ORAL REHYDRATION SOLUTION IN THE YEAR 2000 - PATHOPHYSIOLOGY, EFFICACY AND EFFECTIVENESS

The use of oral rehydration solution (ORS) with early refeeding forms the basis of therapy for dehydration secondary to diarrhoea. ORS has p roduced such positive results in dehydrated patients that no further s cientific demonstration is needed to confirm its efficacy. This review presents several issues that remain unsettled or controversial. They include the following. 1. The mechanism of water handling by the intes tine is discussed; this is more complex than initially thought, at the epithelial, cellular and molecular level. 2. The composition of ORS w hich has been successfully adapted for the most frequent conditions, e xcept for severely malnourished children, is described. 3. in contrast to the strong scientific basis and obvious efficacy in rehydration of ORS, its consequences for growth, nutrition and mortality are difficu lt to demonstrate, unless adequate long-term nutritional support is al so provided in addition to ORS. 4. Finally, discrepancies between the recommendations and the practice of oral rehydration therapy are now w ell documented. Analysis of the causes of these discrepancies may part icipate in improving public health campaigns.