Skip to main content
NCBI home page
Gut logoLink to Gut
. 1992 Dec;33(12):1652–1659. doi: 10.1136/gut.33.12.1652

Water and solute absorption from a new hypotonic oral rehydration solution: evaluation in human and animal perfusion models.

J B Hunt 1, A V Thillainayagam 1, A F Salim 1, S Carnaby 1, E J Elliott 1, M J Farthing 1
PMCID: PMC1379577  PMID: 1487167

Abstract

Controversy continues regarding the optimal composition of glucose electrolyte oral rehydration solutions for the treatment of acute diarrhoea. Four perfusion models (normal human jejunum, normal rat small intestine, cholera toxin treated secreting rat small intestine and rotavirus infected rat small intestine) have been developed and used to compare the efficacy of a hypotonic oral rehydration solution with standard United Kingdom British National formulary and developing world oral rehydration solutions (WHO). Despite obvious physiological and pathophysiological differences between these models there was general congruence in the water and solute absorption profiles of the different oral rehydration solutions. Hypotonic oral rehydration solution promoted significantly greater water absorption than other oral rehydration solutions in all rat models (p < 0.001) but apparently increased water absorption failed to achieve significance in human jejunum. British National Formulary-oral rehydration solution was unable to reverse net water secretion in both rotavirus and cholera toxin models. Net sodium absorption from hypotonic and WHO-oral rehydration solutions was significantly greater than from the low sodium British National Formulary-oral rehydration solutions (p < 0.001) except in the rotavirus model when absorption was similar to hypotonic-oral rehydration solutions. These findings show that there is agreement in the apparent efficacy of oral rehydration solutions in these animal and human perfusion models, and that improved water absorption with adequate sodium absorption may be achieved by reducing oral rehydration solution osmolality.

