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70-426: Oral rehydration therapy ( ORT ) is a type of fluid replacement used to prevent and treat dehydration , especially due to diarrhea . It involves drinking water with modest amounts of sugar and salts, specifically sodium and potassium . Oral rehydration therapy can also be given by a nasogastric tube . Therapy can include the use of zinc supplements to reduce the duration of diarrhea in infants and children under

140-497: A child regains his or her full appetite, the WHO recommends combining 25 grams skimmed milk powder, 20 grams vegetable oil, 60 grams sugar, and 60 grams rice powder or other cereal into 1,000 milliliters water and boiling gently for five minutes. Give 130 mL per kilogram of body weight during per 24 hours. A child who cannot or will not eat this minimum amount should be given the diet by nasogastric tube divided into six equal feedings. Later on,

210-410: A dropper or a syringe. Infants under two may be given a teaspoon of ORS fluid every one to two minutes. Older children and adults should take frequent sips from a cup, with a recommended intake of 200–400 mL of solution after every loose movement. The WHO recommends giving children under two a quarter- to a half-cup of fluid following each loose bowel movement and older children a half- to a full cup. If

280-758: A grant from the National Institute of Allergy and Infectious Diseases. He observed that children voluntarily drank as much of the solution as needed to restore hydration, and that rehydration and early re-feeding would protect their nutrition. This led to increased use of ORT for children with diarrhea, especially in developing countries. In 1980, the Bangladeshi nonprofit BRAC created a door-to-door and person-to-person sales force to teach ORT for use by mothers at home. A task force of fourteen women, one cook, and one male supervisor traveled from village to village. After visiting with women in several villages, they hit upon

350-749: A health facility. ORT is known in Bangladesh as Orosaline or Orsaline. From 2006 to 2011, UNICEF estimated that worldwide about a third of children under 5 who had diarrhea received an oral rehydration solution, with estimates ranging from 30% to 41% depending on the region. ORT is one of the principal elements of the UNICEF "GOBI FFF" program (growth monitoring; ORT; breast feeding; immunization; female education; family spacing and food supplementation ). The program aims to increase child survival in developing nations through proven low-cost interventions. Sources Fluid replacement Oral rehydration therapy (ORT)

420-446: A severely dehydrated child may be lethargic. If the child drinks poorly, a nasogastric tube should be used. The IV route should not be used for rehydration except in cases of shock and then only with care, infusing slowly to avoid flooding the circulation and overloading the heart. Feeding should usually resume within 2–3 hours after starting rehydration and should continue every 2–3 hours, day and night. For an initial cereal diet before

490-646: A small surgery may cause a loss of approximately 4 ml/kg/hour, and a large surgery approximately 8 ml/kg/hour, in addition to the basal fluid requirement. The table to the right shows daily requirements for some major fluid components. If these cannot be given enterally, they may need to be given entirely intravenously. If continued long-term (more than approx. 2 days), a more complete regimen of total parenteral nutrition may be required. Resuscitation fluid can be broadly classified into: albumin solution, semisynthetic colloids, and crystalloids. The types of intravenous fluids used in fluid replacement are generally within

560-402: Is where the solvent is substance 1, and the solute is substance 2. For solutions with more than one solute, the conversion is The sum of molar concentrations gives the total molar concentration, namely the density of the mixture divided by the molar mass of the mixture or by another name the reciprocal of the molar volume of the mixture. In an ionic solution, ionic strength is proportional to

630-503: Is a measure of the concentration of a chemical species , in particular, of a solute in a solution , in terms of amount of substance per unit volume of solution. In chemistry , the most commonly used unit for molarity is the number of moles per liter , having the unit symbol mol/L or mol / dm in SI units. A solution with a concentration of 1 mol/L is said to be 1  molar , commonly designated as 1 M or 1  M . Molarity

700-403: Is a simple treatment for dehydration associated with diarrhea , particularly gastroenteritis /gastroenteropathy, such as that caused by cholera or rotavirus . ORT consists of a solution of salts and sugars which is taken by mouth . For most mild to moderate dehydration in children, the preferable treatment in an emergency department is ORT over intravenous replacement of fluid. It

