Talk:Oral rehydration therapy/Archive 1

Merge
(Merge done. Article still needs work. --Singkong2005 01:42, 7 May 2006 (UTC))

I think both oral rehydration therapy and oral rehydration salt articles are in poor condition (for the "drug of the century"), and should be merged and expanded! --Steven Fruitsmaak 13:30, 27 April 2006 (UTC)
 * Strong support for merge (and agree on need for lots of work). I agree that "oral rehydration therapy" is the better title, as it seems like a broader term than "Oral rehydration salts". --Singkong2005 15:12, 6 May 2006 (UTC)

Developed where?
The treatment using various salts have been developed in the late sixties -early 1970s. I'm surprised to hear about the "claim" of the salt being developed in mid 1980s. To the best of my knowledge, the Oral rehydration salt/saline was in market even in the 1970s. Claims like this need to be verified. Thanks --Ragib 06:01, 7 May 2006 (UTC)


 * I've removed this paragraph:
 * It has also been claimed that the ORS solution was invented in Finland during the mid 1980's by a pediatric medical research team working at the University of Tampere Hospital and Medical Center (TAYS). This team is also currently at work on Celiac Disease reaearch.
 * It seems like there is work done on oral rehydration therapy at the University of Tampere (I googled "Oral rehydration" Tampere), but the claim of invention seems dubious. --Singkong2005 06:49, 7 May 2006 (UTC)

Major work needed
As stated by Steven Fruitsmaak, above, the article is in poor condition. I've done some editing, and here are some more ideas:


 * Fluids and Hydration in Sport - includes a discussion of the role of hypotonic, isotonic and hypertonic drinks.


 * Create a Mechanism section. Mention osmosis. If drink is too concentrated, it will help to draw moisture into intestine (dehydrating). This seems to suggest that hypotonic mixtures are ideal, as suggested by the Fluids and Hydration in Sport page.


 * There are warnings on packets and on this website that the solution must be made accurately. However, note that recommended concentrations have varied over time, with different concentrations being considered effective. E.g. New formulation of Oral Rehydration Salts (ORS) with reduced osmolarity describes the change to a weaker solution, to reduce stool output while being just as effective at rehydrating; (the formula described appears much weaker than the webmd.com formula). However, too weak and it will be similar to water (going straight through the body); too strong and it won't rehydrate effectively.


 * Some formulas describe the use of anhydrous glucose - i.e. with no water of crystalization. I'm not sure how much this affects the measurement - I didn't think ordinary sugar had a significant amount of water in it, so I would guess that it shouldn't make a difference, and the glucose could be replaced by the same amount of ordinary sugar, if making it at home.


 * Treatment of dehydration: WHO recommendations, according to the degree of dehydration: Solutions correcting water, electrolyte and acid-base disturbances. Also states: "In cases of cholera, oral rehydration salts containing a higher concentration of sodium may be required to prevent hyponatraemia".

Cheers --Singkong2005 06:40, 7 May 2006 (UTC)

I tried making a quarter-size version of your "low-cost home recipe", curious about what it would taste like. (Disclaimer: the sugar I used was Sugar in the Raw turbinado sugar rather than pure white sugar, and it proved tough to measure out exactly a quarter-teaspoon of salt. Also, the water I used was bottled Dasani, which has a little bit of magnesium sulfate touch of potassium and a very, very small pinch of sodium chloride in it ("for a clean taste").) The taste was decent, even without adding bananas or orange juice. &mdash; Rickyrab | Talk 02:32, 17 June 2006 (UTC)


 * The low cost recipe described in Bangladesh by public health officials (as suggested by ICDDRB) is:


 * Tin anguler prothom bhajer ek chimti lobon (a pinch of table salt, as much as fits up to the first knuckle when using 3 fingers)
 * ek muth gur (1 fist ful of Jaggery)
 * adhaser pani (about 400 ml of water, equal to 1/2 ser (.4 kg in weight, local weight unit)


 * Apparently, the recipe is very simple and works fine. You don't need a precise quarter-teaspoon, just your fingure to measure the salt and your fist to measure the Jaggery. --Ragib 02:39, 17 June 2006 (UTC)

Remove and link recipes
I added a cleanup tag to the Recipe section, but then decided to delete most of it.

Wikipedia is not for recipes, but good links would be appropriate.

Appropedia (which is the major wiki for international development and public health, among other things) will develop links and a guide to appropriate recipes at Oral rehydration solution recipes, but it's not ready yet. If anyone has good info on recipes, it's most welcome there.

I've also discovered there are concerns about "Reduced osmolarity" ORS, as part of my work on related pages at Appropedia: Oral rehydration therapy,     Reduced osmolarity oral rehydration solution and  Starch-based oral rehydration solutions. I'm not ready to draw conclusions yet though (and haven't found secondary sources on the subject). --Chriswaterguy talk 04:11, 12 May 2008 (UTC)


 * I understand that wikipedia is, in general, not a guidebook, but I think a well-crafted recipe of an effective ORT solution would greatly benefit this article (among other things that it needs). I think in this case, we should make an exception because of the content. The article itself is not a guidebook or manual, it is detailed information surrounding ORT. I think a "preparation" section based on UNICEF/WHO guidelines would be most appropriate. Chaldor (talk) 10:58, 15 July 2008 (UTC)


 * Strongly agree. A common preparation is illustrative and complements the discussion of proper concentrations and osmosis. --Neurophyre(talk) 05:33, 17 August 2008 (UTC)


 * I have removed the cleanup tag from the Recipe section and have renamed it to Alternative Formulations with the impression that the home made receipe information is essential for the topic and has been adequately placeed with references. I have also placed the article in C Class as it seemed to be better than a Start-Class article but not impressive enough for a B-Class  D ip ta ns hu Talk 13:58, 1 November 2008 (UTC)

A key part of this article seems to be missing
I came here because i'm trying to understand how Oral Rehydration Therapy works. I read the entire page, and I still have no idea. Someone who does understand it should put a more simple description of why it works up somewhere. —Preceding unsigned comment added by 124.148.156.17 (talk) 03:30, 5 June 2010 (UTC)

Some of the history has been removed - some may be relevant
I notice that this section has been removed from the text. Some of it may be relevant, though, particularly if someone can give sources, so I'm noting it here:


 * ORT was developed in the late 1960s by researchers in India and International Centre for Diarrhoeal Disease Research in Bangladesh (then East Pakistan), for the treatment of cholera.

--Singkong2005 talk 01:09, 5 September 2006 (UTC)


 * Seemed to be ok, I readded it again.--Steven Fruitsmaak (Reply) 13:38, 5 September 2006 (UTC)

Following section sounds like advertisement of some researchers in ICDDRB. It could be rewritten in compact format. On the other hand it did not mention research work of Chatterjee who has publication in 1953 in Lancet journal who suggested almost same ORT formula that has been accepted later on.

"In 2002, Drs. Norbert Hirschhorn, Dilip Mahalanabis, David R. Nalin, and Nathaniel F. Pierce were awarded the first Pollin Prize for Pediatric Research, in recognition of their work in developing ORT.[3] In May 2001, the International Centre for Diarrhoeal Disease Research, Bangladesh received the first Gates Award for Global Health in recognition of its role in developing Oral Rehydration Solution. In 2007, three former ICDDR,B scientists, Dr. Richard Alan Cash, Dr. Dilip Mahalanabis and Dr. David R. Nalin, were also individually honoured for their efforts in testing and implementing ORS, sharing the 2006 Prince Mahidol Award for public health, which is presented annually for outstanding contributions in public health and medicine. In addition to the award for public health, a separate award for medicine was also presented to Professor Stanley George Schultz in recognition of his research on sodium absorption, which provided an important basis for the discovery of ORS."


 * I removed this section. It's not necessary. We need to be succinct in the history section. There's a lot of history to cover. Chaldor (talk) 09:43, 17 February 2009 (UTC)

Sports drinks
The article says sports drinks should not be used because they have "too much sugar and not enough salt", but my doctor prescribed sports drinks for this purpose, and I found a double-blind study (http://jpen.aspenjournals.org/cgi/content/abstract/30/5/433) that says Gatorade is just as effective as pedialyte or oral rehydration solution. Can the person who claimed sports drinks are bad please give a reference or something? 72.177.116.87 14:18, 13 September 2007 (UTC)


 * Current literature has shown that gatorade can be as effective as ORS for the treatment of mild diarrhea. However, gatorade does not contain enough potassium as ORS, so the patient will remain hypokalemic. This is typically not a problem in mild diarrhea, however, it can be a serious issue for moderate or severe diarrhea, where potassium losses can be significant. Gatorade treatment should be used with caution, and should not be used for children, as parents can often underestimate the severity of dehydration in their children. Chaldor (talk) 22:30, 15 July 2008 (UTC)


 * gatorade has too much sugar. it is actually osmotically more concentrated and causes osmotic diarrhea. You have to dilute the gatorade in half - and even that has too much sugar.  Pedialyte is closer - but even that has too much sugar and not enough of other salts.  It would be nice to see a table comparing them.  I've seen tables in lecutres - brands on the left / juices and molecules/Na/K/etc on the top. 75.43.214.71 (talk) 02:43, 20 November 2008 (UTC)


 * This is correct, I dug around for the nutrition facts and most sports drinks have 4x the sugar content than recommended for ORT. That makes them completely unsuitable as therapy. I will adjust the administration section accordingly. Chaldor (talk) 09:55, 17 February 2009 (UTC)


