In search of a super oral rehydration solution: can optimum use of organic solute-mediated sodium absorption lead to the development of an absorption promoting drug?
Mahalanabis, D.; Patra, F.C.
Journal of Diarrhoeal Diseases Research 1(2): 76-81
1983
ISSN/ISBN: 0253-8768 PMID: 6389663 DOI: 10.2307/23497902Document Number: 400133
A hypothesis is proposed that may lead to the development of a super oral rehydration solution (ORS). Possible ways of further enhancing the absorption of sodium and water from the small intestine in acute diarrhoea, through water-soluble organic solute-linked transport without imposing an osmotic penalty due to unabsorbed organic compounds are suggested. These ways are: (i) use of suitable polymers, such as polysaccharides and proteins; (ii) use of mixtures of rapidly absorbed organic molecules, such as D-hexoses and amino acids; and (iii) use of complex and variable mixtures of polysaccharides, proteins, protein hydrolysates, oligo- and mono-saccharides, di- and tri-peptides and amino acids. Based on these principles, optimum concentrations of organic compounds in ORS and use of compounds other than glucose (including sucrose, glucose polymer and rice powder) are discussed. Through clinical trials it already has been shown that addition of the amino acid glycine to standard glucose-containing ORS enhanced absorption of sodium and water, without imposing an osmotic penalty. To explore the possibility of further enhancing the absorption of ORS, clinical trials were conducted [in India] in infants and children, who had moderate-to-severe dehydration due to diarrhoea caused by rotavirus, Vibrio cholerae, enterotoxigenic Escherichia coli and others. The control group received standard WHO recommended ORS with glucose, while one study group received the same solution with added glycine, and the other received ORS in which 20 g glucose was replaced by 50 g of popped rice powder for each litre of fluid. Compared to the control groups, in the groups treated with rice ORS and glycine-glucose ORS, respectively, there was a significant reduction of three things: diarrhoeal stool output, by 49% and 50%; mean duration of diarrhoea, by 30% in each group; and volume of ORS needed to treat them, by 36% and 43%, respectively. In addition to replacing diarrhoeal losses, these two study solutions led to reduced magnitude and duration of diarrhoea. Thus, the two solutions assumed the role of highly effective absorption-promoting drugs. The results were superior to the effects of antisecretory drugs so far being tested in human studies.