770-490: Is also reduced. The reduced osmolarity oral rehydration solution has lower concentrations of glucose and sodium chloride than the original solution, but the concentrations of potassium and citrate are unchanged. The reduced osmolarity solution has been criticized by some for not providing enough sodium for adults with cholera. Clinical trials have, however, shown reduced osmolarity solution to be effective for adults and children with cholera. They seem to be safe but some caution

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840-582: Is another isotonic crystalloid solution and it is designed to match most closely blood plasma . If given intravenously, isotonic crystalloid fluids will be distributed to the intravascular and interstitial spaces. Plasmalyte is another isotonic crystalloid. Blood products, non-blood products and combinations are used in fluid replacement, including colloid and crystalloid solutions. Colloids are increasingly used but they are more expensive than crystalloids. A systematic review found no evidence that resuscitation with colloids, instead of crystalloids, reduces

910-526: Is based on the weight of the patient using the Holliday-Segar formula . For weights ranging from 0 to 10 kg, the caloric expenditure is 100 cal/kg/day; from 10 to 20 kg the caloric expenditure is 1000 cal plus 50 cal/kg for each kilogram of body weight more than 10; over 20 kg the caloric expenditure is 1500 cal plus 20 cal/kg for each kilogram more than 20. More complex calculations (e.g., those using body surface area) are rarely required. It

980-485: Is best treated with ORT. Persons taking ORT should eat within six hours and return to their full diet within 24–48 hours. Oral rehydration therapy may also be used as a treatment for the symptoms of dehydration and rehydration in burns in resource-limited settings. ORT may lower the mortality rate of diarrhea by as much as 93%. Case studies in four developing countries also have demonstrated an association between increased use of ORS and reduction in mortality. ORT using

1050-487: Is called perioperative restrictive fluid therapy, also known as near-zero or zero-balance perioperative fluid approach; this approach recommends lower amounts of fluids during surgery, replacing fluids when the person is low (basal fluid requirements) or loses fluid due to a surgical procedure or bleed. The effectiveness of goal-directed fluid therapy compared to restrictive fluid therapy is not clear as evidence comparing both approaches have very low certainty. Fluid overload

1120-1190: Is defined as an increase in body weight of over 10%. Aggressive fluid resuscitation can lead to fluid overload which can lead to damage of multiple organs: cerebral oedema, which leads to delirium ; pulmonary oedema and pleural effusion , which lead to respiratory distress; myocardial oedema and pericardial effusion , which lead to impaired contractility of the heart; gastrointestinal oedema, which leads to malabsorption; hepatic congestion, which leads to cholestasis and acute kidney injury ; and tissue oedema, which leads to poor wound healing. All these effects can cause disability and death, and increase in hospitalisation costs. Fluid overload causes cardiac dilation, which leads to increased ventricular wall stress, mitral insufficiency and leads to cardiac dysfunction. Pulmonary hypertension can lead to tricuspid insufficiency. Excess administration of fluid causes accumulation of extracellular fluid , leading to pulmonary oedema and lack of oxygen delivery to tissues. The use of mechanical ventilation in such case can cause barotrauma , infection, and oxygen toxicity , leading to acute respiratory distress syndrome. Fluid overload also stretches

1190-402: Is important to achieve a fluid status that is good enough to avoid low urine production . Low urine output has various limits, and varies for children, infants, and adults (see low urine production ). The Parkland formula is not perfect and fluid therapy will need to be titrated to hemodynamic values and urine output. The speed of fluid replacement may differ between procedures. For example,

1260-746: Is not a contraindication to receiving oral rehydration therapy. In persons who are vomiting, drinking oral rehydration solution at a slow and continuous pace will help resolve vomiting. WHO and UNICEF have jointly developed official guidelines for the manufacture of oral rehydration solution and the oral rehydration salts used to make it (both often abbreviated ORS ). They also describe other acceptable solutions, depending on material availability. Commercial preparations are available as prepared fluids and as packets of powder ready to mix with water. A basic oral rehydration therapy solution can also be prepared when packets of oral rehydration salts are not available. The molar ratio of sugar to salt should be 1:1 and

