Replacement of intravenous therapy by oral rehydration solution in a large treatment centre for diarrhoea with dehydration

Abstract

In this study the efficacy of oral rehydration solution (ORS) was compared with that of intravenous fluid (IVF) in the treatment of moderate and some severe cases of dehydration due to diarrhea in a treatment center in Bangladesh during 1980-81. 10,379 patients with moderate and severe dehydration in 1980 and 9897 in 1981 were studied, most were under age 5. Almost all uncomplicated diarrhea patients with moderate and severe dehydration admitted in 1980 were initially treated with IVF followed by ORS. The average amounts of IVF, ORS, and total fluid used/patient (based on a 10% sample of patients) were 1.26, 0.10, and 1.36 litres respectively in 1980 and 0.65, 1.16, and 1.81 litres in 1981. As of December 1980 only patients with pulselessness, shock, and vomiting were given IVF. In 1981, 94% of severe cases of dehydration were treated with IVF plus ORS compared to 100% in 1980 (p0.01) and 6% were treated with ORS alone compared to 0% in 1980 (p0.01). Among moderate cases of dehydration, 29% received IVF plus ORS in 1981 (92% in 1980) and 71% were successfully treated with ORS alone (8% in 1980). The percentage of patients staying for over 12 hours in the treatment center was 29.9% in 1980 and 42.1% in 1981. Among the patients staying less than 12 hours the mean duration of stay was 6.02 +or- 3.18 hours in 1980 and 6.73 +or- 3.35 hours in 1981, significant at the 0.001 level. IVF is shown to be effective in treating dehydration but costs more and presents greater risks including the introduction of septicaemic infection, pyrogenic reactions, embolism, phlebitis, thrombosis, and even rupture of the veins. ORS treatment is simple, safe, less costly, and can be taught to parents. No children treated with ORS died, but some IVF patients did, suggesting that only ORS therapy is fully effective. Average cost per patient in the treatment center was US$6.60 in 1980 and US$4.40 in 1981, a savings of 33.3%. Replacement of IVF by ORS led to the conclusion that developing countries should make ORS services available throughout the country in order to reduce hospital admissions and mortality