Demonstration of the benefits of oral therapy for cholera in 19681 soon led to application of the method to all forms
of infectious diarrheal diseases.2 The original
oral rehydration solution (ORS) formulation developed by the World Health
Organization (WHO) (Table 1) struck
a compromise between the ideal solutions for these diverse disorders to meet
the programmatic goal of a single formulation and packaging for global use
in cholera and noncholera diarrheas, in both adults and children. Recently,
WHO recommended a new oral solution (Table
1) for all acute diarrheas, including cholera. This new formula
would replace the original ORS, which saved millions of lives, with a new
formulation containing less sodium and glucose.3 This
change was ostensibly to reduce gross stool volume and use of unscheduled
intravenous therapy by lowering solution osmolarity. However, the reduced-osmolarity
formulation is particularly unsuitable for universal use because it contains
an amount of sodium insufficient to maintain sodium balance in cholera patients,
in whom its use induces negative sodium balance and may lead to hyponatremia,4,5 polyuria,4 and
a small but clinically significant risk of neurologic complications. The new
reduced-osmolarity formulation stretches the original compromise to the breaking
point. It may be time to promote use of different solutions for patients with
cholera, beginning in controlled settings such as cholera treatment centers
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