Full text

PDF
1652

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Alam A. N., Sarker S. A., Molla A. M., Rahaman M. M., Greenough W. B., 3rd Hydrolysed wheat based oral rehydration solution for acute diarrhoea. Arch Dis Child. 1987 May;62(5):440–444. doi: 10.1136/adc.62.5.440. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Aperia A., Marin L., Zetterström R., Günöz H., Neyzi O., Saner G., Sökücü S. Salt and water homeostasis during oral rehydration therapy. J Pediatr. 1983 Sep;103(3):364–369. doi: 10.1016/s0022-3476(83)80404-1. [DOI] [PubMed] [Google Scholar]
  3. Banwell J. G., Pierce N. F., Mitra R. C., Brigham K. L., Caranasos G. J., Keimowitz R. I., Fedson D. S., Thomas J., Gorbach S. L., Sack R. B. Intestinal fluid and electrolyte transport in human cholera. J Clin Invest. 1970 Jan;49(1):183–195. doi: 10.1172/JCI106217. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Barclay G. R., Turnberg L. A. Effect of cold-induced pain on salt and water transport in the human jejunum. Gastroenterology. 1988 Apr;94(4):994–998. doi: 10.1016/0016-5085(88)90558-6. [DOI] [PubMed] [Google Scholar]
  5. Bhargava S. K., Sachdev H. P., Das Gupta B., Daral T. S., Singh H. P., Mohan M. Oral rehydration of neonates and young infants with dehydrating diarrhea: comparison of low and standard sodium content in oral rehydration solutions. J Pediatr Gastroenterol Nutr. 1984 Sep;3(4):500–505. doi: 10.1097/00005176-198409000-00004. [DOI] [PubMed] [Google Scholar]
  6. Cleghorn G. J., Shepherd R. W., Patrick M. K., Chin S. E. Comparison of two oral rehydration solutions in children with gastroenteritis in Australia. Clin Ther. 1990;12 (Suppl A):81–85. [PubMed] [Google Scholar]
  7. Elliott E. J., Cunha-Ferreira R., Walker-Smith J. A., Farthing M. J. Sodium content of oral rehydration solutions: a reappraisal. Gut. 1989 Nov;30(11):1610–1621. doi: 10.1136/gut.30.11.1610. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Elliott E. J., Da Cunha Ferreira R. M., Cameron D., Farthing M. J., Walker-Smith J. A. Evaluation of three oral rehydration solutions designed for use in developed communities. Aliment Pharmacol Ther. 1989 Jun;3(3):233–243. doi: 10.1111/j.1365-2036.1989.tb00209.x. [DOI] [PubMed] [Google Scholar]
  9. Field M., Fromm D., al-Awqati Q., Greenough W. B., 3rd Effect of cholera enterotoxin on ion transport across isolated ileal mucosa. J Clin Invest. 1972 Apr;51(4):796–804. doi: 10.1172/JCI106874. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Fordtran J. S., Rector F. C., Jr, Carter N. W. The mechanisms of sodium absorption in the human small intestine. J Clin Invest. 1968 Apr;47(4):884–900. doi: 10.1172/JCI105781. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Fordtran J. S., Rector F. C., Jr, Ewton M. F., Soter N., Kinney J. Permeability characteristics of the human small intestine. J Clin Invest. 1965 Dec;44(12):1935–1944. doi: 10.1172/JCI105299. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Graham D. Y., Sackman J. W., Estes M. K. Pathogenesis of rotavirus-induced diarrhea. Preliminary studies in miniature swine piglet. Dig Dis Sci. 1984 Nov;29(11):1028–1035. doi: 10.1007/BF01311255. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Hirschhorn N., Kinzie J. L., Sachar D. B., Northrup R. S., Taylor J. O., Ahmad S. Z., Phillips R. A. Decrease in net stool output in cholera during intestinal perfusion with glucose-containing solutions. N Engl J Med. 1968 Jul 25;279(4):176–181. doi: 10.1056/NEJM196807252790402. [DOI] [PubMed] [Google Scholar]
  14. Hirschhorn N. The treatment of acute diarrhea in children. An historical and physiological perspective. Am J Clin Nutr. 1980 Mar;33(3):637–663. doi: 10.1093/ajcn/33.3.637. [DOI] [PubMed] [Google Scholar]
  15. Hoffman S. L., Moechtar M. A., Simanjuntak C. H., Punjabi N. H., Kumala S., Sutoto, Silalahi P., Sutopo B., Kuncoro Y. S., Soriano M. Rehydration and maintenance therapy of cholera patients in Jakarta: citrate-based versus bicarbonate-based oral rehydration salt solution. J Infect Dis. 1985 Dec;152(6):1159–1165. doi: 10.1093/infdis/152.6.1159. [DOI] [PubMed] [Google Scholar]
  16. Hunt J. B., Elliott E. J., Farthing M. J. Efficacy of a standard United Kingdom oral rehydration solution (ORS) and a hypotonic ORS assessed by human intestinal perfusion. Aliment Pharmacol Ther. 1989 Dec;3(6):565–571. doi: 10.1111/j.1365-2036.1989.tb00249.x. [DOI] [PubMed] [Google Scholar]
  17. Islam M. R., Samadi A. R., Ahmed S. M., Bardhan P. K., Ali A. Oral rehydration therapy: efficacy of sodium citrate equals to sodium bicarbonate for correction of acidosis in diarrhoea. Gut. 1984 Aug;25(8):900–904. doi: 10.1136/gut.25.8.900. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Johnson R. E., Kagan A. R., Hafermann M. D., Keyes J. W., Jr Patient tolerance to extended irradiation in Hodgkin's disease. Ann Intern Med. 1969 Jan;70(1):1–6. doi: 10.7326/0003-4819-70-1-1. [DOI] [PubMed] [Google Scholar]
