animal Nutrition published by Blackwell Verlag GmbH.)

Termed by the Lancet, as "potentially the most important medical advance of the twentieth century," therapy with oral rehydration solutions (ORSs) has been essential to reducing mortality in children less than 5 years (under five) with infectious gastroenteritis and diarrhea. The target of the diarrhea-control programs in the 1990s was to achieve ORS use in 80% of diarrhea cases by the year 2000. Nevertheless, nearly 20 years later, global uptake remains limited to only a third of the cases. Our analysis shows that from 1990 to 2017, mean ORS coverage in Countdown countries [the 81 Countdown-to-2030 priority countries, which together account for 95% of maternal deaths and 90% of under-five deaths] increased from ~ 30% to nearly 40%. Flawed government policies, inadequate supplies, and lack of awareness among health workers and communities all contributed to this shortfall in coverage. Moreover, imperfect measurement methodology is implicated in questionable coverage data. A multipronged approach focusing on the manufacture, supply, training, and behavioral change is essential to ensure that ORS is used in all epidemic diarrhea cases globally, especially in the under-five population.

Purpose of Review: An understanding of fluid and electrolyte losses from diarrhea and mechanisms of solute cotransport led to development of oral rehydration solution (ORS), representing a watershed in efforts to reduce diarrheal disease morbidity and mortality. This report reviews the scientific rationale and modifications of ORS and barriers to universal application., Recent Findings: Solutions with osmolality and electrolyte composition different from original ORS for routine and unique pathophysiology such as in malnutrition have met with varying success. Following the conceptual rationale of sodium-glucose cotransportation to facilitate water absorption, other cotransporters and formulations have been explored with the aim to improve ORS efficacy and acceptance. ORS remains the anchor of acute watery diarrhea and dehydration management worldwide. Despite development of different formulations, the current standard solution is the mainstay of treatment for nearly all situations. Efforts to improve oral hydration solution and to increase acceptance and usage are ongoing.

Oral rehydration solution (ORS) is the mainstay of treatment of acute watery diarrhoea, but it is underutilized in many hospitals, resulting in children with moderate degrees of dehydration being unnecessarily hospitalized and receiving intravenous fluids. We aimed to assess the utility of an ORS tolerance test on initial presentation to an emergency department, and determine the volume of ORS a child with diarrhoea and moderate dehydration needed to tolerate to be successfully managed at home. One hundred and twenty-nine children with acute watery diarrhoea and moderate dehydration were given ORS and observed in a Children's Emergency Department (CED) over a period of 2-4 h. Patients were admitted, kept in the CED for further management or discharged, based on the assessment of oral intake and the clinical judgement of the treating health workers. Seventy-nine (61.2%) patients tolerated ORS well. They drank a median [interquartile range (IQR)] of 24.4 ml (IQR 12.5-28.8) ml/kg, were judged to have passed the ORS test and were discharged to continue oral rehydration treatment at home. At follow-up on days 2 and 5, 63/79 (79.7%) children had improved, were adequately hydrated and the diarrhoea had reduced. Sixteen of the 79 (20.3%) failed oral home treatment, with persisting diarrhoea, vomiting, hypokalaemia and/or weakness. The 63 who succeeded had tolerated a median of 25.8 (IQR 18.4-30.0) ml/kg of ORS in the CED, whilst the 16 who failed oral home treatment had tolerated 11.1 (IQR 9.1-23.0) ml/kg ORS (p < 0.001)., (© The Author(s) [2019]. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

The objective of the present study was to identify risk factors for mortality at admission in children admitted to the Pediatric Intensive Care Unit (PICU) with acute gastroenteritis (AGE) with severe dehydration and shock. This was a retrospective chart review of all cases of AGE with severe dehydration and shock admitted to the PICU from 2012 to 2017. Children who died during hospital stay were compared with those who survived. A total of 62 children were admitted with AGE to the PICU during this period. Twenty-four children (39%) died. The following variables were found to be significantly associated with death on univariate analysis: clinical pallor (p = 0.01), thrombocytopenia (p = 0.018), elevated leucocyte count (p = 0.02), hypoalbuminemia (p = 0.02) and severe acute malnutrition (SAM) (p = 0.04). On multivariate analysis, only hypoalbuminemia {RR [95% CI: 2.6 (1.27 to 9.21)]; 0.039} and SAM {RR [95% CI: 4.9 (1.12 to 10)]; 0.045} remained statistically significant. Children admitted with severe dehydration and shock had high mortality rates. These children were a sicker subset with probable sepsis. Severe acute malnutrition and hypoalbuminemia were associated with increased risk of death in these patients.

