Home-administered oral therapy for diarrhoea: a laboratory study of safety and efficacy

Abstract

Serum electrolytes were measured for persons treated for diarrhoea at home with prepackaged or locally available sugar and salt oral rehydration therapy (ORT) solutions and for persons with diarrhoea who received no ORT but were treated according to local customs. No detrimental effect was found for persons treated with ORT at home; no significant difference was found in the frequency at which members of the groups had hypernatraemia. The rates of hyponatraemia and hypokalaemia were significantly lower for persons who took estimated appropriate volumes of ORT than for those who took less than appropriate volumes or for persons treated according to local customs without ORT. These laboratory results indicate that ORT administered in rural homes in Bangladesh was safe and effective under the conditions of our study.

PIP: As part of an oral rehydration therapy (ORT) field trial, the serum electrolytes of 3 groups with diarrhea were analyzed: 1) persons receiving premixed packet fluids, 2) those receiving locally available salt (labon) and sugar (gur) fluids, and 3) those receiving no ORT intervention and treated according to local custom. Village workers provided instruction and supervision in the preparation of ORT during bimonthly home visits. Questionnaires and serum electrolyte measurements were available from 81 persons in the packet villages and 75 persons from the labon-gur villages. 5 persons treated with packet ORT (6%) and 3 persons treated with labon-gur ORT (4%) had electrolyte abnormalities, but all of them were taking less than appropriate volumes of ORT. In addition, serum electrolytes were evaluated in 489 persons admitted to a medical center after home treatment for diarrhea. No cases who took an appropriate volume of either type of ORT had hyponatremia or hypokalemia. There was no indication that electrolyte abnormalities varied by season or pathogen. Although the close supervision given to study participants and small size limit extrapolation of these results, the study suggests that ORT can be made and safely administered by villagers and that ORT administered at home may be a beneficial effect in preventing hyponatremia and hypokalemia