 * The inclusion of Sports Drinks in the category of fluids to be avoided is not supported by the footnoted reference http://whqlibdoc.who.int/hq/1993/WHO_CDD_93.44.pdf. Use of clean water to dilute Sports Drinks (making two liters of Gatorade with a 1 liter sachet) allows one to achieve whatever concentration one desires.  Even if the off-the-shelf concentration is 4x greater than the concentration of ORS, this does not equate to hypertonicity, it just means the sugar concentration is 4x that of ORS.  Just because a fluid is not ideal doesn't mean it should be avoided.  Extra sugar makes the fluid more palatable to a small child.  Who wants to drink saltwater? I view the inclusion of Sports Drinks in the category of fluids to be avoided as perpetuation of the old wives tale that soft drinks cause dehydration.  If this were true, my mother, who never drinks anything but Coca-Cola, would have been dead before I was ever born.  This is an important matter to settle, because it's a matter of life and death.  Gatorade is much more widely available in my world than ORS sachets.  Surely a rule of thumb like "1 part water 1 part Gatorade" is more useful to a mother whose infant has diarrhea than telling her to parch the child until she can find an NGO do-gooder handing out ORS sachets.  email broughtonspence@hughes.net if anyone wants to discuss.  —Preceding unsigned comment added by 199.208.239.141 (talk) 17:08, 27 March 2009 (UTC)


 * Hi 199.208.239.141, thanks for your comment. You are correct, there isn't explicit mention of sports drinks in the reference mentioned, however page 3 clearly states that sweetened drinks should be avoided. Sports drinks are definitely in the category of sweetened drinks, so I think the statement, though perhaps it could be better referenced, is still valid. Please comment if you think this is still not valid.
 * Further, the fact that soft drinks cause dehydration is not an old wives' tale. It is actually grounded in physiology. Please see the mechanism of the SGLT transporter (coupling of glucose transport to salt). As mentioned in the same reference on page 3, sweetened drinks do indeed exacerbate dehydration through osmosis: since there is not enough salt to aid in absorbing the excess glucose, the glucose, by passive osmosis, draws water into the lumen of the intestine, lowering the extracellular fluid volume and furthering dehydration. The reason this does not affect most people who solely drink cola (like your mother) is twofold: 1) they have likely never been severely dehydrated to the point that any of this would be of effect, and 2) they have not been without salt intake (to help absorb the excess sugar) for any extended period of time (most people get far too much salt in their diet in a typical day). Those people who are severely dehydrated generally do not eat solid foods, and if they were to rely on sweetened drinks like cola or sports drinks, they would only worsen their dehydration. It can be a dangerous situation. This is supported to an extent by the following paper as well:
 * Your comment regarding titrating down the sports drink is definitely reasonable, particularly if the appropriate level of salt is also added to the mixture. However, the issue is that not all sports drinks contain the same ingredients, and any blanket statement about what ratios to use will be off for various drinks. Under the administration section, there are several commonly available drinks listed in the case where ORS sachets are unavailable, and under the availability section, there are even links to how to create home-made equivalents to ORS using water, sugar, and salt. Between these options, it seems to me at least, that there is adequate options for any individual seeking to dispense ORT in the case where ORS is not available (i.e. anyone that has access to sports or soft drinks should also have equal access to vegetable or chicken soup). One of the points of the WHO paper cited was to highlight why sweetened drinks are not ideal to use to treat dehydration and to then offer accessible alternatives.
 * Just a small housekeeping note, please sign your statements on talk pages with four tildes ( ~ ) so we can keep track of who said what. I'd also urge you to sign up for an account to gain even more abilities! Please continue to contribute. Thanks! Chaldor (talk) 04:01, 28 March 2009 (UTC)


 * Coconut water deserves more than just a 1-line mention. According to the coconut water article, it looks like it's superior to Gatorade and other sports drinks for purposes of oral rehydration therapy. According to the cited sources, it can even be used as intravenous saline in a pinch.
 * In the US, coconut water is available packaged in drink boxes; it's marketed in natural food stores as an alternative to sports drinks. Reading this article makes me want to keep a few of those aseptic boxes of coconut water on hand for gastric emergencies. ~Amatulić (talk) 01:58, 30 January 2009 (UTC)
 * This is not true. Coconut water is not suitable as ORT because there is too little salt and far too much sugar in it. It's not as bad as a soft drink, but still far from ideal. It is even listed in the WHO/CDD/93.44 reference as an unsuitable drink. I will add it to the list under the administration section. Chaldor (talk)

No magnesium?
This article needs some mention of magnesium. Why is it not part of the recipes? --Una Smith (talk) 05:30, 28 December 2007 (UTC)


 * Magnesium is not part of the UNICEF/WHO guidelines for ORT. There is very little magnesium in the extracellular compartment (diarrhea is an isotonic loss of fluid from this space) and therefore there is no need to replace it. Chaldor (talk) 11:03, 15 July 2008 (UTC)
 * I have worked this into the article. --Una Smith (talk) 15:20, 15 July 2008 (UTC)
 * I'm not quite sure this is worth mentioning in the article. Why would we discuss the lack of magnesium versus any other trace mineral in the body? We could just as well insert the same line for iron, calicium, phosphorus, copper, flouride, idoine, selenium, etc. Do you see where I'm going with this? In my opinion, it's not important to list any of these that are lacking in the ORT formula (it's just not relevant to the article), magnesium is no different. Chaldor (talk) 20:03, 15 July 2008 (UTC)
 * I think the common ingredients of commercial electrolyte drinks are worth mentioning, with explanation of why those ingredients are not included in ORT. However, perhaps they should be collected under a separate heading? --Una Smith (talk) 20:09, 15 July 2008 (UTC)
 * That, I completely agree with. An explanation surrounding why the UNICEF/WHO guidelines don't include the stuff that's found in commercial electrolyte drinks would be very appropriate. It does need its own section. Chaldor (talk) 20:40, 15 July 2008 (UTC)
 * Please go ahead and make the section, then. --Una Smith (talk) 03:18, 16 July 2008 (UTC)


 * I'm going to take a step back here and say that there's no need to bother with what the sports drinks have or don't have. This article is on ORT and ORS, there's no need to defend why certain items are missing. We'll state what's in ORS, describe the physiological basis, and briefly explain why too much sugar is bad. Chaldor (talk) 09:59, 17 February 2009 (UTC)

Receipe
In the receipe section ORS content is mentioned in mmol/l, i think the constituent should be mentioned in grams/litre, as mentioned in UNICEF, i think i need to learn how to make tables on wikipedia, some assistance will be helpful on doing this. -- Rohit Singh 04:15, 17 June 2006 (UTC)

More importantly, it needs to be presented in *USEFUL* units of measure.

This isn't rocket science, it's a simple emergency in-home treatment for a dangerous medical condition. People don't need to be getting instructions fit for a chemistry lab, they need simple basic units of measure THAT THEY ARE FAMILIAR WITH. Teaspoons and tablespoons, pinches and handfuls, etc. Very few people have laboratory balances in their homes. —Preceding unsigned comment added by 68.241.151.35 (talk) 07:50, 15 February 2009 (UTC)

Variations on recipe
Here, it is recommended that the solution be made from "8 level teaspoons of sugar and 1 level teaspoon of table salt mixed in 1 liter of water (Rehydration Project: Home made recipe)....A half cup of orange juice or half of a mashed banana can be added to each liter both to add potassium and to improve taste."

However, the webmd.com website suggests a solution of 2 tablespoons of sugar and one quarter teaspoon of salt, plus one quarter teaspoon of baking soda.

Another web site suggests that the correct proportion actually depends on the medical diagnosis of the patient. Thus, both formulæ may be correct: the WebMD formula may be best for certain diseases (such as, for example, some type of gastroenteritis that causes loss primarily of fluids), and the formula in the current version of this article may be best for different diseases (such as, for example, those that cause loss of both fluids and electrolytes); can an expert review this please? 69.140.152.55 02:59, 2 November 2007 (UTC)


 * I think we should be very careful with the way we design the recipe (or whatever we change the name to) section. Whatever we create, it should reflect the low osmolarity ORS concentrations set by UNICEF/WHO and we need to have strong cautions against home-made preparation for pediatric use. As the pediatric population is incredibly sensitive to the salt levels, whenever possible, commercial preparations, such as Pedialyte or ORS sachets, should be used. Chaldor (talk) 22:38, 15 July 2008 (UTC)


 * I want to reaffirm my position on this issue. I don't think this article should be providing information on how to make a home-made ORS solution. The WHO/UNICEF recommendations are pretty clear that home remedies as ORT are acceptable during initial stages of diarrhea, but once dehydrated, it should be handled with official ORS preparations, ideally via a trained health care provider. As such, I think it is fine if the recipe is in units not easily measurable because no one should undertake creating non-exact ORS solutions (i.e. those that you don't have to break the chemistry set out for). As far as a home-made solution goes, salted rice water or salted chicken soup should be more than adequate for preventing dehydration for mild/moderate diarrhea. For anything more serious than that, you don't want to leave things to chance with imprecise measurements. Chaldor (talk) 10:07, 17 February 2009 (UTC)

Rework History Section
The entire history section needs to be redone. Not only is it unbalanced and biased, it doesn't even have a coherent flow (i.e. not based on chronology). Additionally, the large paragraph on Chatterjee borders on original research. I'll try to get to work on this and make some sense of it and clean this up. I also don't think the history section should to be the first section of this article. Chaldor (talk) 06:29, 11 February 2009 (UTC)
 * Reading through the history section more carefully, it definitely seems like the writer of many of the Chatterjee sections was on some mission to validate this individual's work. I'm not going to downplay or call into question his work, but no other scientists were cited by name in the section and neither should Chatterjee. I will remove all the conspiracy stuff regarding crediting or not crediting his discovery and condense the paragraphs to make it about this history of ORT, not the work of one man. Chaldor (talk) 09:40, 16 February 2009 (UTC)
 * I take some of that back. There are scientists/physicians referenced by name. A single reference to him is appropriate. Chaldor (talk) 10:06, 16 February 2009 (UTC)

Likewise with the content about the alleged history of Gatorade. Whether or not it's true, it doesn't belong here. —Preceding unsigned comment added by 68.241.151.35 (talk) 07:53, 15 February 2009 (UTC)
 * Agreed, I didn't notice that. I have removed it. Thanks! Chaldor (talk) 09:37, 16 February 2009 (UTC)


