Oral rehydration salt solutions: consensus and controversy

Oral rehydration salt (ORS) solutions were developed as an alternative to intravenous fluid for the treatment of dehydrated patients with diarrhoea. After a brief review of the historical background and the physiological basis for using ORS, the discussion is focused on the evolution of ORS and oral rehydration therapy (ORT) in the context of the original WHO-ORS. The debate centers around optimal electrolyte concentrations, particulary solidum and the ideal osmolality for use in children. The change in the original WHO-ORS was motivated by a desire to lessen stool outpout and the rate of resuming intravenous fluid. Newly formulated ORS containing a lower concentration of glucose and salts with reduced osmolality, is now officially recommended by WHO and UNICEF for global use. ORS containing complex carbohydrates as substrate (super-ORS) instead of glucose or resistant starch (super super-ORS), have shown a number of important benefits. Finally, a review of recent advances in ORS and ORT in USA, Europe and Croatia is presented. Nowadays, the use of ORT is universally recognized as the standard therapy for dehydration secondary to diarrhea.