Aim: Exertional heastroke (EHS) can lead to acute kidney injury. Oral rehydration solution III (ORS III), recommended by WHO in 2004, is used to rehydrate children with gastroenteritis. This study aimed to characterize the renoprotective effect of ORS III in EHS rats., Methods: Rats were randomly divided into Group Control, Group EHS, Group EHS + Water, and Group EHS + ORS. Thirty minutes before the experiment, ORS III was orally administrated to Group EHS + ORS, Water was given to Group EHS + Water. Rats from Group EHS, Group EHS + Water and Group EHS + ORS were then forced to run until they fatigued. Core temperature (Tc) was monitored and 40.5 °C was considered as the onset of heatstroke. Serum creatinine (SCr), blood urea nitrogen (BUN) were measured using an automated biochemical analyzer. Serum neutrophil gelatinase-associated lipocalin (NGAL) was measured using an NGAL ELISA Kit. Light microscopy was used for kidney structural analysis., Results: SCr level in Group EHS was no different from Group Control (p > .05), while BUN and NGAL levels in Group EHS were higher than Group Control (p <.001, p < .001). SCr, BUN and NGAL concentrations in group EHS + Water were no different from Group EHS (p > .05). SCr, BUN levels in Group EHS + ORS were no different from Group EHS (p > .05). But NGAL levels were significant in these two groups (p = .012). Renal histopathologies of rats in Group EHS and Group EHS + Water showed flattened lumens filled with eosinophilic materials. The damage was milder in Group EHS + ORS, in which injured tubules showed degeneration of the tubular epithelium and sloughing of the brush border membrane., Conclusion: ORS III could alleviate the kidney injury in EHS rats.

Objective: No previous study has compared water and oral rehydration solution (ORS) intake after dehydration induced by exercise in the heat for the effect on muscle cramps. The present study tested the hypothesis that water ingestion after dehydration would increase muscle cramp susceptibility, but this would be prevented by ORS ingestion., Methods: Ten men performed two bouts of downhill running (DHR; -5%) in the heat (35°C-36 °C) until their body mass was reduced by 2%. Ten minutes after DHR, either spring water or electrolyte water similar to ORS (OS-1 ® ) was ingested in a counter-balanced order on two different days separated by a week. Muscle cramp susceptibility was assessed by a threshold frequency (TF) of electrical train stimulation to induce cramp before, immediately after (0), and 30 and 60 min after the ingestion. Blood samples were taken before, immediately and 80 min after DHR to measure serum electrolyte concentrations., Results: Muscle cramp susceptibility assessed by TF did not change from baseline to immediately after DHR for both conditions (water: 24.6 ± 2.1 Hz, OS-1 ® : 24.7 ± 1.4 Hz). TF decreased after water intake by 4.3 Hz (30 min) and 5.1 Hz (60 min post-ingestion), but increased after OS-1 ® intake by 3.7 and 5.4 Hz, respectively. Serum sodium and chloride concentrations decreased after water intake but maintained after OS-1 ® intake., Conclusion: These results suggest that water intake after dehydration makes muscles more susceptible to electrical simulation-induced muscle cramp, probably due to dilution of electrolytes, and when OS-1 ® is consumed, the susceptibility to muscle cramp decreases., Competing Interests: Competing interests: None declared.