 * Reverted edits regarding Chatterjee again. Please discuss these before reverting again. Chaldor (talk) 02:24, 22 February 2009 (UTC)


 * you people are idiots. if you can't tolerate the legitimate info about gatorade, then all this PC bengali war stuff shouldn't be in there either.  hey chaldor, you don't own the history of Oral rehydration therapy.  and guess what, more people care about college football than some lame bengali war and some amateur 'scientist'.  get over it, and keep your nationalist emotions out of wikipedia.
 * 66.31.140.250, thank you for your input. I have reverted your edit regarding gatorade history because I cannot see its connection to ORT. Dehydration due to diarrhea is treated with ORT. That is the standard of care. Dehydration due to sweating is a different type of fluid loss. The ions lost in sweating are different from that lost in diarrhea, and therefore ORT is not the best mechanism for rehydration. Further, gatorade is not ORT (please see the administration section the reference cited there, currently reference #4, for further information why). This article is stricly about ORT. Please feel welcome to reply to this if you have any further questions or insight that you feel is relevant. Thank you. Chaldor (talk) 00:41, 23 February 2009 (UTC)


 * the section is about HISTORY. The history of the development of the diarrhea treatment you love so much.  The section is not saying that gatorade is oral rehydration therapy, it is just a portion of the history that led to the development of oral rehydration therapy.  just like the info about Sushruta and coconut milk.  or are you going to delete that too?
 * Please stop your reverting. It is vandalism. If it persists, I will call for admin intervention. What you need to understand is that gatorade did not lead to the development of ORT. Where is the reference for that? There is no evidence as far as I am aware of that gatorade had any connection to the development of ORT. Until you can provide a viable reference for this, please keep the history section clean of any mention of gatorade. I will revert your edit one last time. If you add it in once again, I will call for intervention. Please discuss and provide references for your information in the talk page here before continuing, otherwise you may face a ban. Further, please sign your posts to talk pages (both here and on my talk page) with four tildes ~ to identify yourself. Thank you. Chaldor (talk) 00:53, 23 February 2009 (UTC)


 * hey chaldor, it's not vandalism, since it's explained in the discussion section, right here, why you are wrong. you are the one needly reverting things because you feel like you control the history of ort.  why do you feel that way? who put you in charge?  as i mentioned before, gatorade is just as relevant as the info about Sushruta and coconut milk.  where's the evidence that sushruta directly led to ort?  but for some reason, it's still in there.  what you are trying to create is the impression that some third worlder pulled ort out of the sky.  the history of gatorade shows that the use of salt and sugar drinks to treat dehydration was already well-known and mass-marketed in the rest of the world.  the use of gatorade solutions to treat dehydration specifically from diarrhea is just the next step leading to what is now called ort.  why is that so hard for you to understand? and by the way, i'd love to see you ban me. remember, what goes around comes around. if you want to enjoy wikipedia, your shouldn't pick fights like this.
 * Just to make everything crystal clear, I want to point out the issue here. You say "the use of gatorade solutions to treat dehydration specifically from diarrhea is just the next step leading to what is now called ort". That is the crucial line that is the problem. In saying that it's the next logical step, you are making a claim that is unverified. This is original research (WP:OR) and it is not allowed in articles. In retrospect from 2009, of course it seems like the next logical step; however, back when ORT was being developed, it was anything but the next step. Physicians were treating dehydration due to diarrhea with IV fluids, and restricting even food intake (a horribly ineffective treatment that had a mortality rate upwards of 30% for severe cases). Nonetheless, that was considered the standard of care back then. The entire medical community had to be convinced via evidence through numerous publications and reports that an oral solution was effective. Had the gatorade folk tried to say that their electrolyte drink was useful for diarrhea dehydration back then (I have no idea whether they did or not), they would have been mocked by the physicians of the time. I will admit that historical context is hard to come by, and I'm sure this section isn't presenting the context in the best light and could be improved, but until there is any credible references to gatorade having any impact on the development of ORT, it can't be included. What I do see though, is a need to explain what the standard of care for dehydration due to diarrhea was back in the 1950s-60s so this all makes a bit more sense. Thanks for helping to bring that to light! Chaldor (talk) 08:20, 23 February 2009 (UTC)

hey chaldor, you don't control the history of Oral rehydration therapy, nor the definition. you need to learn to accept your limitations. you'll be happier in life.


 * hey chaldor, i fixed the history section so now even you can understand it. it now has subsections so you can see how ort treatment was actually developed.  can you accept that?
 * No, I'm sorry, I can't accept that. You still have not addressed the issue of inserting non-referenced material into the article. You also fail to understand that your justification of why gatorade lead to ORT constitutes original research policy and is a violation of wiki policy (please see WP:OR). The wiki also has a three revert rule (WP:3RR) which you have violated, but I will not. I am not trying to promote any nationalistic tendancy here. In fact, I am the one that removed the large portion of Chatterjee's discussion if you read above (attributiting the development of ORT to Dr. Phillips). I am sorry, I have tried to be patient with you, but I am referring this to the admins for review. Chaldor (talk) 01:34, 23 February 2009 (UTC)
 * User was blocked per WP:AIV notification. See User_talk:66.31.140.250. Chaldor (talk) 05:52, 23 February 2009 (UTC)


 * so chandor, just because you "can't accept" my contributions, you can delete it and try to have me banned? you sure are an asset to wikipedia.  oh, and by the way, the history section should should have the gatoraide info to provide historical context for the development of sucrose/sodium drinks.  im giving you one last chance to try to understand this.

hey chandor, do you know what vandalism means?
Does this sound like vandalism to you?

http://en.wikipedia.org/wiki/Wikipedia:VAND#NOT

Stubbornness. Some users cannot come to agreement with others who are willing to talk to them about an editing issue, and repeatedly make changes opposed by everyone else. This is regrettable—you may wish to see our dispute resolution pages to get help. Repeated deletion or addition of material may violate the three-revert rule, but this is not "vandalism" and should not be dealt with as such. See also Tendentious editing

If a user treats situations which are not clear vandalism as such, then it is he or she who is actually harming the encyclopedia by alienating or driving away potential editors.

Based on the fact that you can't understand what is vandalism and what isn't, is it safe to assume that you don't understand the history of ORT? we're going to have to get an administrator, won't we? I know you put in a lot of hard, well-meaning work into this topic, but you don't own it. —Preceding unsigned comment added by 129.170.125.75 (talk • contribs) 2009-02-23


 * I don't know of any other way to say this to help you understand. Original research is not allowed in articles pages. Please see WP:OR. This is not my rule, this is a wiki policy. The claim you are making that gatorade contributed to the development of ORT must be backed up by a credible reference. I have asked you several times to please provide a reference for the claim you are making, but you have provided none. Until you can provide one, it cannot be included in the article. That being said, if you do find one, I'd be happy to see it in the history section! I am not trying to be a fascit or a dictator, nor do I think I own the page (far from it!). I am just following the very clear rules set forth by the wiki regarding content inclusion. If you refuse to accept these and continue with your changes, then your edits do constitute vandalism. If you don't believe me, please see the second paragraph of WP:VAN, which states: adding a controversial personal opinion to an article once is not vandalism; reinserting it despite multiple warnings is. I will revert your edit once again. Please do not add it back in until you can provide a credible reference for it. If you continue to revert without an edit, then it is vandalism and I will have no choice but to refer you to WP:AIV. I don't want to do this, because I welcome your contributions, but if you force my hand, I will have no choice. The duration of the bans will only get longer from here on out, and I don't want you to leave, so I please ask for your cooperation in accordance with wiki policy. As fellow wikipedians, we must all cite our sources (WP:CITE) for our claims! Otherwise there's no merit behind our work. Thanks for your understanding! Chaldor (talk) 23:56, 23 February 2009 (UTC)


 * I agree with Chaldor here. You can contribute content. Controversial claims require sources that comply with the Wikipedia policies WP:V and WP:RS. If you can find such sources, then add your content and cite your sources.


 * One more thing: Anonymous user, sign your posts please. It's easy, just put four tildes ( ~ ) at the end of what you type. ~Amatulić (talk) 01:47, 24 February 2009 (UTC)


 * chaldor, the information i added was extensively referenced. and they are hardly "controversial claims." Amatulic, i would invite to actually read it before you jump in. the section you keep deleting doesn't claim that gatoraid is ort.  the subtitle of the section is "Glucose and sodium solutions and treatment of dehydration."  this provides historical context to the treatment of dehydration using sucrose/sodium solutions.  sucrose/sodium solutions solutions were then used to treat diarrhea, which what ort is.  that is in the next section.  the subtitles should make it easy for even you to understand.  so, it'll go back in.  it seems that you just don't think it's fits in with your idea of the "history of ort." but that's just your idea of history.  history isn't just what's in chaldor's head.  oops, i forgot to sign again.  —Preceding unsigned comment added by 129.170.124.78 (talk) 20:16, 27 February 2009 (UTC)


 * This is still not acceptable. You've changed your argument now. Previously, you were saying that gatorade helped in the development of ORT and thus should be included. You are no longer saying that (as you have no credible reference) and are now saying that gatorade should be included in the article for historical context because it relates to treating dehydration. That might be all well and good if this were an article on dehydration and dehydration therapy. However, this article is on ORT. Anything that does not directly relate to ORT has no business in this article. Claiming that gatorade has some relation to ORT because they both treat dehydration is an incredible stretch (as I've explained before the types of losses are different) and an unrelated fact which provides no historical context in the development of ORT. Further, you do cannot claim that gatorade helped influence the development of ORT either. Therefore, I cannot see on what basis this content should be included in the article. By your inclusion criteria, we should also add a paragraph or two on the big bang and how it lead to the formation of water because cavemen drank water to treat their dehydration. Don't you see how absurd your proposal is? I am removing this, again. As there is a disagreement on inclusion here, I am requesting that you withhold any futher edits/reverts until consensus has been reached. Please see WP:CON for more information about this wiki policy. Let me remind you that other editors have already commented that gatorade has no business in this article (Amatulic and 68.241.151.35) and thus the currently established consensus is for this content to not be included in the article. Before you can add the information in, you must seek consensus supporting your position. If you continue to include information about gatorade without seeking consensus here on the talk page first, you are breaking wiki policy and I will have no choice but to refer this again. Chaldor (talk) 04:45, 28 February 2009 (UTC)


 * Anonymous editor: yes, I agree the text you added was well referenced. However, it does not fit the context of this article. The refereces don't say that Gatorade was developed as a treatment for the ailments that require oral rehydration therapy. The reference don't say that Gatorade is used for such therapy. In fact, other references advise against using sports drinks as part of oral rehydration therapy. That last word "therapy" is the key word you're missing. ORT is a medical procedure, not mere rehydration needed as a result of physical exertion. Claiming that the development of Gatorade has anything to do with the development of oral rehydration therapy worldwide, constitutes original research.


