[e-drug] Re: Oral rehydration salts (ORS) - formulation (cont'd)

["Nalin, David R." <david_nalin@merck.com>]

E-drug: Re: Oral rehydration salts (ORS) - formulation (cont'd)
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The rationale for the WHO ORS formulation is based on well known published
clinical studies by Norbert Hirschhorn, David Nalin, Nathaniel Pierce,
Richard Cash and others. These studies determined the proportions of the
various components and the concentrations which in patients yielded the
best possible absorption rate and the  best net balance of water, sodium,
potassium and chloride, in the most severely ill patients with cholera and
other acute watery diarrheal diseases. The formulations were shown to have
highly satisfactory safety profiles, in infants as well as adults, and in
cases presenting with hypo- or hypernatremia at the start of treatment.
Reference list can be made available on request, but are freely available
in many published articles and can be obtained by searching Medline.
 
The major specific rational for the WHO formulation was that it could be
used in all ages and in cholera as well as noncholera acute watery
diarrheas. It achieves this by using less sodium and less chloride
concentration compared to the fluids lost by cholera patients (children as
well as adults) or by adult noncholera patients. Therefore adult cholera
patients remain in modest negative balance for a longer period when the
WHO formulation is used, compared to other formulations; however overall
treatment outcomes are similar.
 
An additional minor change affecting shelf life of the current WHO
formulation is the replacement of sodium bicarbonate with sodium citrate.
 
David Nalin
david_nalin@merck.com

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