Oral Rehydration, Rapid Feeding, and Cholestyramine for Treatment of Acute Diarrhea

Abstract

Different combinations of fluid therapy, feeding regimen and cholestyramine were compared in search for optimal treatment of infants hospitalized for acute diarrhea. The infants (n = 81) received either rapid oral rehydration using the oral rehydration solution-WHO formula (Na 90 mmol/L, ORS-WHO) or traditional oral fluid replacement using a commercial glucose-electrolyte solution (Na 35 mmol/L); 1/2 of the infants in both groups received full feedings at 24 h of hospitilization; in the remaining infants, feedings were gradually introduced over 5 days. All the children were randomized to receive either cholestyramine 2 g 4 times daily or an equivalent amount of placebo. Rehydration with ORS-WHO, but not traditional fluid replacement therapy, led to correction of initial metabolic acidosis after 6-10 h; no cases of hypernatremia were observed with the use of ORS-WHO. Rapid return to full feedings appropriate for age, including milk products, was associated with better wt gain and significantly shorter duration of diarrhea compared with gradual introduction of feedings. Cholestyramine treatment further shortened the duration of diarrhea without adverse effects in those children who received ORS-WHO and thus were properly rehydrated. In children with poor initial hydration, cholestyramine treatment was associated with prolonged metabolic acidosis. Treatment of acute diarrhea by rehydration with ORS-WHO and rapid introduction of full feedings is effective and safe; this combination forms a therapy of choice for typical hospitalized cases of acute infantile diarrhea in Finland. Cholestyramine may be of value as an adjunct therapy after adequate rehydration.