 * I actually like what you wrote, but it belongs in sports drink or Gatorade, not here.


 * Chaldor, I recommend you use the "Undo" feature for reverting good-faith edits. The tool you're using erroneously labels the anon's edit as vandalism. This isn't vandalism. It's a good-faith contribution that, regrettably, belongs in another article. ~Amatulić (talk) 20:55, 2 March 2009 (UTC)
 * Hi Amatulic, thanks for you comments and your involvement in this issue. Your feedback is most appreciated and very timely. I would like to clarify my position and point out my contrasting view on this situation. The first or second time, I will agree with you, it would be a good-faith edit. If you look back on the edit history, you will see that I did assume good-faith on the first reversion and did not flag it as vandalism. However, as the second paragraph in the WP:VAN policy states (quoted above earlier) that subsequent edits done intentionally despite warnings and with disregard to consensus can be viewed as vandalism. Particularly given the belligerent and insulting communication that accompanied these edits, I think my flagging as vandalism was appropriate. Perhaps I could have reverted the second edit with AGF as well, but I think my take on this is valid particularly since a admin(s?) at WP:AIV agreed with my report and issued a 12-hour block (see User_talk:66.31.140.250, though it was defined as edit-warring). I think there is a sentiment among many of the editors that vandalism is limited only to clear cases of page defacement (blanking, adding obscenity/nonsense), but my interpretation of the policy seems to extend quite a bit beyond that (and takes into account the conveyed intent in the edit as well). I place a great emphasis on cooperation and respect when it comes to the editing of articles. When one editor (registered or otherwise) clearly goes out of their way to disrespect both other contributing editors (with insults and other derogatory means) and wiki policies (explicitly and intentionally violating consensus policies and even the simple signing of talk page posts guidelines), I perceive that as a pretty clear case of vandalism. Given that my sentiment is backed up by the definition of the policy, I think my position is justifiable. At the same time, I also do recognize that this behavior can also fit within the definition of WP:EW. Ultimately, I'm still not entirely clear on the distinction between vandalism as defined by the second paragraph of WP:VAN and edit-warring. I would certainly like to hear your opinion on my view if you have the time, because it certainly wasn't an easy decision to make and then follow through with. Thanks! Chaldor (talk) 10:27, 4 March 2009 (UTC)
 * I'm actually fairly curious about this, so I'm also going to ask the general question in Wikipedia_talk:Vandalism with a link to this as an example so I can gain additional feedback. I still definitely want your feedback as well though! Chaldor (talk) 10:32, 4 March 2009 (UTC)


 * Sorry, I haven't visited here in a while. In my view, edit-warring isn't necessarily vandalism. Most edit-warring I see involves editors attempting to make changes that they view as constructive improvements, and the editors disagree about what constitutes improvement. In these cases the tempers may flare but the edits are nevertheless made in good faith, in spite of heated disagreement. In these cases vandalism warnings are inappropriate, although 3RR warnings may be warranted.
 * That seems to be what happened here. Just because someone isn't as cooperative as you want, doesn't mean you can accuse that editor of vandalism because you disagree with the edits. ~Amatulić (talk) 04:13, 31 March 2009 (UTC)


 * Hi Amatulic. Thanks for your continued feedback on this. I did ask this question in WP:VPP and you were right. I gathered that the general consensus regarding this kind of edits was edit warring, not vandalism. However, my interpretation was made based on the lines found on the second paragraph of of WP:VAN. I still find the lines in question to be a bit unclear. I need to suggest a revision to this sentence to clarify any confusion. Thanks for helping me to understand the distinction between these two more clearly. Chaldor (talk) 23:09, 6 April 2009 (UTC)

Robert Crane in History Section
Hi Armando Navarro. Thanks for your contribution to the history section. I undid this edit because it's a bit out of context and Crane is mentioned in the review article by Guerrant (currently ref 29). Going into futher detail surrounding the all the contributors of the discovery of the SGLT transporter is a bit much for this article in my opinion. Additionally, the statement isn't exactly accurate. Crane was not the first to find the absorption correlation of sugar+salt. There were definitely studies in animals (guinea pigs) that predated Crane's findings in the 50s. Let me know what you think. Chaldor (talk) 23:01, 6 April 2009 (UTC)

Response
The reference that you, Chaldor, base your arguments on, "Cholera, Diarrhea, and Oral Rehydration Therapy: Triumph and Indictment”, is extremely vague on the history of the discovery of cotransport. It is so vague that it only devotes one short phrase to the subject : “Physiological studies performed during the 1950s illustrated the cotransport of sodium and glucose”. The word discovery doesn’t appear, but a Wikipedia contributor (you ?) has abusively, as I demonstrate below, interpreted this and written: “In 1950s, by experimenting on rats and guinea pigs, physiologists discovered that sodium and glucose were transported together across the gastrointestinal epithelium.”

The scientists mentioned in "Cholera, Diarrhea, and Oral Rehydration Therapy: Triumph and Indictment" in relation to cotransport are Fisher and Parsons on the one hand and Riklis and Quastel on the other, but none of them discovered the sodium-glucose cotransport as the mechanism for intestinal glucose absorption as I will show below, only Crane discovered cotransport.

In the Welcome Witness to 20th Century Medicine symposium, based on a meeting of experts, the role of Fisher and Parsons as compared to Crane is explained:

“Of course, the seminal work that led to our key modern view of how sodium-coupled glucose transport occurs was a model drawn by R. K. Crane, published in an extraordinarily interesting symposium which was held in Prague in 1960. -- Without doubt this model --- continues to dominate thinking right through to 1999. I would like to ask the question, why wasn’t such a model put forward by able people such as Dennis Parsons – or David Smythe in Sheffield”. (A large part of the following discussion in the symposium involved why workers from the UK failed to discover sodium-glucose cotransport).

Crane has himself discussed the work of Riklis and Quastel:

“the focus of their work was on the effects of K+ concentrations on transport, effects with which I disagreed and the effect of zero Na+ was only observed incidentally to the use of the highest K+ concentration. Riklis and Quastel made no speculation on the meaning of the Na+ effect so there was no question of any priority on my concept of coupling.”

The fact that Crane was the sole discoverer of cotransport and the importance of his discovery are well documented, here are some samples :

In “Sugar Absorption in the Intestine: The Role of GLUT 2” Crane is reference 28, and his work is discussed on page 36 as the “classical model of secondary active intestinal glucose absorption.” by two members of the Department of Biology of The University of York and two others from the Centre de Recherche des Cordeliers in Paris.

From the Department of Physiology of the David Geffen School of Medicine at UCLA :

“Crane and colleagues (3) were the first to propose that active solute transport may employ the potential energy inherent in the Na+ gradient across the cell membrane. Specifically, they postulated that active glucose transport across the brush border of the intestinal epithelium is driven by the Na+ gradient across the membrane, i.e., Na+-glucose cotransport.”

“Crane in 1961 was the first to formulate the cotransport concept to explain active transport [7]. Specifically, he proposed that the accumulation of glucose in the intestinal  epithelium across the brush border membrane was  coupled to downhill Na+ transport cross the brush border. This hypothesis was rapidly tested, refined and extended [to] encompass the active transport of a diverse range of molecules and ions into virtually every cell type.”

“In the 1960s, two milestones were reached in the physiology of intestinal sugar absorption. The ﬁrst was the Na+ -glucose cotransport hypothesis of Crane and colleagues, which explained active sugar transport”

From the Department of Physiology of the UCLA School of Medicine : “In 1960 Bob Crane proposed that the ‘active’ transport of sugars was due to Na+/sugarcotransport. Over the past 34 years the cotransport hypothesis has been conﬁrmed, reﬁnedand extended to many other active transport systems in animals, plants and bacteria.”

A professor of the Department of Physiology, Anatomy & Genetics of the University of Oxford:

“the insight from this time that remains in all current text books is the notion of Robert Crane published originally as an appendix to a symposium paper published in 1960 (Crane et al. 1960). The key point here was 'flux coupling', the cotransport of sodium and glucose in the apical membrane of the small intestinal epithelial cell. Half a century later this idea has turned into one of the most studied of all transporter proteins (SGLT1), the sodium–glucose cotransporter.”

Chaldor, you are right on one thing, my contribution was repetitive, but the repetition that should have been eliminated is the previous contribution which, as I have shown above, abusively interprets a reference that is too vague to begin with.

Therefore the paragraph about the history of cotransport in the Wikipedia ORT article should be written in the following manner:

In 1960, the biochemist Robert K. Crane presented for the first time his discovery of the sodium-glucose cotransport as the mechanism for intestinal glucose absorption. Using histological analysis and isotope studies, it was shown that the intestinal mucosa was not disrupted in cholera, as previously thought. These findings were confirmed in human experiments, where it was shown that glucose-containing ORT significantly decreased the necessity for IV fluids by 70-80%. These results helped establish the physiological basis for the use of ORT in clinical medicine.