Diarrhoea therapies in general include a number of approaches (depending on local practise and the cause of the diarrhoea) aimed at: (i) removing the cause (e.g. lactose in the diet); (ii) treating the cause of infection if present (e.g. antibiotics); (iii) reducing the effect of the cause (e.g. adsorbent); (iv) depressing gastric motility and secretions (e.g. various drugs); (v) probiotic bacteria with perhaps prebiotic energy sources and most importantly of all (vi) rehydration using rehydration salt solutions (oral rehydration therapy, ORT, using oral rehydration solutions, ORS). Glucose has been included in ORS formats for rapidly available energy since ORS formats were developed initially- but has the disadvantage of a high osmotic pressure. It is used in modern ORS formats to promote sodium absorption, however. The use of α-glucans (glucose containing oligo- or polysaccharides) in ORS formats is gaining ground in terms of utilisation for diarrhoea - a fairly recent approach to therapy in the western world. The use of different α-glucans in ORS formulations is discussed and strategies for the development further of therapies is investigated. This review is aimed at the scientific and medical communities., (Copyright © 2018 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.)

The efficacy of oral rehydration solution (ORS) enriched with Lactobacillus reuteri DSM 17938 and zinc in infants with acute gastroenteritis, is poorly defined. The aim of this double-blind, randomized, placebo-controlled study, was to assess the efficacy of an ORS enriched with Lactobacillus reuteri DSM 17938 and zinc (ORS⁺Lr&Z) in well-nourished, non-hospitalized infants with acute diarrhoea. Fifty one infants with acute diarrhoea were randomly assigned to receive either ORS⁺Lr&Z (28 infants, mean ± SD age 1.7 ± 0.7 years, 21 males), or standard ORS (ORS - Lr&Z; 23 infants, mean ± SD age 1.8 ± 0.7 years, 16 males). Stools volume and consistency were recorded pre- and posttreatment using the Amsterdam Infant Stool Scale and were compared between the two groups, as well as lost work/day care days, drug administration and need for hospitalization. Both groups showed reduction in the severity of diarrhoea on day two ( p < 0.001) while, all outcomes showed a trend to be better in the ORS⁺Lr&Z group, without reaching statistical significance, probably due to the relatively small number of patients. No adverse effects were recorded. In conclusion, both ORS were effective in managing acute diarrhoea in well-nourished, non-hospitalized infants. ORS enriched with L. reuteri DSM 17938 and zinc was well tolerated with no adverse effects.

Objectives: The possible effects and benefits of oral rehydration solution (ORS) on chronic dehydration after total proctocolectomy., Methods: To evaluate the effect of ORS on the renin-angiotensin system after remnant proctocolectomy in patients with ulcerative colitis (UC), we selected 20 patients after remnant proctocolectomy, ileal J pouch-anal anastomosis, and construction of a diverting ileostomy for UC. Patients were randomly divided into two groups, A (n=9) or B (n=11), 2 weeks after the surgery. In group A, ORS (1000 mL/day) was given for the first 7 days and mineral water (1000 mL/day) for the next 7 days. In group B, mineral water (1000 mL/day) was given for the first 7 days and ORS (1000 mL/day) for next 7 days. Plasma levels of renin, aldosterone and excretion of sodium in urine were evaluated at days 0, 7, and 14. We defined day 0 as the day of beginning this study., Results: Mean plasma renin levels on day 0 were six to eight times greater than the upper normal limit. In group A, ORS lowered plasma renin levels. In group B, plasma levels of renin and aldosterone after ORS were lower than those at days 0 and 7., Conclusions: ORS corrected increased plasma levels of renin and aldosterone to within the normal range in patients after proctocolectomy., Competing Interests: Conflicts of Interest There are no conflicts of interest., (Copyright © 2017 by The Japan Society of Coloproctology.)

