Oral rehydration therapy

Refers to a type of fluid replacement used to prevent and treat dehydration, especially that due to diarrhea.

Involves the drinking of water with modest amounts of sugar and salts, specifically sodium and potassium.

Can also be given orally or by nasogastric tube.

Management should routinely include the use of zinc supplements.

Such therapy decreases the risk of death from diarrhea by about 93%.

Has reduced the number of deaths in children under the age of five.

ORT side effects include: vomiting, high blood sodium, or high blood potassium.

The recommended formulation includes: sodium chloride, sodium citrate, potassium chloride, and glucose.

Glucose may be replaced by sucrose.

Sodium citrate may be replaced by sodium bicarbonate.

Glucose increases the uptake of sodium and thus water by the intestines.

Mild to moderate dehydration in children seen in an emergency department is best treated with ORT.

ORT should be followed by eating within 6 hours and a return to their full diet within 24–48 hours.

The degree of dehydration is assessed before initiating ORT, as it is not suitable for people who are dehydrated.

ORT is used for patients with signs and symptoms of mild to moderate dehydration.

With severe dehydration patients should receive intravenous rehydration as soon as possible to rapidly replenish fluid volume in the body.

ORT is contraindicated in people who have impaired airway protective reflexes.

Short-term vomiting is not a contraindication to receiving oral rehydration therapy.

Sports drinks are not optimal oral rehydration solutions.

The rationale for ORT is due to the evidence that water continues to be absorbed from the gastrointestinal tract even while fluid is lost through diarrhea or vomiting.

ORT should be utilized at the first sign of diarrhea in order to prevent dehydration.

Oral rehydration solution can be given by syringe or dropper, and by frequent teaspoon administration to babies and infants, respectively.

Older children and adults should take frequent of oral rehydration solution sips from a cup.

WHO recommendation for oral rehydration therapy: giving children under two a quarter- to a half-cup of fluid following each loose bowel movement and older children a half- to a full cup.

If the patient vomits, resume giving oral rehydration solution after 5–10 minutes.

As part of oral rehydration therapy, WHO recommends supplemental zinc (10 to 20 mg daily) as part of ORT, for ten to fourteen days, to reduce the severity and duration and likelihood of recurrent illness.

After severe dehydration is corrected, the recovery of normal intestinal function is restored, it minimizes weight loss and supports continued growth in children.

Normal feeding as soon as possible is encouraged.

The IV route should not be used for rehydration except in cases of shock.

Feeding should usually resume within 2–3 hours after starting rehydration and should continue every 2–3 hours, day and night.

During digestion fluid enters the intestinal lumen, and the fluid is isosmotic with the blood and contains a high quantity, about 142 mEq/L, of sodium.

Normally one secretes 2000–3000 milligrams of sodium per day into the intestinal lumen, but early all of this is reabsorbed so that sodium levels in the body remain constant.

With diarrheal, sodium-rich intestinal secretions are lost before they can be reabsorbed, and can lead to life-threatening dehydration or electrolyte imbalances within hours when fluid loss is severe.

Replenishment of sodium and water losses by ORT or intravenous infusion is the therapeutic purpose.

Sodium absorption occurs in two stages.: via intestinal epithelial cells, Sodium passes into these cells by co-transport with glucose, via the SGLT1 protein, and is pumped by active transport via the sodium-potassium pump through the basolateral cell membrane into the extracellular space.

Without glucose, intestinal sodium is not absorbed, so oral rehydration salts include both sodium and glucose.

Water molecules move into the epithelial cell to maintain osmotic equilibrium, resulting in absorption of sodium and water and achieving rehydration even while diarrhea continues.

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