Abstract

UNICEF, the United Nations International Children Emergency Funds, has staged an enormous program to improve children's health conditions in the developing countries. One extremely fruitful field of engagement was, and still is, the treatment of dehydration. Oral rehydration therapy (ORT) has reluctantly been accepted in the industrialized countries. From clinical observations, we have gained a new understanding of known pathophysiological principles. Dehydration most often is a result of diarrhea, and therefore oral rehydration therapy is mostly referred to in the context of infections of the digestive system. We discuss additional causes of dehydration and its immediate and secondary consequences. We demonstrate not only that, but why and how, a very simple, inexpensive regimen is beneficial and effective in the treatment of dehydration. Without consideration of sodium deficit, understanding will fail, and treatment will remain ineffective.

PIP:

UNICEF promotes the use of a very effective, inexpensive treatment of dehydration in developing countries: oral rehydration therapy (ORT), which is oral administration of a solution with equimolar concentrations of sodium and glucose (osmolality of about 300 mosmol). The solution is isotonic with respect to total body water when it reaches the small intestine. It expands the extracellular fluid without changing serum osmolality, thus, brain edema does not occur. Further, metabolic degradation of glucose eventually releases free water. On the other hand, intravenous rehydration with saline solution can be lethal, causing excess free water to expand shrunken cells and, thereby, causing brain swelling, rupture of blood vessels and hemorrhage. Yet, physicians and other health workers in developed countries have been quite sow to accept ORT. Leading conditions of dehydration include insensible loss of water and heat through evaporation from the respiratory tract and skin (common in dry air, hot environment, and fever), sensible loss of water and heat through perspiration (common in hot, humid environment and with warm and absorbent clothing), and irritation of the intestinal mucosa by allergies, infections, toxins, and intolerance to some nutrients, resulting in diarrhea. Diarrhea is indeed the main cause of dehydration. Other causes of dehydration are: failure of the hypothalamus to secrete antidiuretic hormone (ADH), kidney unresponsiveness to ADH, diabetes mellitus, protein-rich nutrition, catabolic states, and brush-border lactase after weaning. Physiological changes in dehydration consist of rigidity of the connective tissue (vascular system and lungs) and intracellular fluid loss to the extracellular spaces, resulting in dry mucous membranes, shrunken muscle cells in the lips and the tongue, soft eyes, and adverse effects to the central nervous system. Children become dehydrated more readily than adults, but they tolerate it better.