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Controversies | Clinician's Corner

Scientific Rationale for a Change in the Composition of Oral Rehydration Solution

Christopher Duggan, MD, MPH; Olivier Fontaine, MD; Nathaniel F. Pierce, MD; Roger I. Glass, MD, PhD; Dilip Mahalanabis, MD; Nur Haque Alam, MD; Maharaj K. Bhan, MD; Mathuram Santosham, MD, MPH
JAMA. 2004;291(21):2628-2631. doi:10.1001/jama.291.21.2628.
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Diarrheal diseases remain important causes of death and morbidity in developing countries, with an estimated 1.5 billion episodes and 1.5 million to 2.5 million deaths each year among children younger than 5 years.14 Although the number of children currently dying from diarrhea continues to be unacceptably high, it is substantially lower than the 5 million deaths per year estimated 20 years ago.5

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Figure. Coupled Transport of Sodium and Glucose in Intestinal Epithelial Cells
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Although nutrient-independent sodium absorption across the brush border membrane of intestinal epithelial cells is impaired in patients with diarrhea, coupled transport of sodium and glucose is preserved, allowing absorption of salt and water provided by oral rehydration solutions (ORSs). Sodium-glucose transporter type 1 (SGLT1) mediates the transport of glucose against its concentration gradient by coupling it to sodium transport. Sodium that enters the cell is pumped into the blood by the Na+K+ATPase (adenosine triphosphatase) pump in the basolateral membrane, maintaining the sodium electrochemical gradient that drives the sodium-glucose cotransport mechanism. Transport of glucose into the blood is facilitated by glucose transporter type 2 (GLUT2).

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