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