Instead of :

In 1950s, by experimenting on rats and guinea pigs, physiologists discovered that sodium and glucose were transported together across the gastrointestinal epithelium. Using histological analysis and isotope studies, it was shown that the intestinal mucosa was not disrupted in cholera, as previously thought. These findings were confirmed in human experiments, where it was shown that glucose-containing ORT significantly decreased the necessity for IV fluids by 70-80%. These results helped establish the physiological basis for the use of ORT in clinical medicine.

Armando Navarro (talk) 14:45, 8 April 2009 (UTC)


 * Sounds great to me. It's concise, accurate, and fits well in the context. I know very little about the history of the cotransport pump, so I was just going by the references at hand. The sources you've provided make it more than clear who the credit goes to and it seems relevant in the article. Definitely a bit overkill just to convince me, but hey...I appreciate the info dump! Thanks! Chaldor (talk) 07:02, 14 April 2009 (UTC)

Recent recipe addition removed
I'd like to provide further feedback since there was a comment that the talk page did not discuss the recipe issue. First, the information is not authoritative. It is not linked, it is not verifiable. Further, based on my understanding of the recommendations, I don't believe the WHO would advise home formulations of ORS. Published literature by the WHO (for exmaple, current reference #4) states that basic sugar+salt preparations (or things like vegetable soup or rice water) should be administered during the early stages of dehydration. However, moderate/severe dehydration should always be treated by a licensed medical professional. Providing an unreferenced recipe for ORS is not aligned with these recommendations. The danger is that home-preparations may not be properly formulated and can cause more harm than good if the proper balance of ingredients is not present. Additionally, the article links (in reference #8 under availability) to some recipes that can be used with sufficient supporting material and alternatives so that individuals seeking an ORS equivalent have something to turn to. As also previously mentioned earlier in the talk page, the wiki is not a howto or a cookbook, and providing some recipe when the WHO guidelines stipulate using ORS sachets is not a good idea. I have, once again, removed this recipe. Chaldor (talk) 02:53, 8 June 2009 (UTC)
 * I came to this article to look for the recipe I had noticed previously. As far as I can see you removed it arbitrarily. Your deletion reduces the usefulness and readability of the article. Your comments above don't justify your removal. The recipe is given in reference #8. The recipe or, if you wish to call it a solution, is an illustrative example of a sugar+salt solution. Your deletion in my opinion is unjustified and arbitrary. Please don't simply delete useful information, fix the problem. Darrell_Greenwood (talk) 04:54, 8 June 2009 (UTC)


 * I'm sorry that you disagree with my justification and the previously established consensus. That recipe was added recently without consensus and despite the previous discussion about recipes here. The recipe issue had been discussed in previous sections on this talk page, please refer to them for comments from other users. Please refer to wiki policy regarding what wikipedia is not: WP:NOTHOWTO. In the past, I had made the argument that this article could benefit from a carefully detailed recipe. Upon reading the WHO guidelines, it became clear that there are no recommended ways to make a homemade ORS solution, only the official one from sachets, ideally dispensed from a medical professional. This ultimately took the form of exact concentration of ingredients table that is currently displayed on the article. Providing a recipe that is non-WHO approved is a false representation of an equivalent solution and constitutes original research WP:OR. ORS is, by definition, only the exact preparation detailed in the chart set by WHO/UNICEF. ORT, on the other hand, encompasses all forms of rehydration and does not require special preparation. As mentioned before and in the article, vegetable soup or rice water can constitute ORT. I understand that the recipe is listed in reference 8, that was probably where the original editor got it from. However, rehydrate.org is not WHO, nor does it claim to be. Additionally, rehydrate.org does a fairly decent job of providing the supporting material explaining that there are very easy alternatives to use (carrot soup, rice water) instead of making a home formula. It is enough that this article links to that page at all. I believe I did fix the problem by removing the unrefereced, non-athoritative, wrongly-attributed, and non-guideline compliant home formula. Please let me know if you still disagree with this and we can seek a third opinion. Thanks. Chaldor (talk) 06:56, 8 June 2009 (UTC)
 * OK I'll leave the section deleted. I have added an illustrative example of a simple solution of salt, sugar and water from the reference to the preceeding paragraph. Thanks Darrell_Greenwood (talk) 16:24, 8 June 2009 (UTC)


 * That's a great idea. It's very clear that's it's just some attempt at a home formula, and the reference is also right there. Sounds like a perfect compromise without drawing too much attention to the recipe itself. Thanks! Chaldor (talk) 18:08, 8 June 2009 (UTC)

Needs to mention home recipes & Pedialyte
For this article to be of practical usefulness, it needs to at least mention what's available if, e.g., you have a sick kid on the weekend. If there's shyness about giving a home recipe, at least mentioning that it can be made at home is of considerable practical value.


 * Pedialyte has been in the article for some time now. Thanks for the comment. Chaldor (talk) 05:54, 28 June 2009 (UTC)

Rice based ORS is recommended in patients with cholera (quite good in other patients)
Fontaine O, Gore SM, Pierce NF. Rice-based oral rehydration solution for treating diarrhoea.

Cochrane Database Syst Rev. 2000;(2):CD001264. Update in: Cochrane Database Syst Rev. 1998;(4):CD001264.

Division of Child Health and Development, World Health Organization, Via Appia, 1211 - Geneva -27, Switzerland. fontaineo@who.ch

BACKGROUND: Oral rehydration therapy is used to treat dehydration caused by diarrhoea. However the rehydration solution does not reduce stool loss or length of illness. A solution able to do this may lessen the use of ineffective diarrhoea treatments as well as improve morbidity and mortality related to diarrhoea. OBJECTIVES: The objective of this review was to assess the effects of rice-based oral rehydration salts solution compared with glucose-based oral rehydration salts solution on reduction of stool output and duration of diarrhoea in patients with acute watery diarrhoea. SEARCH STRATEGY: We searched the Cochrane Infectious Diseases Group trials register, the Cochrane Controlled Trials Register, Medline, Embase, Lilacs and the reference lists of relevant articles. We also contacted researchers in the field. SELECTION CRITERIA: Randomized trials comparing standard World Health Organization oral rehydration solution with an experimental oral rehydration salts solution in which glucose (20 grams per litre) was replaced by 50-80 grams per litre of rice powder, with the electrolytes remaining unchanged. DATA COLLECTION AND ANALYSIS: Data were extracted independently by a statistician and a clinician. MAIN RESULTS: Twenty-two trials were included. Concealment of allocation was adequate in 15 of these trials. Irrespective of age, people with cholera who were given rice oral rehydration salts solution had substantially lower rates of stool loss than those given oral rehydration salts solution in the first 24 hours. Mean stool outputs in the first 24 hours were lower by 67 millilitres/kg of body weight (weighted mean difference -67.4, 95% confidence interval -94.3 to -41.0) in children, and by 51 millilitres/kg of body weight (weighted mean difference -51.1, 95% confidence interval -65.9 to -36.3) in adults. The rate of stool loss in infants and children with acute non-cholera diarrhoea was reduced by only four millilitres/kg of body weight (weighted mean difference -4.3, 95% confidence interval -9.3 to 0.8). REVIEWER'S CONCLUSIONS: Rice-based oral rehydration appears to be effective in reducing stool output in people with cholera. This effect was not apparent in infants and children with non-cholera diarrhoea.

[PubMed - indexed for MEDLINE]

---

Alam NH, Islam S, Sattar S, Monira S, Desjeux JF. Safety of rapid intravenous rehydration and comparative efficacy of 3 oral rehydration solutions in the treatment of severely malnourished children with dehydrating cholera.

J Pediatr Gastroenterol Nutr. 2009 Mar;48(3):318-27.

Clinical Sciences Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh. nhalam@icddrb.org

OBJECTIVES: Assess the safety of rapid intravenous rehydration of severely malnourished children and compare the efficacy of 3 formulations of oral rehydration salts solutions. PATIENTS AND METHODS: A group of 175 severely malnourished children of either sex (weight/length <70% of National Center for Health Statistics median), ages 6 to 36 months with cholera, were randomly assigned to receive 1 of 3 oral rehydration solutions (ORSs): glucose-ORS (n=58), glucose-ORS plus 50 g/L of amylase-resistant starch (n=59), or rice-ORS (n=58). Severely dehydrated children at enrollment were administered 100 mL/kg of an intravenous solution for 4 to 6 hours before randomisation, and those with some dehydration were randomised on enrollment. The electrolytes of the 3 ORSs were identical. In acute and convalescence phases, treatment was similar other than the nature of the ORSs. RESULTS: Intravenous fluid (mean) administered to 149 study children was 103 mL/kg (95% confidence interval [CI] 96-109), and all were rehydrated within 6 hours. None of them developed overhydration or heart failure. During the first 24 hours, stool output (31%; 95% CI 14%-42%; P=0.004) and the ORS intake (26%; 95% CI 12%-37%; P=0.002) of children receiving rice-ORS were significantly less compared with children receiving glucose-ORS. The mean duration of diarrhoea in all children (66 hours; 95% CI 62-71), and time to attain 80% of median weight/length (7.15+/-2.81 days) were not different. CONCLUSIONS: Dehydration in severely malnourished children can safely be corrected within 6 hours. All study ORSs were equally efficient in correcting dehydration. Rice-ORS significantly reduced the stool output and ORS intake, confirming previous reports.

[PubMed - in process]


 * Salted rice water is mentioned as a sourced recommendation for the early home stages of ORT. Thanks. Chaldor (talk) 05:56, 28 June 2009 (UTC)

Emergency home-made ORT -- when the WHO isn't handy and you have a sick kid.
The recipe or some links are needed to provide information needed pronto by someone who has a really sick child (or is really sick but doing self-care) so they can either find it in a store or (if they can't get out) mix it themselves.

As Wikipedia's article on Oral Rehydration Therapy shows, glucose or dextrose plus salt are essential to the transport of water out of the gut and into the bloodstream.

