Written by Dr. Arturo C. Ludan
Reprinted from Pediatric Bulletin , July 1996

The principal objective in the successful management of acute diarrhea is to shorten its clinical course and reduce its severity to minimize fluid and electrolyte losses, prevent under nutrition and avoid protracted diarrhea and its complications.

Two relevant and timely articles were publish recently in the American Journal of Pediatrics that provide clinicians with fresh and practical information which ushers some of the new approach in limiting the course of acute diarrhea and decreasing its severity. These two companion articles are annotated in this issue of Pediatric Bulletin.

Zinc supplementation in acute diarrhea

In a large study that was abstracted in the Journal of Pediatrics (March, 1996), Sazawal et al performed an extensive study among clinic patients to determine the benefits of zinc supplementation in the management of acute diarrhea. The study which was abstracted from the original article published in the New England Journal of Medicine 1995;333;839-44, is reproduced as follows:

“In this double-blind, randomized, controlled trial of 937 children 6 to 35 months of age, daily supplementation with 20mg of elemental zinc during acute diarrhea episodes not requiring hospitalization resulted in clinically important reductions in the duration and severity of diarrhea. ”

In the previous issue of Pediatric Bulletin,  the  beneficial effects of zinc supplementation is small -for-gestational age babies were highlighted.  This study on the benefits of zinc for yet another condition, acute diarrheas , stresses the multi-faceted functions of this amazing trace mineral.

Reduced osmolarity ORS vs. high osmorality WHO ORS in acute diarrhea

In a double-blind clinical trial comparing a reduced osmolarity ORS with the high osmolarity WHO ORS formulation, Santosham et al demonstrated the significant advantages with the administration of a reduced osmolarity ORS in the management of acute diarrhea. Their study was published in the Journal of Pediatrics (January, 1996)

In their study, Santosham et al compared the WHO ORS with an osmolarity of 311 mmol/ L with a reduced osmolarity ORS with 245 mmol/L. The WHO ORS has sodium 90 mmol/L and glucose of 20 13.5 gms./L (75 mmol/L.)

Based on the result of their study,  the investigators conclude:

“The reduced osmolarity ORS has beneficial effects on the clinical course of acute diarrhea in children by reducing stool output, and the proportion of children with vomiting during the rehydration phase, and by reducing the need for supplemental intravenous therapy. These results provide support for the use of a reduced osmolarity ORS in children with acute moncholera diarrhea.  ”

This  study of Santhosam et al supports the recommendation of the American Academy of  Pediatrics (AAP) and the European Society of Pediatrics Gastroenterology and Nutrition (ESPGN) that an ideal ORS should have a total osmorality of 200-250 mmol./L.

To guide physicians in making the right decision to choose the most appropriate reduce osmorality ORS for the successful management of acute diarrhea, the following table of locally available ORS formulation with their respective osmolarity is provided.

 

OSMOLARITY OF LOCALLY AVAILABLE  ORS

( Based on available ORS in 1996 )

Total Osmolarity = total no. of  millimols/ L of electrolytes, particularly sodium, and the CHO substrate (glucose, surcose etc.)

ORS Formulation	Total osmorality mmo1/L	Sodium mmo1/L	CHO Substrate mmo1/L
Oresol hydriet (1 tablet 100ml water) and other brands similar to the WHO ORS formulation	311	90	111 as glucose
Cholyte - 50	236	50	Sucrose 58 Glucose 55
Pedialyte - 45	249	45	Glucose 139
Glucolyte	290	50	Glucose 168
Hydrite (1 tablet in 200ml water)	155	45	Glucose 55.55

Based on the above data. Only Cholryte-50 and Pedialyte – 45 meet the recommendation of a reduced osmolarity ORS which helps reduce stool fluid and electrolyte losses, decreases  vomiting and minimize the need for I.V fluid therapy. Very low osmolarity or dilute ORS ( Hydrite 1 tablet in 200ml water carriers the traditional risk of Hyponatremia or hypo-osmorality )

Editor's Note-

Sports drinks like Gatorade, Powerade, etc., should never be used for Oral Rehydration  Therapy. Sports drinks are very low in sodium and extremely high in carbohydrate ( 6%) which can cause osmotic diarrhea and worsen the dehydration.

TRY A NEW APPROACH IN DIARRHEA MANAGEMENT

1. ZINC SUPPLEMENTATION WITH Z-VITA

Two teaspoonfuls of Z-Vita daily shortens the course and reduces  the severity of acute diarrhea.

Z-Vita , the only vitamin-mineral combination with the right RDA of Zinc.

2. REDUCED OSMOLARITY ORS WITH CHOLYTE-50

Reduced osmolarity ORS decreases stool losses, lessened vomiting and minimizes I.V. fluid therapy.

Cholyte-50 , the ideal ORS formulation with a reduced osmolarity or 23 mmol/ L.

Cholyte-50 , improves acute diarrhea while it prevents and corrects dehydration.

Z-VITA AND CHOLYTE-50

A NEW AND EFFECTIVE 1-2 COMBINATION IN THE SUCCESSFUL MANAGEMENT OF ACUTE DIARRHEA!

( In 2004 or eight years after this 1996 publication, the WHO recommended zinc supplementation and reduced osmolarity ORS in the Management of Acute Diarrhea. )