1330-526: Is not absorbed. This is why oral rehydration salts include both sodium and glucose. For each cycle of the transport, hundreds of water molecules move into the epithelial cell to maintain osmotic equilibrium. The resultant absorption of sodium and water can achieve rehydration even while diarrhea continues. In the early 1980s, "oral rehydration therapy" meant only the preparation prescribed by the World Health Organization (WHO) and UNICEF . In 1988,

1400-399: Is often depicted with square brackets around the substance of interest; for example, the molarity of the hydrogen ion is depicted as [H ]. Molar concentration or molarity is most commonly expressed in units of moles of solute per litre of solution . For use in broader applications, it is defined as amount of substance of solute per unit volume of solution, or per unit volume available to

1470-531: Is often impossible to reliably distinguish between moderate and severe dehydration. A severely malnourished child who has signs of severe dehydration but who does not have a history of watery diarrhea should be treated for septic shock . The original ORS (90 mmol sodium/L) and the current standard reduced-osmolarity ORS (75 mmol sodium/L) both contain too much sodium and too little potassium for severely malnourished children with dehydration due to diarrhea. ReSoMal ( Re hydration So lution for Mal nutrition)

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1540-462: Is on the World Health Organization's List of Essential Medicines . Globally, as of 2015, oral rehydration therapy is used by 41% of children with diarrhea. This use has played an important role in reducing the number of deaths in children under the age of five . ORT is less invasive than the other strategies for fluid replacement, specifically intravenous (IV) fluid replacement. Mild to moderate dehydration in children seen in an emergency department

1610-728: Is potentially unsafe; rehydration takes precedence. When oral rehydration salts packets and suitable teaspoons for measuring sugar and salt are not available, the WHO has recommended that homemade gruels, soups, etc., may be considered to help maintain hydration. A Lancet review in 2013 emphasized the need for more research on appropriate home made fluids to prevent dehydration. Sports drinks are not optimal oral rehydration solutions, but they can be used if optimal choices are not available. They should not be withheld for lack of better options; again, rehydration takes precedence. But they are not replacements for oral rehydration solutions in nonemergency situations. In 2003, WHO and UNICEF recommended that

1680-500: Is preferred, and may be lifesaving. It is especially useful where there is depletion of fluid both in the intracellular space and the vascular spaces . Fluid replacement is also indicated in fluid depletion due to hemorrhage, extensive burns and excessive sweating (as from a prolonged fever), and prolonged diarrhea (cholera). During surgical procedures, fluid requirement increases by increased evaporation, fluid shifts , or excessive urine production, among other possible causes. Even

1750-415: Is recommended for such children. It contains less sodium (45 mmol/L) and more potassium (40 mmol/L) than reduced osmolarity ORS. It can be obtained in packets produced by UNICEF or other manufacturers. An exception is if the severely malnourished child also has severe diarrhea (in which case ReSoMal may not provide enough sodium), in which case standard reduced-osmolarity ORS (75 mmol sodium/L)

1820-431: Is recommended. Malnourished children should be rehydrated slowly. The WHO recommends 10 milliliters of ReSoMal per kilogram body weight for each of the first two hours (for example, a 9-kilogram child should be given 90 mL of ReSoMal over the course of the first hour, and another 90 mL for the second hour) and then continuing at this same rate or slower based on the child's thirst and ongoing stool losses, keeping in mind that

1890-500: Is sometimes called formal concentration or formality ( F A ) or analytical concentration ( c A ). For example, if a sodium carbonate solution ( Na 2 CO 3 ) has a formal concentration of c ( Na 2 CO 3 ) = 1 mol/L, the molar concentrations are c ( Na ) = 2 mol/L and c ( CO 2− 3 ) = 1 mol/L because the salt dissociates into these ions. In the International System of Units (SI),

1960-429: Is suspected give an antibiotic to which V. cholera e are susceptible. This reduces the volume loss due to diarrhea by 50% and shortens the duration of diarrhea to about 48 hours. Fluid from the body enters the intestinal lumen during digestion . This fluid is isosmotic with the blood and contains a high quantity, about 142 mEq/L, of sodium . A healthy individual secretes 2000–3000 milligrams of sodium per day into