Dr. Grattan Woodson, MD, FACP has provided this F&OS manual August 29, 2006 © Copyright 2006 Grattan Woodson Available at http://www.birdflumanual.com/resources/Home_Influenza_Treatment/files/Good%20Home%20Treatment%20of%20Influenza/Default.asp 10-point download http://www.birdflumanual.com/resources/Home_Influenza_Treatment/files/Good%20Home%20Treatment%20of%20Influenza%2010pt.pdf


 * Preventing or treating dehydration in people with flu will save more lives than any other intervention during the influenza pandemic.


 * Treatment of dehydration
 * The Oral Rehydration Solution (ORS) is an excellent treatment for all causes of dehydration. It is just what the thirsty body needs to restore the lost fluid.  The water, salt, and sugar in the formula team up to speed the patient’s recovery.  The quantity of sugar in the ORS can be varied depending on patient preference.  It can be increased up to 4 tbsp or reduced to 2 tbsp if desired by the patient.  For some people, the ORS will taste too salty.  In this case, increase the water content to 1.5 or even 2 quarts leaving the remainder of the formula unchanged.


 * The Adult ORS formula for dehydration
 * 1-quart clean water
 * 1 level tsp table salt
 * 3 tbsp table sugar

"This booklet on home treatment of influenza was written for consumers, public health agencies, businesses, and non-profit organizations and may be copied and distributed in part or in whole without a licensing fee as long as it is properly referenced as below. Suggested reference:  Grattan Woodson, MD, FACP An edited excerpt from The Bird Flu Manual, BookSurge Publishing, Charleston, SC, reprinted with permission."

A tiny pinch of baking soda or potassium salt, added to the mixture won't hurt if one or both are handy, but neither is it essential, and take care not to overdo potassium or baking soda.

If diarrhea is an issue, ORT based on rice starch may work even better at providing patient comfort than the original dextrose-based formulation. Table sugar (sucrose) by itself can actually cause more diarrhea, even as it allows more water to be absorbed, because it splits into a dextrose, which promotes hydration, and fructose, which tends to draw water into the bowel. Rice starch breaks down into glucose at a fairly measured rate, and just when needed for the transport, reducing or at least not increasing the diarrhea that can occur even with a glucose / salt formula.

Commercial preparations such as Pedialyte and others are available in the infant-care section of pharmacies or large grocery stores. Many of these are based on rice starch.

"Too little" salt or sugar is better than too much.

It's dextrose that is your target. Other sugars -- table sugar, even fruit juice, contain both dextrose and other unhelpful sugars, such as fructose, that may increase diarrhea.

Sports drinks such as Gatorade are counterproductive where dehydration is from diarrhea, rather than sweat. They have 4x too much sugar for a diarrhea treatment, which actually promotes diarrhea, and may be worse than nothing. If they are all you have, dilute with 3X their volume in potable water and add just a bit of salt. —Preceding unsigned comment added by 68.165.11.120 (talk • contribs) 2009-06-25


 * Not withstanding the fact that all of the above is completely unsourced and therefore inappropriate for inclusion, we have a strict policy: Wikipedia is not a how-to guide or source of medical advice. ~Amatulić (talk) 21:37, 25 June 2009 (UTC)


 * Yes, there is a line to be crossed with avoiding unsourced how-to lists. This suggestion is in discussion to allow discussion and consensus on how to reconcile Wikipedia's mission making general, useful information readily available with its sound policy to avoid giving medial advice.


 * Answering a post of someone's symptoms to tell the person what they should do is medical advice. General information is general information -- not tailored. To people who have determined for themselves that, e.g., the baby has diarrhea, the very most useful general information is what, in general, might be done to save a baby that appears to have diarrhea.  Wikipedia's mission would be undercut if the most salient general information were unavailable.


 * BTW, infants often have diarrhea when they first get flu, and adults sometimes get it when exposed to a pandemic strain. Patients with both H5N1 bird flu and the 2009 swine flu variant not uncommonly present with diarrhea -- which is one reason it is timely to include general information useful for triage by a parent with very limited time, or a very sick person, readily available.  Here's Wikipedia's policy, for ready reference:


 * WIKIPEDIA DOES NOT GIVE MEDICAL ADVICE


 * Wikipedia contains articles on many medical topics; however, no warranty whatsoever is made that any of the articles are accurate. There is absolutely no assurance that any statement contained or cited in an article touching on medical matters is true, correct, precise, or up-to-date. The overwhelming majority of such articles are written, in part or in whole, by nonprofessionals. Even if a statement made about medicine is accurate, it may not apply to you or your symptoms.


 * The medical information provided on Wikipedia is, at best, of a general nature and cannot substitute for the advice of a medical professional (for instance, a qualified doctor/physician, nurse, pharmacist/chemist, and so on). Wikipedia is not a doctor.


 * None of the individual contributors, system operators, developers, sponsors of Wikipedia nor anyone else connected to Wikipedia can take any responsibility for the results or consequences of any attempt to use or adopt any of the information presented on this web site.


 * Nothing on Wikipedia.org or included as part of any project of Wikimedia Foundation Inc., should be construed as an attempt to offer or render a medical opinion or otherwise engage in the practice of medicine.
 * —Preceding unsigned comment added by 67.101.142.46 (talk • contribs) 2009-06-26


 * First: Please sign your posts using four tildes ( ~ ).
 * Second: Please review NOTHOWTO.
 * Third: Medical advice disguised as general information is still medical advice, especially if you go so far as to provide a recipe. If you can propose some concise and well-referenced text that does not advocate a specific recipe, then feel free to do so. So far, what you are proposing is not appropriate. ~Amatulić (talk) 19:12, 26 June 2009 (UTC)


 * See [Oral Rehydration Therapy, Section: Availability] for example of home-prepared solution and reference to other recipies. Darrell_Greenwood (talk) 23:33, 25 June 2009 (UTC)

Rice based ORS is recommended in patients with cholera.

 * Rice based ORS


 * Rice powder, being mostly starch, releases more than twice the amount of glucose when digested than is present in standard ORS solution. This is enough glucose to support both the absorption of water and electrolytes in the ORS solution and the reabsorption of a portion of the water and electrolytes secreted into the bowel as part of the diarrheal process. Protein in the rice powder may add to this effect through the release and absorption of amino acids. The osmotic activity of rice-ORS solution (about 220 mOsm/l) is lower than that of blood or other tissues (about 290 mOsm/l).


 * The results of the clinical trials performed to date indicate that the rate of stool loss is significantly reduced in patients with acute diarrhea given rice-ORS solution as compared with patients given glucose-ORS solution and it also reduces the duration of diarrhea.


 * Rice based ORS is recommended in patients with cholera. Future studies are needed to assess the effect of rice based ORS in children with acute, non-cholera diarrhea.

http://www.pediatriconcall.com/fordoctor/diarrhea/oral_dehydration_therapy.asp

— Preceding unsigned comment added by 66.167.61.124 (talk) 01:39, 25 June 2009 (UTC)

History's neutrality
Following Talk:Robert_K._Crane, neutrality requires history to show that : Armando Navarro (talk) 13:30, 22 July 2009 (UTC)
 * 1) the view that cotransport led to ORT is the scientific consensus;
 * 2) the opposing viewpoint is a tiny minority view.


 * I must politely disagree. The discussion in Crane's page never reached consensus, and cannot be used to support a position here or elsewhere. Please resolve the discussion there before attempting to present a consensus to influence other articles. Thank you. Chaldor (talk) 04:13, 25 July 2009 (UTC)

As shown in Talk:Robert_K._Crane : History must therefore conform to WP:Undue weight.
 * 1) the scientific consensus is supported by numerous sources,
 * 2) the opposing view is supported by only one source.

Armando Navarro (talk) 13:27, 25 July 2009 (UTC)

See also section - removed
I provided a brief edit summary for removing the see also section the first time in mid-July. I found it recently added in again. I have removed it once more and would like to explain further why I don't feel the listed items should be in a see also section. Both pedialyte and dehydration are linked in the article body itself. According to WP:SEEALSO, items linked directly in the article body are generally not linked again in a see also section. I just wikilinked electrolyte as well, so that one is taken care of also. Sports drink is not a good choice to link in a see-also for this article because sports drinks are not advised for use in ORT. Most sports drinks contain far too much sugar and not enough salt and will worsen diarrhea. If it belongs anywhere in the article, it should be in the list of drinks to avoid under the administration section. Chaldor (talk) 09:59, 3 August 2009 (UTC)

An example of a home mix to prevent (although not necessarily to treat)
ORS: The medical advance of the century, UNICEF, The State of the World’s Children 1996, panel 10:

“ .  .  .  The Bangladesh Rural Advancement Committee (BRAC), for example, has shown mothers in Bangladesh how to mix water, salt and molasses to prevent dehydration when a child falls ill with diarrhoea. . .  ”


 * As we state in our lead, we need to draw a distinction between preventing dehydration and treating it once it occurs. But this might be a good practical example of a home mix to prevent.   Cool Nerd (talk) 23:40, 5 March 2010 (UTC)

tsp. vs. tablespoon differences between ORT formulas on "Cholera" Treatment section and ORT pages
I'm very new at this, but believe I found what appears to be major difference between 2 Wiki articals that address units of measurement for ORT formulas. For subject Cholera paragraph Treatment the 1 to 8 ratio is listed as tsp (teaspoon) per liter of water. For subject Oral Rehydration Therapy the 1 to 8 ratio measurment units are listed as Tablespoon for same liter of water. Hopefully this is the correct way of asking if someone needs to review the units of measure. Cft67ygv (talk) 01:24, 29 October 2010 (UTC)

WHO on Basic Solution.
The following is perhaps not quite what we need, but perhaps an example of the kind of information WHO might be able to provide. Cool Nerd (talk) 19:32, 12 August 2011 (UTC)

http://www.who.int/bulletin/archives/78(10)1246.pdf page 4 (page 1250 internally)

“North-east Brazil. . . ORT was introduced in the early 1980s and was accompanied by extensive efforts to train health workers and strong campaigns in the mass media. ORS became widely available and millions of plastic measuring spoons were distributed for the preparation of salt

