Electrolyte Therapy in Acute and Chronic Diarrhea

Worldwide, the impact of acute diarrheal disease is immense and is particularly important in infants and young children. It has been estimated that each child experiences six to eight episodes of diarrhea per year in developing countries (1) and that this represents an annual mortality of up to 18 million children under 5 in those countries (2). Severe dehydration resulting from diarrhea occurs more readily in infants as a result of their higher basal fluid requirements compared to adults, their relative inability to gain access to fluids when thirsty, the immaturity of tubular reabsorption processes, and the popular misconception that fluids should be withheld in infants with diarrhea. In 1831, O'Shaughnessy (3) and Latta (4) first described the biochemical changes occurring in the blood and the use of parenteral fluid replacement, respectively, in patients with cholera. However, the use of oral electrolyte solutions in children with acute diarrhea was not formally advocated for over another hundred years (5,6). In fact, in the West, parenteral rehydration has remained the cornerstone of the management of acute diarrhea in all but mild cases (7,8). Glucose was included in early oral electrolyte solutions solely as a source of calories, and the high carbohydrate content of these early formulas may well have increased stool volumes by an osmotic effect (9). However, incorporation of carbohydrate into such solutions was shown to be effective in rehydrating even severely dehydrated infants (10), and it is now realized that glucose and certain other organic solutes also have a very important noncaloric role in stimulating transport at the brush border of the enterocyte.