2030-484: Is the Avogadro constant , since 2019 defined as exactly 6.022 140 76 × 10  mol . The ratio N V {\displaystyle {\frac {N}{V}}} is the number density C {\displaystyle C} . In thermodynamics , the use of molar concentration is often not convenient because the volume of most solutions slightly depends on temperature due to thermal expansion . This problem

2100-402: Is the molar mass of constituent i {\displaystyle i} . The conversion to mole fraction x i {\displaystyle x_{i}} is given by where M ¯ {\displaystyle {\overline {M}}} is the average molar mass of the solution, ρ {\displaystyle \rho } is the density of

2170-511: Is to maintain fluid and electrolyte levels and restore levels that may be depleted. Intravenous fluid therapy is used when a person cannot control their own fluid intake and it can also reduce nausea and vomiting. Goal-directed fluid therapy is a perioperative strategy in which the person is administered fluids continuously and the amount of fluids given are based on the person's physiological and haemodynamic (blood flow) measurements. A second approach to fluid management during surgical procedures

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2240-561: Is used around the world, but is most important in the developing world , where it saves millions of children a year from death due to diarrhea —the second leading cause of death in children under five. Similar precaution should be taken in administration of resuscitation fluid as to drug prescription. Fluid replacement should be considered as part of the complex physiological in the human body. Therefore, fluid requirements should be adjusted from time to time in those who are severely ill. In severe dehydration , intravenous fluid replacement

2310-457: Is usually resolved by introducing temperature correction factors , or by using a temperature-independent measure of concentration such as molality . The reciprocal quantity represents the dilution (volume) which can appear in Ostwald's law of dilution . If a molecule or salt dissociates in solution, the concentration refers to the original chemical formula in solution, the molar concentration

2380-470: Is via intestinal epithelial cells ( enterocytes ). Sodium passes into these cells by co-transport with glucose, via the SGLT1 protein. From the intestinal epithelial cells, sodium is pumped by active transport via the sodium-potassium pump through the basolateral cell membrane into the extracellular space . The sodium–potassium ATPase pump at the basolateral cell membrane moves three sodium ions into

2450-481: Is warranted according to the Cochrane review . ORT is based on evidence that water continues to be absorbed from the gastrointestinal tract even while fluid is lost through diarrhea or vomiting. The World Health Organization specify indications, preparations and procedures for ORT. WHO/UNICEF guidelines suggest ORT should begin at the first sign of diarrhea in order to prevent dehydration. Babies may be given ORS with

2520-456: The coherent unit for molar concentration is mol / m . However, most chemical literature traditionally uses mol / dm , which is the same as mol / L . This traditional unit is often called a molar and denoted by the letter M, for example: The SI prefix " mega " (symbol M) has the same symbol. However, the prefix is never used alone, so "M" unambiguously denotes molar. Sub-multiples, such as "millimolar" (mM) and "nanomolar" (nM), consist of

2590-434: The osmolarity of oral rehydration solution be reduced from 311 to 245 mOsm/L. These guidelines were also updated in 2006. This recommendation was based on multiple clinical trials showing that the reduced osmolarity solution reduces stool volume in children with diarrhea by about twenty-five percent and the need for IV therapy by about thirty percent when compared to standard oral rehydration solution. The incidence of vomiting

2660-507: The 1829 cholera pandemic in Russia and Western Europe. In 1831, William Brooke O'Shaughnessy noted the changes in blood composition and loss of water and salt in the stool of people with cholera and prescribed intravenous fluid therapy (IV fluids). The prescribing of hypertonic IV therapy decreased the mortality rate of cholera to 40%, from 70%. In the West, IV therapy became the "gold standard" for

2730-406: The WHO recommends supplemental zinc (10 to 20 mg daily) for ten to fourteen days, to reduce the severity and duration of the illness and make recurrent illness in the following two to three months less likely. Preparations are available as a zinc sulfate solution for adults, a modified solution for children and in tablet form. After severe dehydration is corrected and appetite returns, feeding