Background : Diarrhoea complicates over half of admissions to hospital with severe acute malnutrition (SAM). World Health Organization (WHO) guidelines for the management of dehydration recommend the use of oral rehydration with ReSoMal (an oral rehydration solution (ORS) for SAM), which has lower sodium (45mmols/l) and higher potassium (40mmols/l) content than old WHO ORS. The composition of ReSoMal was designed specifically to address theoretical risks of sodium overload and potential under-treatment of severe hypokalaemia with rehydration using standard ORS. In African children, severe hyponatraemia at admission is a major risk factor for poor outcome in children with SAM complicated by diarrhoea. We therefore reviewed the evidence for oral rehydration therapy in children with SAM. Methods : We conducted a systematic review of randomised controlled trials (RCTs) on 18 th July 2017 comparing different oral rehydration solutions in severely malnourished children with diarrhoea and dehydration, using standard search terms. The author assessed papers for inclusion. The primary endpoint was frequency of hyponatraemia during rehydration. Results : Six RCTs were identified, all published in English and conducted in low resource settings in Asia. A range of ORS were evaluated in these studies, including old WHO ORS, standard hypo-osmolar WHO ORS and ReSoMal. Hyponatraemia was observed in two trials evaluating ReSoMal, three children developed severe hyponatraemia with one experiencing convulsions. Hypo-osmolar ORS was found to have benefits in time to rehydration, reduction of stool output and duration of diarrhoea. No trials reported over-hydration or fatalities. Conclusions : Current WHO guidelines strongly recommend the use of ReSoMal based on low quality of evidence. Studies indicate a significant risk of hyponatraemia on ReSoMal in Asian children, none have been conducted in Africa, where SAM mortality remains high. Further research should be conducted in Africa to evaluate optimal ORS for children with SAM and to generate evidence based, practical guidelines., Competing Interests: Competing interests: No competing interest were declared., (© 2017 Houston KA et al.)

Objective:   To present evidence-based recommendations that promote optimized fluid-maintenance practices for physically active individuals., Background:   Both a lack of adequate fluid replacement (hypohydration) and excessive intake (hyperhydration) can compromise athletic performance and increase health risks. Athletes need access to water to prevent hypohydration during physical activity but must be aware of the risks of overdrinking and hyponatremia. Drinking behavior can be modified by education, accessibility, experience, and palatability. This statement updates practical recommendations regarding fluid-replacement strategies for physically active individuals., Recommendations:   Educate physically active people regarding the benefits of fluid replacement to promote performance and safety and the potential risks of both hypohydration and hyperhydration on health and physical performance. Quantify sweat rates for physically active individuals during exercise in various environments. Work with individuals to develop fluid-replacement practices that promote sufficient but not excessive hydration before, during, and after physical activity.

Purpose: To compare oral rehydration solution (ORS) with saline infusion for preventing contrast-induced nephropathy (CIN) in a rat model., Materials and Methods: Adult male Sprague-Dawley rats (310-360 g) received intravenous indomethacin (10 mg/kg), N G -nitro-L-arginine methyl ester (10 mg/kg), and iohexol (10 mL/kg) to induce acute contrast-induced renal injury (CIN group); control rats received saline only. For hydration, rats received either continuous infusion (20 mL/kg/h) of saline or three oral doses (20 mL/kg each) of ORS. Acute renal injury was evaluated by assaying urine collected for 24 h beginning 2 h before the contrast injection, evaluating blood taken 22 h after the contrast injection, and examining the kidneys histopathologically., Results: Hydration with saline prevented only the contrast-induced increase in plasma creatinine, whereas ORS prevented deleterious changes in plasma creatinine, blood urea nitrogen, and creatinine clearance as well as in urinary protein, albumin, and N-acetyl-D-glucosaminidase concentrations. Histopathologic changes noted in the CIN group were diminished in both saline and ORS groups., Conclusion: Both intravenous saline administration and oral hydration with ORS decreased the severity of CIN. Hydration with ORS was comparable to intravenous saline infusion in preventing CIN-associated abnormalities.