  19. Kenya P. R., Odongo H. W., Oundo G., Waswa K., Muttunga J., Molla A. M., Nath S. K., Molla A., Greenough W. B., 3rd, Juma R. Cereal based oral rehydration solutions. Arch Dis Child. 1989 Jul;64(7):1032–1035. doi: 10.1136/adc.64.7.1032. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Lifshitz F., Wapnir R. A. Oral hydration solutions: experimental optimization of water and sodium absorption. J Pediatr. 1985 Mar;106(3):383–389. doi: 10.1016/s0022-3476(85)80661-2. [DOI] [PubMed] [Google Scholar]
  21. Meeuwisse G. W. High sugar worse than high sodium in oral rehydration solutions. Acta Paediatr Scand. 1983 Mar;72(2):161–166. doi: 10.1111/j.1651-2227.1983.tb09689.x. [DOI] [PubMed] [Google Scholar]
  22. Modigliani R., Bernier J. J. Absorption of glucose, sodium, and water by the human jejunum studied by intestinal perfusion with a proximal occluding balloon and at variable flow rates. Gut. 1971 Mar;12(3):184–193. doi: 10.1136/gut.12.3.184. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Molla A. M., Rahman M., Sarker S. A., Sack D. A., Molla A. Stool electrolyte content and purging rates in diarrhea caused by rotavirus, enterotoxigenic E. coli, and V. cholerae in children. J Pediatr. 1981 May;98(5):835–838. doi: 10.1016/s0022-3476(81)80863-3. [DOI] [PubMed] [Google Scholar]
  24. Molla A. M., Sarker S. A., Hossain M., Molla A., Greenough W. B., 3rd Rice-powder electrolyte solution as oral-therapy in diarrhoea due to Vibrio cholerae and Escherichia coli. Lancet. 1982 Jun 12;1(8285):1317–1319. doi: 10.1016/s0140-6736(82)92396-0. [DOI] [PubMed] [Google Scholar]
  25. Moore W. L., Jr, Bieberdorf F. A., Morawski S. G., Finkelstein R. A., Fordtran J. S. Ion transport during cholera-induced ileal secretion in the dog. J Clin Invest. 1971 Feb;50(2):312–318. doi: 10.1172/JCI106496. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Nalin D. R., Cash R. A., Islam R., Molla M., Phillips R. A. Oral maintenance therapy for cholera in adults. Lancet. 1968 Aug 17;2(7564):370–373. doi: 10.1016/s0140-6736(68)90591-6. [DOI] [PubMed] [Google Scholar]
  27. Patra F. C., Mahalanabis D., Jalan K. N., Sen A., Banerjee P. Is oral rice electrolyte solution superior to glucose electrolyte solution in infantile diarrhoea? Arch Dis Child. 1982 Dec;57(12):910–912. doi: 10.1136/adc.57.12.910. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Pierce N. F., Banwell J. G., Rupak D. M., Mitra R. C., Caranasos G. J., Keimowitz R. I., Mondal A., Manji P. M. Effect of intragastric glucose-electrolyte infusion upon water and electrolyte balance in Asiatic cholera. Gastroenterology. 1968 Sep;55(3):333–343. [PubMed] [Google Scholar]
  29. Raghu M. B., Deshpande A., Chintu C. Oral rehydration for diarrhoeal diseases in children. Trans R Soc Trop Med Hyg. 1981;75(4):552–555. doi: 10.1016/0035-9203(81)90197-8. [DOI] [PubMed] [Google Scholar]
  30. Rao M. C., Field M. Enterotoxins and ion transport. Biochem Soc Trans. 1984 Apr;12(2):177–180. doi: 10.1042/bst0120177. [DOI] [PubMed] [Google Scholar]
  31. Rolston D. D., Borodo M. M., Kelly M. J., Dawson A. M., Farthing M. J. Efficacy of oral rehydration solutions in a rat model of secretory diarrhea. J Pediatr Gastroenterol Nutr. 1987 Jul-Aug;6(4):624–630. doi: 10.1097/00005176-198707000-00023. [DOI] [PubMed] [Google Scholar]
  32. Rolston D. D., Moriarty K. J., Farthing M. J., Kelly M. J., Clark M. L., Dawson A. M. Acetate and citrate stimulate water and sodium absorption in the human jejunum. Digestion. 1986;34(2):101–104. doi: 10.1159/000199317. [DOI] [PubMed] [Google Scholar]
  33. Sack D. A., Chowdhury A. M., Eusof A., Ali M. A., Merson M. H., Islam S., Black R. E., Brown K. H. Oral hydration rotavirus diarrhoea: a double blind comparison of sucrose with glucose electrolyte solution. Lancet. 1978 Aug 5;2(8084):280–283. doi: 10.1016/s0140-6736(78)91687-2. [DOI] [PubMed] [Google Scholar]
  34. Santosham M., Burns B. A., Reid R., Letson G. W., Duncan B., Powlesland J. A., Foster S., Garrett S., Croll L., Nyunt Nyunt W. Glycine-based oral rehydration solution: reassessment of safety and efficacy. J Pediatr. 1986 Nov;109(5):795–801. doi: 10.1016/s0022-3476(86)80696-5. [DOI] [PubMed] [Google Scholar]
  35. Sladen G. E., Dawson A. M. Interrelationships between the absorptions of glucose, sodium and water by the normal human jejunum. Clin Sci. 1969 Feb;36(1):119–132. [PubMed] [Google Scholar]
  36. Spiller R. C., Jones B. J., Silk D. B. Jejunal water and electrolyte absorption from two proprietary enteral feeds in man: importance of sodium content. Gut. 1987 Jun;28(6):681–687. doi: 10.1136/gut.28.6.681. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Gut are provided here courtesy of BMJ Publishing Group

RESOURCES