2800-546: The age of 5. Use of oral rehydration therapy has been estimated to decrease the risk of death from diarrhea by up to 93%. Side effects may include vomiting , high blood sodium , or high blood potassium . If vomiting occurs, it is recommended that use be paused for 10 minutes and then gradually restarted. The recommended formulation includes sodium chloride , sodium citrate , potassium chloride , and glucose . Glucose may be replaced by sucrose and sodium citrate may be replaced by sodium bicarbonate , if not available, although

2870-500: The arterial endothelium , which causes damage to the glycocalyx , leading to capillary leakage and worsens the acute kidney injury. Proctoclysis, an enema, is the administration of fluid into the rectum as a hydration therapy. It is sometimes used for very ill persons with cancer. The Murphy drip is a device by means of which this treatment may be performed. Molar concentration Molar concentration (also called molarity , amount concentration or substance concentration )

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2940-474: The basolateral membrane. Both SGLT1 and SGLT2 are known as symporters , since both sodium and glucose are transported in the same direction across the membrane. The co-transport of glucose into epithelial cells via the SGLT1 protein requires sodium. Two sodium ions and one molecule of glucose (or galactose ) are transported together across the cell membrane via the SGLT1 protein. Without glucose, intestinal sodium

3010-458: The body. ORT should be discontinued and fluids replaced intravenously when vomiting is protracted despite proper administration of ORT; or signs of dehydration worsen despite giving ORT; or the person is unable to drink due to a decreased level of consciousness; or there is evidence of intestinal blockage or ileus . ORT might also be contraindicated in people who are in hemodynamic shock due to impaired airway protective reflexes. Short-term vomiting

3080-714: The child should be given cereal made with a greater amount of skimmed milk product and vegetable oil and slightly less sugar. As appetite fully returns, the child should be eating 200 mL per kilogram of body weight per day. Zinc, potassium, vitamin A, and other vitamins and minerals should be added to both recommended cereal products, or to the oral rehydration solution itself. Children who are breastfed should continue breastfeeding. The WHO recommends that all severely malnourished children admitted to hospital should receive broad-spectrum antibiotics (for example, gentamicin and ampicillin ). In addition, hospitalized children should be checked daily for other specific infections. If cholera

3150-532: The class of volume expanders . Physiologic saline solution , or 0.9% sodium chloride solution, is often used because it is isotonic , and therefore will not cause potentially dangerous fluid shifts . Also, if it is anticipated that blood will be given, normal saline is used because it is the only fluid compatible with blood administration. Blood transfusion is the only approved fluid replacement capable of carrying oxygen; some oxygen-carrying blood substitutes are under development. Lactated Ringer's solution

3220-422: The definition was changed to include recommended home-made solutions, because the official preparation was not always available. The definition was also amended in 1988, to include continued feeding as associated therapy. In 1991, the definition became "an increase in administered hydrational fluids "; in 1993, "an increase in administered fluids and continued feeding". Dehydration was a major cause of death during

3290-777: The diarrhea losses reduced the need for IV fluid therapy by eighty percent.[46] In 1971, fighting during the Bangladesh Liberation War displaced millions and an epidemic of cholera ensued among the refugees. When IV fluid ran out in the refugee camps , Dilip Mahalanabis , a physician working with the Johns Hopkins International Center for Medical Research and Training in Calcutta, issued instructions to prepare an oral rehydration solution and to distribute it to family members and caregivers. Over 3,000 people with cholera received ORT in this way. The mortality rate

3360-415: The extracellular space, while pulling into the enterocyte two potassium ions. This creates a "downhill" sodium gradient within the cell. SGLT proteins use energy from this downhill sodium gradient to transport glucose across the apical membrane of the cell against the glucose gradient. The co-transporters are examples of secondary active transport . The GLUT uniporters then transport glucose across

3430-532: The idea of encouraging the women in the village to make their own oral rehydration fluid. They used available household equipment, starting with a "half a seer" (half a quart) of water and adding a fistful of sugar and a three-finger pinch of salt. Later on, the approach was broadcast over television and radio, and a market for oral rehydration salts packets developed. Three decades later, national surveys have found that almost 90% of children with severe diarrhea in Bangladesh are given oral rehydration fluids at home or in