“and sugar solutions at home. In 1991 a representative survey showed that either ORS solution or homemade salt and sugar solutions were used in 35%of all episodes and in 62% of those regarded as severe by mothers. Socioeconomic conditions worsened during this decade but there were improvements in water supply, vaccine coverage, the duration of breastfeeding and nutritional status. A simulation model indicated that changes in factors other than ORT explained a 21% reduction in infant mortality attributable to diarrhoea, about a third of the actual decline. . .  ”

Need additional authoritative sources for Basic Solution
Our section Basic Solution currently cites two sources which are okay but not great. One is a wiki how-to, and the other seems okay but has crapola ads right in the middle of of the text. Let's keep these two, but perhaps add a couple of additional sources as well. And, as noted below, the recipe of the ratio of sugar and salt added to one liter of water does differ somewhat between these two sources. Cool Nerd (talk) 05:22, 12 August 2011 (UTC)

http://www.wikihow.com/Make-an-Oral-Rehydration-Salts-Drink-(ORS) "Place 4 level teaspoons of sugar and a half a level teaspoon of salt into one litre of clean water." "Be very careful to mix the correct amounts, as too much sugar can make the diarrhoea worse, and too much salt can be extremely harmful to the child."

http://rehydrate.org/solutions/homemade.htm " .  .  .  properly mixed with clean water from a safe source, and (2) take zinc tablets or syrup for 10–14 days" "The following traditional remedies make highly effective oral rehydration solutions and are suitable drinks to prevent a child from losing too much liquid during diarrhoea: "Ingredients:
 * Breastmilk
 * Gruels (diluted mixtures of cooked cereals and water)
 * Carrot Soup
 * Rice water -  Congee"
 * Six (6) level teaspoons of Sugar
 * Half (1/2) level teaspoon of Salt
 * One Litre of clean drinking or boiled water and then cooled - 5 cupfuls (each cup about 200 ml.)"

'''^^^ PLEASE NOTICE THAT BOTH THESE RECIPES ARE A LITTLE BIT DIFFERENT, ALTHOUGH PERHAPS BOTH IN ACCEPTABLE RANGE. and there is a question between 'OLD' and 'NEW' recipe, as below section includes link(s). ^^^''' Cool Nerd (talk) 20:00, 13 August 2011 (UTC)

++++++++++++++++++++++++++++++

The following WHO source for cholera goes with the ratio of 6 to 1/2:

World Health Organization, Global Task Force on Cholera Control, WHO position paper on Oral Rehydration Salts to reduce mortality from cholera " .  .  .  In case ORS packets are not available, caregivers at home may use homemade solutions consisting of half a teaspoon of salt and six level teaspoons of sugar dissolved in one litre of safe water [emphasis added]. Alternatively, lightly salted rice water or even plain water may be given. To avoid dehydration, increased fluids should be given as soon as possible. All oral fluids, including ORS solution, should be prepared with the best available drinking water and stored safely. Continuous provision of nutritious food is essential and breastfeeding of infants and young children should continue.  .  .  "

Are we giving 'old' or 'new' recipe?
And this is significant. A lot of the information, as below, seems rather technical. We need to find sources, still authoritative, that rather bridge this gap, and include the best, most current information in terms everyday people can understand. Cool Nerd (talk) 20:37, 13 August 2011 (UTC)

New formulation of Oral Rehydration Salts (ORS) with reduced osmolarity- February 2004 http://www.supply.unicef.dk/catalogue/NewORSQ&A.pdf

The following is good, but it's not telling teaspoons per liter. http://apps.who.int/medicinedocs/en/d/Js4950e/2.4.html

The Document listed first in the following search within UNESCO. http://www.unesco.org/new/en/custom-search/?cx=000136296116563084670%3Ah14j45a1zaw&cof=FORID%3A9&ie=UTF-8&q=osmolarity&hl=en&siteurl=www.unesco.org%2Fnew%2Fen%2Funesco%2F#620 Seems to be saying that the sodium chloride 2.6 grams/liter, glucose (anhydrous) 13.5 grams/liters, potassium chloride 1.5 grams/liter, and trisodium citrate (dihydrate) 2.9 grams/liter (page 4), which is the new reduced osmolarity formula is APPROXIMATELY EQUAL to a home recipe of 8 teaspoons sugar and 1 teaspoon salt to a liter of water (page 8). Although the packet formula (page 7) seems somewhat different, specifically more sugar. Cool Nerd (talk) 18:44, 14 August 2011 (UTC)

--

New formulation of Oral Rehydration Salts (ORS) with reduced osmolarity-February 2004 “New ORS” Q&A http://www.supply.unicef.dk/catalogue/NewORSQ&A.pdf " .  .  .  In spite of this success, there remains criticism from health workers and mothers that the original ORS solution did not stop diarrhoea or reduce the duration of the episode. This is why, during the past 20 years, research has been undertaken to develop an “improved” ORS that would be safe and effective for treating or preventing dehydration in all types of diarrhoea, and would also have other clinical benefits when compared with standard ORS.  .  .  "
 * So the problem is the diarrhea. The parent, understandably, wants something that will reduce the diarrhea.  Cool Nerd (talk) 22:36, 14 August 2011 (UTC)

--

THE TREATMENT OF DIARRHOEA, A manual for physicians and other senior health workers, World Health Organization, 2005 http://whqlibdoc.who.int/publications/2005/9241593180.pdf (page 9) Fluids that normally contain salt, such as: • ORS solution • salted drinks (e.g. salted rice water or a salted yoghurt drink) • vegetable or chicken soup with salt. (page 10) "Zinc can be given as a syrup or as dispersible tablets, whichever formulation is available and affordable. By giving zinc as soon as diarrhoea starts, the duration and severity of the episode as well as the risk of dehydration will be reduced. .  .  "  (page 10) "The infant usual diet should be continued during diarrhoea and increased afterwards. Food should never be withheld and the child's usual foods should not be diluted. Breastfeeding should always be continued. The aim is to give as much nutrient rich food as the child will accept. Most children with watery diarrhoea regain their appetite after dehydration is corrected, whereas those with bloody diarrhoea often eat poorly until the illness resolves. These children should be encouraged to resume normal feeding as soon as possible. "When food is given, sufficient nutrients are usually absorbed to support continued growth and weight gain. Continued feeding also speeds the recovery of normal intestinal function, including the ability to digest and absorb various nutrients. In contrast, children whose food is restricted or diluted lose weight, have diarrhoea of longer duration, and recover intestinal function more slowly." (page 12, bullet item in chart) "For infants under 6 months who are not breastfed, if using the old WHO ORS solution containing 90 mmol/L of sodium, also give 100-200ml clean water during this period. However, if using the new reduced (low) osmolarity ORS solution containing 75mmol/L of sodium, this is not necessary." (page 13) "With the previous ORS, signs of dehydration would persist or reappear during ORT in about 5% of children. With the new reduced (low) osmolarity ORS, it is estimated that such treatment “failures” will be reduced to 3%, or less." The usual causes for these “failures” are: • continuing rapid stool loss (more than 15-20 ml/kg/hour), as occurs in some children with cholera; • insufficient intake of ORS solution owing to fatigue or lethargy; • frequent, severe vomiting. "Such children should be given ORS solution by nasogastric (NG) tube or Ringer's Lactate Solution intravenously (IV) (75 ml/kg in four hours), usually in hospital. After confirming that the signs of dehydration have improved, it is usually possible to resume ORT successfully." (page 15-16) "Some children with diarrhoea develop hypernatraemic dehydration, especially when given drinks that are hypertonic owing to their excessive content of sugar (e.g. soft drinks, commercial fruit drinks, too concentrated infant formula) or salt. These draw water from the child's tissues and blood into the bowel, causing the concentration of sodium in extra-cellular fluid to rise. If the solute in the drink is not fully absorbed, the water remains in the bowel, causing osmotic diarrhoea." (page 16) "Cholera differs from acute diarrhoea of other causes in three ways: • it occurs in large epidemics that involve both children and adults; • voluminous watery diarrhoea may occur, leading rapidly to severe dehydration with hypovolaemic shock; • for cases with severe dehydration appropriate antibiotics may shorten the duration of the illness."  (page 17) "MANAGEMENT OF ACUTE BLOODY DIARRHOEA (DYSENTERY)" . . .  (page 22) "MANAGEMENT OF DIARRHOEA WITH SEVERE MALNUTRITION"  (please see below separate section entitled "Treatment of DIARRHOEA WITH SEVERE MALNUTRITION at the same time is somewhat different")

---
 * Okay, a lot of information. And the game is a little different when it's diarrhea combined with severe malnourishment.  And this game, with these stakes, this one we win.
 * I AM NOT A DOCTOR. I want to be clear about that.  I'm just a guy who thinks this is important and am excerpting it the best I can.  I really think this kind of thing should be general health information, so that parents and other caretakers, of both adults and children, can start this Oral Rehydration Therapy early, and hopefully prevent severe dehydration, treat it before it gets bad.  Cool Nerd (talk) 23:34, 14 August 2011 (UTC)

Timeline on new (reduced osmolarity) Oral Rehydration Solution
Symptomatic hyponatremia during treatment of dehydrating diarrheal disease with reduced osmolarity oral rehydration solution, Journal Of The American Medical Association [JAMA], Alam NH, Yunus M, Faruque AS, et al., 2006 Aug 2, Vol. 296 (5), pp. 567-73. http://web.ebscohost.com/ehost/detail?vid=3&hid=119&sid=2e844617-ca93-4a1e-a508-c8b0e7892922%40sessionmgr14&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=cmedm&AN=16882963 “In May 2002 [Emphasis added], the World Health Organization and the United Nations Children's Fund recommended that the formulation of oral rehydration solution (ORS) for treatment of patients with diarrhea be changed to one with a reduced osmolarity and that safety of the new formulation, particularly development of symptomatic hyponatremia, be monitored.”
 * posted by Cool Nerd (talk) 16:54, 16 August 2011 (UTC)

