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
Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more
Subscribe for full-text access to content from 1998 forward and a host of useful features
Activate your current subscription (AMA members and current subscribers)
Purchase Online Access to this article for 24 hours
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 11
Customize your page view by dragging & repositioning the boxes below.
More Listings atJAMACareerCenter.com >
and access these and other features:
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.