We aimed to explore whether the body mass index (BMI) was associated with the therapeutic response to oral rehydration solution (ORS) in children with postural tachycardia syndrome (POTS). Fifty-four children diagnosed as having POTS were included in this study. Fifty-six healthy children served as the controls. Children with POTS were treated with ORS, and their treatment response was evaluated. The baseline BMI was obtained by measuring the height and weight. The Pearson correlation was made between the baseline BMI and change in heart rate from supine to upright (ΔHR) and between baseline BMI and symptom score change (post-treatment vs. pre-treatment) in the POTS group. The value of BMI in predicting the therapeutic response to ORS was assessed by analyses of the receiver operating characteristic (ROC) curve. The BMI in the POTS group was significantly lower than that in the control group (18.22 ± 3.23 vs. 20.62 ± 3.05 kg/m(2), p < 0.01). There were no statistical differences between responders and non-responders in symptom scores before treatment (p > 0.05), but symptom score was lower in responders than that in non-responders (1.52 ± 0.95 vs. 2.32 ± 1.22, p < 0.01) after treatment. The BMI in responders to ORS was significantly lower than that of non-responders (16.32 ± 2.28 vs. 20.43 ± 2.74 kg/m(2), p < 0.01). The BMI was correlated negatively with ΔHR in the POTS group (n = 54, r = -0.766, p < 0.01) and with the decrease in symptom scores after treatment in POTS patients (n = 54, r = -0.28, p < 0.05). ROC curve revealed the area under the curve to be 92.3 % (95 % confidence interval 0.829-0.996). A cutoff value of the BMI of 18.02 kg/m(2) had high sensitivity (92 %) and high specificity (82.8 %) for predicting the effect of ORS treatment for POTS. BMI is associated with the therapeutic response to ORS in children with POTS.

Background: Recent studies have suggested that pyruvate-enriched oral rehydration solution (Pyr-ORS) may be superior to the standard bicarbonate-based ORS in the protection of intestine from ischemic injury. The aim of this study was to compare the effects of Pyr-ORS with citrate-enriched ORS (Cit-ORS) on the intestinal hypoxia-inducible factor-1 (HIF-1)-erythropoietin (EPO) signaling pathway for enteral rehydration in a rat model of burn injury., Methods: Rats were randomly assigned to 4 groups (N = 20, 2 subgroups each: n = 10): scald sham (group SS), scald with no fluid resuscitation (group SN), scald and resuscitation with enteral Cit-ORS (group SC), and scald and resuscitation with enteral Pyr-ORS (group SP). At 2.5 and 4.5 hours after a 35% total body surface area (TBSA) scald, intestinal mucosal blood flow (IMBF), contents of HIF-1, EPO, endothelial nitric oxide synthase (eNOS), nitric oxide (NO), barrier protein (ZO-1), levels of serum diamine oxidase (DAO), and intestinal mucosal histology injury score were determined., Results: Serum DAO activities in the scalded groups were significantly elevated, but less raised in group SP than in group SC, at 2.5 hours and at 4.5 hours after the scald. Further, group SP more profoundly preserved intestinal HIF-1 expression compared with group SC at the 2 time points. Compared with group SC, group SP had markedly elevated intestinal EPO, eNOS, and NO levels at the same time points, respectively (P < .05). Similarly, IMBF and ZO-1 levels were significantly higher in group SP than in group SC. Intestinal mucosal histopathological scores were statistically higher at 2.5 hours and 4.5 hours after scalding but were more attenuated in group SP than in group SC (P < .05). Immunofluorescence expression of intestinal mucosal ZO-1 was consistent with the above changes. The above parameters were also significantly different between groups SC and SN (all P < .05)., Conclusion: Pyr-ORS provides a superior option to Cit-ORS for the preservation of intestinal blood flow and barrier function and the attenuation of histopathological alterations in enteral resuscitation of rats with burn injury. Its underlying mechanism may be closely related to the pyruvate in activation of intestinal HIF-1-EPO signaling cascades., (© 2015 American Society for Parenteral and Enteral Nutrition.)

