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Oral Rehydration Solutions in Non-Cholera Diarrhea

A Review

Atia, Antwan N., MD1; Buchman, Alan L., MD, MSPH, FACP, FACG, FACN, AGAF2

American Journal of Gastroenterology: October 2009 - Volume 104 - Issue 10 - p 2596–2604

The use of oral rehydration solution (ORS) has revolutionized the management of acute diarrhea. The implementation of the standard World Health Organization ORS (WHO-ORS) has resulted in decreased mortality associated with acute diarrheal illnesses in children, although in general stool volume and diarrhea durations are not reduced. Decreased morbidity and mortality have occurred because of improved hydration status. Decreased morbidity has also been described in adults who used this therapy. Various modifications to the standard ORS have been derived. These modifications have included hypo-osmolar or hyperosmolar solutions, use of rice-based ORS, zinc supplementation, and the use of amino acids, including glycine, alanine, and glutamine. Some of these variations have been successful, some have not, and others are still under investigation. ORS has been used for travelers' diarrhea and to decrease intravenous (IV) fluid requirements in patients with short bowel syndrome (SBS) who require parenteral nutrition (PN). This paper reviews the standard WHO-ORS and its mechanism of action, followed by more contemporary reduced osmolarity ORS and rice-based ORS in non-cholera diarrhea. Various modifications to improve ORS are also discussed.

Am J Gastroenterol 2009; 104:2596-2604; doi:10.1038/ajg.2009.329; published online 23 June 2009

1Department of Internal Medicine, East Tennessee State University, Johnson City, Tennessee, USA; 2Division of Gastroenterology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA. Correspondence: Alan L. Buchman, MD, MSPH, FACP, FACG, FACN, AGAF, Inflammatory Bowel Disease Center, Medical Director, Intestinal Rehabilitation and Transplant Center, Division of Gastroenterology, Feinberg School of Medicine, Northwestern University, Suite 1400, Chicago, IL 60611, USA. E-mail:

Received 19 January 2009; accepted 1 May 2009

© The American College of Gastroenterology 2009. All Rights Reserved.
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