4A-S1-3

 

THE SODIUM-GLUCOSE CO-TRANSPORTER AND NEW ORAL REHYDRATION SOLUTIONS IN ACUTE DIARRHEA

Emanuel Lebenthal

Department of Pediatrics, Hadassah University Hospital, Mt. Scopus, Jerusalem, Israel

 

The rationale for the use of oral rehydration solution is based on recognition of the intestinal transport function during diarrhea. First, because during diarrhea, the normal mechanism for water or saline fluids alone will only lead to more diarrhea. On the other, hand, the sodium-glucose-coupled transport water transport generally remains intact. This mechanism stimulates water transport generally by solvent drag. Recent studies demonstrate the advantage of short glucose polymers as the carbohydrate source in ORS. Our studies have shown that glucose absorption is optimized when the source is short polymers of glucose (G2-G9) made from a hydrolysate of rice. In higher caloric density and increased moles of glucose, yet present a smaller osmotic load. In addition, the high resistance of glucoamylade activity, the key enzyme for short polymers of glucose absorption, In addition to other intestinal disaccharidases during intestinal mucosal injury, is further rationale for their use. It is interesting that many developing countries have traditionally used rice water as a rehydration solution; only recently has ¡°science¡± documented its biological advantage. Some infants with diarrhea exhibit small intestinal mucosal injury reflective of both functional and anatomic disruption of the brush border membrane. Formulas consisting of complex carbohydrates, fats, and proteins require intact absorptive epithelial cells. Thus, the specific aim of the nutritional, therapy is to provide a high caloric, elemental, isosmorlar, and hypoallergenic formula that is easily absorbed and minimally dependent on digestive enzymes and active transport mechanisms. The specially designed formulas contain amino acids, short-chain polypeptides, glucose, short-chain glucose polymers, medium-chain triglycerides, and unsaturated fatty acids. These nutrient components require minimal intraluminal and mucosal surface digestion.

1. Lebenthal E: The pediatric Clinic of North America, 43:307-590,1996

2. Lebenthal E et al: Thermophilic amylase-digested rice-electrolyte solution in the treatment of acute diarrhea in children.pediatics95:198-202,1995

3. Lebenthal E et al: High-calorie, rice-derived, short-chain, glucose polymer-based oral rehydration solution in acute watery diarrhea Acta pediatr. 84:165-172,1995