Background: We characterize health knowledge and practices in urban and rural Makeni, Sierra Leone, drawing comparisons between areas served by community health workers (CHWs) with those that are not. We also inquire about causes of infant and maternal mortality and how they are understood in the local context. Our objective was to provide a baseline understanding of health knowledge and practices in Makeni during the implementation of a CHW program., Methods: We conducted 100 household interviews in Makeni City and rural villages in the surrounding area. We compared data between urban and rural areas to identify differences in health knowledge and practices., Results: Our sample size covered 855 individuals. Insecticide treated bednet ownership was lower in urban settings compared to rural populations (58% vs 94%; p<.001). With regards to maternal mortality, most respondents indicated 'no clinic' (lack of clinical care or skipped antenatal care visits) as the primary cause (n=35), followed by bleeding (n=17), 'lack of blood' (anemia) (n=11) and 'will of God' (n=11)., Conclusions: This initial survey of health knowledge and practices in rural and urban Makeni, Sierra Leone, highlights some simple opportunities for community health promotion, health education programming and behavioral interventions. Findings will inform future iterations of a CHW training module for community health education., (© The Author 2015. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Introduction: Diarrhea is a leading killer of children, accounting for 9% of all deaths among under-five children worldwide. WHO protocol deviation in management of diarrheas in children is likely due to various reasons., Aim: To study the prescription practices, regarding adherence to WHO protocol and deviations, in the management of acute diarrhea in children presenting at a tertiary care hospital and its impact on the outcome., Materials and Methods: This was a prospective observational hospital based study at a tertiary care carried out over a 12-month period including all cases of acute diarrhea (defined as 3 or more loose stools in last 24 hours) in children belonging to the age group of 6 months to 5 years. Patients were followed up on day 3,7,14 and 28 from the day of presentation. Software SPSS Version 17.0 was used for analysis. Correlation regression analysis was used to study predictiveness of different variables affecting outcome., Results: In this study, 447 children aged between 6 months and 5 years were enrolled, of which 45 cases were lost in follow-up and excluded. The median age was 14 months. Some deviation from WHO protocol was noted in 78.4% of the cases. Most common deviations from WHO protocol were addition of probiotics (78.1% of cases) and addition of race cadotril (15.9% of cases). Inadvertent use of antibiotics in diarrhea was noted in 12.2% of cases. Presence of fever was strong predictor for use of antibiotics. Cases of early recovery within 3 days of presentation were higher in WHO protocol deviation group. Use of probiotics had statistically significant association with early recovery., Conclusion: In diarrhea management, WHO protocol deviation is common. Probiotics are likely to help in early recovery.

Management of acute diarrhea remains a global challenge, particularly in resource-limiting countries. Oral rehydration solution (ORS), a passive rehydrating therapy developed approximately 40 years ago, remains the mainstay treatment. Although ORS is effective for hydration, since it does not inhibit enterotoxin-mediated excessive secretion, reduced absorption and compromised barrier function - the primary mechanisms of diarrhea, ORS does not offer a rapid relief of diarrhea symptom. There are a few alternative therapies available, yet the use of these drugs is limited by their expense, lack of availability and/or safety concerns. Novel anti-diarrheal therapeutic approaches, particularly those simple affordable therapies, are needed. This article explores intestinal calcium-sensing receptor (CaSR), a newly uncovered target for therapy of diarrhea. Unlike others, targeting this host antidiarrheal receptor system appears "all-inclusive": it is anti-secretory, pro-absorptive, anti-motility, and anti-inflammatory. Thus, activating CaSR reverses changes of both secretory and inflammatory diarrheas. Considering its unique property of using simple nutrients such as calcium, polyamines, and certain amino acids/oligopeptides as activators, it is possible that through targeting of CaSR with a combination of specific nutrients, novel oral rehydrating solutions that are inexpensive and practical to use in all countries may be developed.