3500-678: The illness resolves. Such children should be encouraged to resume normal feeding as soon as possible. Once diarrhea is corrected, the WHO recommends giving the child an extra meal each day for two weeks, and longer if the child is malnourished. Dehydration may be overestimated in wasted children and underestimated in edematous children. Care of these children must also include careful management of their malnutrition and treatment of other infections. Useful signs of dehydration include an eagerness to drink, lethargy, cool and moist extremities, weak or absent radial pulse (wrist), and reduced or absent urine flow. In children with severe malnutrition, it

3570-524: The illness. This supported the notion that oral rehydration might be possible even during severe diarrhea due to cholera. In 1967–1968, Norbert Hirschhorn and Nathaniel F. Pierce showed that people with severe cholera can absorb glucose, salt, and water and that this can occur in sufficient amounts to maintain hydration. In 1968, David R. Nalin and Richard A. Cash , helped by Rafiqul Islam and Majid Molla, reported that giving adults with cholera an oral glucose-electrolyte solution in volumes equal to those of

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3640-478: The intestinal lumen. Nearly all of this is reabsorbed so that sodium levels in the body remain constant . In a diarrheal illness, sodium-rich intestinal secretions are lost before they can be reabsorbed. This can lead to life-threatening dehydration or electrolyte imbalances within hours when fluid loss is severe. The objective of therapy is the replenishment of sodium and water losses by ORT or intravenous infusion. Sodium absorption occurs in two stages. The first

3710-408: The management of volume overload. In acute respiratory distress syndrome (ARDS), conservative fluid management is associated with better oxygenation and lung function with less prevalence of dialysis in the first 60 days of hospitalization when compared with liberal fluid management. Managing fluids during major surgical procedures is an important aspect of surgical care. The goal of fluid therapy

3780-555: The original ORS formula has no effect on the duration of the diarrheic episode or the volume of fluid loss, although reduced osmolarity solutions have been shown to reduce stool volume. The degree of dehydration should be assessed before initiating ORT. ORT is suitable for people who are not dehydrated and those who show signs and symptoms of mild to moderate dehydration. People who have severe dehydration should seek professional medical help immediately and receive intravenous rehydration as soon as possible to rapidly replenish fluid volume in

3850-502: The other half over the next 16 hours. In dehydration, 2/3 of the deficit may be given in 4 hours, and the rest during approximately 20 hours. Fluid replacement in patients with septic shock can be divided into four stages as shown below: Sepsis accounts for 50% of acute kidney injury patients in ( intensive care unit ) (ICU). Intravenous crystalloid is recommended as the first line therapy to prevent or to treat acute kidney injury (AKI) when compared to colloids as colloids increases

3920-420: The person speeds the recovery of normal intestinal function, minimizes weight loss and supports continued growth in children. Small frequent meals are best tolerated (offering the child food every three to four hours). Mothers should continue to breastfeed . A child with watery diarrhea typically regains their appetite as soon as dehydration is corrected, whereas a child with bloody diarrhea often eats poorly until

3990-428: The person vomits, the caregiver should wait 5–10 minutes and then resume giving ORS. ORS may be given by aid workers or health care workers in refugee camps, health clinics and hospital settings. Mothers should remain with their children and be taught how to give ORS. This will help to prepare them to give ORT at home in the future. Breastfeeding should be continued throughout ORT. As part of oral rehydration therapy,

4060-463: The planning of fluid replacement for burn patients is based on the Parkland formula (4mL Lactated Ringers X weight in kg X % total body surface area burned = Amount of fluid ( in ml) to give over 24 hours). The Parkland formula gives the minimum amount to be given in 24 hours. Half of the volume is given over the first eight hours after the time of the burn (not from time of admission to hospital) and