Background: Cisplatin (CDDP) is used as a key anticancer drug for solid cancers, including lung cancer. However, a large quantity of fluid replacement is required to prevent renal dysfunction. This requirement have made outpatient chemotherapies including CDDP administration less popular among the available therapeutic options. We designed a short-term hydration regimen combined with oral rehydration solution (ORS) that has a supplementary water ability equivalent to intravenous electrolyte maintenance infusion and investigated its safety and feasibility in the CDDP including chemotherapy., Methods: The subjects received chemotherapy including CDDP administration (60-80 mg/m(2)) for untreated lung cancer were recruited. The intravenous hydration was infused at around 2000 mL on Day 1, and patients drank ORS at a dose of 1000 mL/day for 3 days. Any renal dysfunction, gastrointestinal symptoms or other tolerability variables pertaining to the remaining three cycles of this regimen were analyzed in the patients who were able to continue treatment after the second cycle., Results: The majority (29/35, 82.9 %) of patients completed intake of ORS for 3 days. The mean ± standard deviation of patient body-surface area-adjusted estimated glomerular filtration rate (eGFR), serum creatinine (sCre) and urea nitrogen from the initial therapy to 1 month after the last administration changed from 79.8 ± 11.7-67.0 ± 16.9 mL/min (p = 0.15), 0.70 ± 0.13-0.85 ± 0.27 mg/dL (p = 0.02), and 14.3 ± 3.8-17.1 ± 5.4 mg/dL (p = 0.09), respectively. The CTCAE ver 4.0 grades 1 or 2 adverse events pertaining to renal function after the last administration were 2 (5.7 %)/2 (5.7 %) patients assessed by sCre, and 14 (40.0 %)/12 (34.3 %) patients assessed by eGFR, respectively. There was no patient with ≥3 grade renal dysfunction based on either evaluation., Conclusions: Based on the results of this study, supplementary use of the ORS as a method of short-term hydration may be a feasible regimen for shortening infusion times and improving safety for those undergoing chemotherapy including CDDP administration.

Introduction: Early management of severe acute pancreatitis (SAP) includes intravenous fluid resuscitation., Aim: To confirm feasibility of naso-jejunal (NJ) fluid resuscitation using oral hydration solution (ORS) and compare its efficacy with intravenous (IV) fluid resuscitation using Ringer Lactate (RL) in predicted SAP., Patients and Methods: All patients of predicted SAP (presence of SIRS or BISAP > 2) without significant co morbidities were randomized to NJ group (ORS: 20 ml/kg bolus and then 3 mL/kg/h) or IV group (RL infusion at same rate). The groups were compared vis-à-vis persistent organ failure (POF), pancreatic necrosis, and mortality., Results: Seventy-seven patients were assessed and after exclusion, 49 patients were randomized to either NJ (24 patients) or IV group (25). The demographic and baseline clinical profile of both groups including BISAP score (2.25 ± 0.73 and 2.32 ± 0.56), hematocrit (40.2 ± 6.8 and 38.3 ± 6.6), blood urea nitrogen (16.88 ± 6.69 and 21.44 ± 17.56 mg/dL), and intra-abdominal pressure (14.55 ± 4.8 and 14.76 ± 5.5 cm of water) were similar. NJ resuscitation had to be stopped in two patients because of abdominal discomfort and distension. The change in intra abdominal pressure after 48 h of hydration was comparable in both groups. The occurrence of POF (66.67% and 68%), pancreatic necrosis (69.5% and 76%), intervention (5 each), surgery (1 each), and mortality (16.5% and 8%) were comparable (P > 0.05)., Conclusion: In select group of patients with SAP, NJ fluid resuscitation with ORS is feasible and is equally efficacious as IV fluid resuscitation with RL., (© 2015 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd.)

Oral rehydration solution (ORS) and zinc are the recommended treatment in developing countries for the management of uncomplicated diarrhoea in children under five (World Health Organization and UNICEF 2004). However, drug sellers often recommend costly and unnecessary treatments instead. This article reports findings from an experiment to encourage licensed chemical sellers (LCS) in Ghana to recommend ORS and zinc for the management of childhood diarrhoea. The intervention consisted of mobile phone text messages (Short Message Service or SMS) sent to a randomly assigned group of LCS who had been trained on the diarrhoea management protocols recommended by the World Health Organization (WHO). The SMS campaign comprised informational messages and interactive quizzes sent over an 8-week period. The study measured the impact of the SMS messages on both reported and actual practices. Analysis of data from both face-to-face interviews and mystery client visits shows that the SMS intervention improved providers' self-reported practices but not their actual practices. The study also finds that actual practices deviate substantially from reported practices., (Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2015; all rights reserved.)

Background: Recent findings showed advantages of a novel pyruvate-enriched oral rehydration solution (Pyr-ORS) in resuscitation of burns. This study focused on effects of Pyr-ORS on the visceral blood perfusion (VBP), gastrointestinal function, and survival rate, compared with the bicarbonate-based World Health Organization-guided oral rehydration solution (WHO-ORS), during intragastric rehydration of lethal hemorrhagic shock in rats., Methods: Sixty adult rats were subjected to 45% total blood volume loss and were randomly allocated to the following three groups (n = 20): group NR (no fluid resuscitation), group PORS (oral Pyr-ORS rehydration), and group BORS (oral WHO-ORS rehydration), respectively. Other 10 rats were served as group NH (the sham group). Enteral rehydration lasted for 4 h after hemorrhage. The mean arterial pressure (MAP), VBP, and plasma enzymes activities of heart, liver, and kidney, and intestinal fatty acid binding protein were measured. Liver, kidney, and ileum were harvested for the evaluation of activities of oxidative enzymes and intestinal barrier protein (ZO-1). Other 84 rats with identical procedures without sampling were observed for their 24-h survival rates., Results: Pyr-ORS was more effective in enhancing the MAP and VBP, inhibiting tissue oxidative damage, and improving organ function, compared with WHO-ORS. Hypoxic lactic acidosis was fully corrected in group PORS in 4 h, whereas it worsened in group BORS, and the 24-h survival rate was twice higher in group PORS than in group BORS (45.8 versus 20.8%, P < 0.05)., Conclusions: A small amount of pyruvate in Pyr-ORS was more therapeutically beneficial than equivalent bicarbonate in WHO-ORS and greatly raised survival in enteral rehydration of lethal hemorrhagic shock. The Pyr-ORS may be an ideal oral fluid in resuscitation of hypovolemic shock, especially in prehospital and resource-poor settings., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Background: Diarrhea's impact on childhood morbidity can be reduced by administering oral rehydration solution (ORS) with zinc; challenges to wider use are changing health-seeking behavior and ensuring access., Methods: We conducted a randomized controlled trial to increase ORS plus zinc uptake in rural Myanmar. Village tracts, matched in 52 pairs, were randomized to standard ORS access vs. a social franchising program training community educators and supplying ORS plus zinc., Results: Intervention and control communities were comparable on demographics, prevalence of diarrhea and previous use of ORS. One year after randomization, ORS plus zinc use was 13.7% in the most recent case of diarrhea in intervention households compared with 1.8% in control households (p < 0.001) (N = 3605). A significant increase in ORS plus zinc use was noted in the intervention (p = 0.044) but not in the control (p = 0.315) group., Conclusions: Social franchising increased optimal treatment of childhood diarrhea in rural Myanmar. Scale-up stands to reduce morbidity among children in similar settings., Trial Registration: Current Controlled Trials ISRCTN73606238., (© The Author [2014]. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Aim: To investigate alteration in intestinal absorption during enteral resuscitation with pyruvate-enriched oral rehydration solution (Pyr-ORS) in scalded rats., Methods: To compare pyruvate-enriched oral rehydration solution (Pyr-ORS) with World Health Organisation oral rehydration solution (WHO-ORS), 120 rats were randomly divided into 6 groups and 2 subgroups. At 1.5 and 4.5 h after a 35% TBSA scald, the intestinal absorption rate, mucosal blood flow (IMBF), Na(+)-K(+)-ATPase activity and aquaporin-1 (AQP-1) expression were determined (n = 10), respectively., Results: The intestinal Na(+)-K(+)-ATPase activity, AQP-1 expression and IMBF were markedly decreased in scald groups, but they were profoundly preserved by enteral resuscitation with WHO-ORS and further improved significantly with Pyr-ORS at both time points. Na(+)-K+-ATPase activities remained higher in enteral resuscitation with Pyr-ORS (Group SP) than those with WHO-ORS (Group SW) at 4.5 h. AQP-1 and IMBF were significantly greater in Group SP than in Group SW at both time points. Intestinal absorption rates of water and sodium were obviously inhibited in scald groups; however, rates were also significantly preserved in Group SP than in Group SW with an over 20% increment at both time points., Conclusion: The Pyr-ORS may be superior to the standard WHO-ORS in the promotion of intestinal absorption of water and sodium during enteral resuscitation., (Copyright © 2013 Elsevier Ltd and ISBI. All rights reserved.)