4130-528: The presence of glucose, sodium, and chloride could be absorbed in patients with cholera; but he failed because his solution was too hypertonic and he used it to try to stop the diarrhea rather than to rehydrate patients. In the early 1960s, Robert K. Crane described the sodium-glucose co-transport mechanism and its role in intestinal glucose absorption. This, along with evidence that the intestinal mucosa appears undamaged in cholera, suggested that intestinal absorption of glucose and sodium might continue during

4200-414: The resulting mixture is not shelf stable in high-humidity environments. It works as glucose increases the uptake of sodium and thus water by the intestines , and the potassium chloride and sodium citrate help prevent hypokalemia and acidosis , respectively, which are both common side effects of diarrhea. A number of other formulations are also available including versions that can be made at home. However,

4270-476: The risk of AKI. 4% human albumin may be used in cirrhotic patients with spontaneous bacterial peritonitis as it can reduce the rate of kidney failure and improve survival. However, fluid overload can exacerbate acute kidney injury. The use of diuretics does not prevent or treat AKI even with the help of renal replacement therapy . The 2012 KDIGO (Kidney Disease: Improving Global Outcomes) guidelines stated that diuretics should not be used to treat AKI, except for

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4340-402: The risk of death in patients with trauma or burns, or following surgery. Maintenance fluids are used in those who are currently normally hydrated but unable to drink enough to maintain this hydration. In children isotonic fluids are generally recommended for maintaining hydration. Potassium chloride and dextrose should be included. The amount of maintenance IV fluid required in 24 hours

4410-410: The solution should not be hyperosmolar . The Rehydration Project states, "Making the mixture a little diluted (with more than 1 litre of clean water) is not harmful." The optimal fluid for preparing oral rehydration solution is clean water. However, if this is not available, the usually available water should be used. Oral rehydration solution should not be withheld simply because the available water

4480-392: The solution. A simpler relation can be obtained by considering the total molar concentration, namely, the sum of molar concentrations of all the components of the mixture: The conversion to mass fraction w i {\displaystyle w_{i}} is given by For binary mixtures, the conversion to molality b 2 {\displaystyle b_{2}}

4550-424: The species, represented by lowercase c {\displaystyle c} : Here, n {\displaystyle n} is the amount of the solute in moles, N {\displaystyle N} is the number of constituent particles present in volume V {\displaystyle V} (in litres) of the solution, and N A {\displaystyle N_{\text{A}}}

4620-400: The sum of the molar concentration of salts. The sum of products between these quantities equals one: The molar concentration depends on the variation of the volume of the solution due mainly to thermal expansion. On small intervals of temperature, the dependence is where c i , T 0 {\displaystyle c_{i,T_{0}}} is the molar concentration at

4690-738: The treatment of moderate and severe dehydration. In 1953, Hemendra Nath Chatterjee published in The Lancet the results of using ORT to treat people with mild cholera. He gave the solution orally and rectally, along with Coleus extract, antihistamines, and antiemetics, without controls. The formula of the fluid replacement solution was 4 g of sodium chloride , 25 g of glucose , and 1000 mL of water . He did not publish any balance data, and his exclusion of patients with severe dehydration did not lead to any confirming study; his report remained anecdotal. Robert Allan Phillips tried to make an effective ORT solution based on his discovery that, in

4760-451: The unit preceded by an SI prefix : The conversion to number concentration C i {\displaystyle C_{i}} is given by where N A {\displaystyle N_{\text{A}}} is the Avogadro constant . The conversion to mass concentration ρ i {\displaystyle \rho _{i}} is given by where M i {\displaystyle M_{i}}

4830-408: The use of homemade solutions has not been well studied. Oral rehydration therapy was developed in the 1940s using electrolyte solutions with or without glucose on an empirical basis chiefly for mild or convalescent patients, but did not come into common use for rehydration and maintenance therapy until after the discovery that glucose promoted sodium and water absorption during cholera in the 1960s. It

4900-573: Was 3.6% among those given ORT, compared with 30% in those given IV fluid therapy. After Bangladesh won independence, there was a wide campaign to promote the use of saline in the treatment of diarrhea. In 1980, the World Health Organization recognized ORT and began a global program for its dissemination. In the 1970s, Norbert Hirschhorn used oral rehydration therapy on the White River Apache Indian Reservation with

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