Technical Bulletin No.9, New formulation of Oral Rehydration Salts (ORS) with reduced osmolarity, UNICEF:

“Two decades ago diarrhoea was responsible for around 5 million deaths annually. Through major public health efforts primarily aimed at preventing and treating dehydration this figure has decreased to around 2 million deaths. Prevention of dehydration is primarily achieved by ensuring that children with diarrhoea are provided with more fluids than usual, and/or increased frequency of breastfeeding, during the acute episode. . .  ”

“ .  .  .  One successful approach is based on reducing the osmolarity of ORS solution to avoid possible adverse effects of hypertonicity on net fluid absorption. This was done by reducing the solution's glucose and salt (NaCl) concentrations. Studies to evaluate this approach were reviewed at a meeting in July 2001* [Emphasis added], and technical recommendations were made to WHO and UNICEF on the efficacy and safety of reduced osmolarity ORS in children with acute non-cholera diarrhoea, and in adults and children with cholera. . .  ”

Treatment of DIARRHOEA WITH SEVERE MALNUTRITION at the same time is somewhat different
THE TREATMENT OF DIARRHOEA, A manual for physicians and other senior health workers World Health Organization, 2005

(starting with page 22, page 26 in PDF)

8. MANAGEMENT OF DIARRHOEA WITH SEVERE MALNUTRITION

“Diarrhoea is a serious and often fatal event in children with severe malnutrition. Although treatment and prevention of dehydration are essential, care of these children must also focus on careful management of their malnutrition and treatment of other infections. . .  "

8.1 Assessment for dehydration “ .  .  .  Skin turgor appears poor in children with marasmus owing to the absence of subcutaneous fat; their eyes may also appear sunken. Diminished skin turgor may be masked by oedema in children with kwashiorkor. . .  ”

(page 23)

“ .  .  .  A severely malnourished child with signs suggesting severe dehydration but without a history of watery diarrhoea should be treated for septic shock. . .  ”

8.2 Management of dehydration “ .  .  .  IV infusion easily causes over-hydration and heart failure; it should be used only for the treatment of shock. . .  ”

“ .  .  .  Oral rehydration should be done slowly, giving 70-100 ml/kg over 12 hours. . .  ”

“Full-strength ORS solution should not be used for oral or NG rehydration. It provides too much sodium and too little potassium. . .  These modified solutions provide less sodium (37.5 mmol/l), more potassium (40 mmol/l) and added sugar (25g/l), each of which is appropriate for severely malnourished children with diarrhoea."
 * dissolve one ORS packet into two litres of clean water (to make two litres instead of one litre);
 * add 45 ml of potassium chloride solution (from stock solution containing 100g KCl/l); and
 * add and dissolve 50g sucrose.

8.3 Feeding “Mothers should remain with their children to breastfeed them and to help with other feeding, which should begin as soon as possible, usually within 2-3 hours of starting rehydration. Food should be given every 2-3 hours, day and night.”

8.3.1 Initial diet "The initial diet should be given from admission until the child's appetite returns to normal. Some children will eat normally at admission, but many will recover their appetite only after 3-4 days, when infections have been treated. The diet contains 75 Kcal/100 ml and is composed as follows: Combine the ingredients and boil gently for five minutes to cook the cereal powder.  .  . ”
 * skimmed milk powder 25 g
 * vegetable oil 20 g
 * sugar 60 g
 * rice powder (or other cereal powder) 60 g, and
 * water to make 1000 ml

(page 24)

8.3.3 Vitamins, minerals and salts “ .  .  .  Zn acetate.2H20 130 mg. . .  ”  [So zinc, as well as other minerals and vitamins.] “ .  .  .  Vitamin A should be given as described in section 9.3. Multivitamin mixtures that provide at least two RDAs of all vitamins. . .  ”

8.4 Use of antimicrobials “All severely malnourished children should receive broad spectrum antimicrobial treatment, e.g. gentamicin and ampicillin, for several days when admitted to hospital. This combination or another that provides broad spectrum coverage should also be given to any child with signs of septic shock. Children should be checked daily for other infections and treated when these are identified.”  -   National Guidelines for the Management of Severely Malnourished Children in Bangladesh, Institute of Public Health Nutrition, Directorate General of Health Services, Ministry of Health and Family Welfare, Government of the People’s Republic of Bangladesh, May 2008. '''Step 3. Treat/prevent dehydration, page 21 (22 in PDF) a) Diagnosis “ .  .  .  Dehydration may be over estimated in a marasmic/wasted child and underestimated in a kwashiorkor/oedematous child. Therefore, assume that children with watery diarrhoea may have dehydration.” b) Treatment:''' “The standard oral rehydration salts (ORS) solution (90 mmol sodium/L) and the newly modified WHO-ORS (75 mmol sodium/L) contains too much sodium and too little potassium for severely malnourished children. Instead give special Rehydration Solution for Malnutrition (ReSoMal) (For recipe see Annex 2). . .  ”  page 22 (23 in PDF)  “If diarrhoea is severe then new WHO-ORS (75 mmol sodium/L) may be used because the loss of sodium in the stool is high and symptomatic hyponatraemia can occur with ReSoMal. “Low blood volume can coexist with oedema. Do not use the IV route for rehydration except in cases of shock and then do so with care, infusing slowly to avoid flooding the circulation and overloading the heart (see Section 7).” '''Step 5. Treat/prevent infection''' page 24 (25 in PDF) “. . .  In severe acute malnutrition the usual signs of infection, such as fever, are often absent, and infections are often hidden. Therefore routinely treat all severely malnourished children on admission with broad-spectrum antibiotics. . .  ”

adding new section?
As of August, cholera has been suspected in 181 deaths in Mogadishu, along with confirmed reports of several other outbreaks elsewhere in Somalia, thus raising fears of tragedy for a severely weakened population. Cholera can usually be successfully treated with oral rehydration solution and antibiotics, but many health centers in Somalia lack even these basic supplies.

The treatment of diarrhea and dehydration in child or adult who is also malnourished is somewhat different from standard treatment. First off, dehydration may be over-estimated in a marasmic/wasted child and under-estimated in a kwashiorkor/edematous child. In addition, the standard reduced-osmolarity oral rehydration solution needs to be modified so that it will have somewhat less salt and somewhat more sugar and more potassium to produce what is called a Rehydration Solution for Malnutrition (ReSoMal). And then, all malnourished persons with diarrhea should be treated with a course of broad-spectrum antibiotics.

What remains the same is that a dehydrated person should continue to be given food. The World Health Organization is quite emphatic on this point, with a 2005 manual for doctors stating: “The infant usual diet should be continued during diarrhoea and increased afterwards. Food should never be withheld and the child's usual foods should not be diluted. Breastfeeding should always be continued." Supplemental zinc is also recommended as it has a good chance of reducing the severity and duration of diarrhea.

Persons with diarrhea should continue to eat
The above WHO source, and also. .

Community Health Worker Training Materials for Cholera Prevention and Control, CDC. (page 7) " .  .  .  Continue to breastfeed your baby if the baby has watery diarrhea, even when traveling to get treatment.  Adults and older children should continue to eat frequently."
 * posted Cool Nerd (talk) 18:40, 21 August 2011 (UTC)

Article needs some pruning
I am tempted to delete large swaths of this article. Although we have the Medical disclaimer for legal purposes, we also have an official policy: What Wikipedia is not. Much of this article reads like a "how to" guide.

It should be sufficient to describe the history, availability, and a short summary of the recommendations. ~Amatulić (talk) 23:58, 22 August 2011 (UTC)


 * Amatulic, I see that you are in there as a contributor. And thank you for being a contributor.  I am also in there as a contributor and ask to be respected as a contributor.  I have done a lot of work recently on this article and think I have been very lucky in finding some excellent sources.  And I want us as a group to be able to use these sources.


 * For example, we have three good sources which state that the person with diarrhea and dehydration should continue to eat. This is supported information.  We have either two or three sources specifically about the importance of zinc (that I've found, additional sources that other people have found).  I think we should include that, too.


 * The biggest problem I've had is that I haven't yet found a readable source giving both the technical and the everyday recipe for the 'new' reduced-osmolarity ORS. I put the 'new' in quotes because it's now about ten years old.  For all intents and purposes, this is the Oral Rehydration Solution.  Should be the central part of the article, should be the 'Basic Solution.'  And then maybe stuff like Rehydration Solution for Malnutrition (ReSoMal) in other sections.  Cool Nerd (talk) 03:18, 24 August 2011 (UTC)


 * I have no problem with the sources you found, and appreciate your hard work. My point was that Wikipedia articles should not be written in such a way as to give medical advice.


 * Without removing any content, I have rearranged the sections in a more logical way, from general to specific, grouping the definitions together, and grouping the treatment sections together. I have tagged the treatment section as something that needs improvement, because it currently reads like Wikipedia is giving medical advice in violation of the policy I cited above. The rest of the article is fine. ~Amatulić (talk) 08:10, 24 August 2011 (UTC)


 * I also do not want us to give medical advice. Now, I do draw a distinction between merely summarizing medical information and giving medical advice.  If we talk about issues freely, if we get a couple of doctors on board to help out (although it sure wouldn’t be a break for them), it’s possible we could slide into medical advice, where a person is told either he should or should not see a doctor, although I really think doctors would be too savvy to do this.  As far as the rest of us, I think we mainly need to avoid the trap where telling someone to see a doctor is the “safe” thing to say.  Instead, we should say, look, here’s what the source says as far as general medical information, but as far as applying it to a specific person in a specific situation, we cannot say anything further.  Cool Nerd (talk) 17:27, 31 August 2011 (UTC)


 * Please, consider the importance of this information. It is all well and good for those of us who can cruise down to the local pharmacy and buy a brand-name electrolyte replenishment, but how about for those less fortunate?  I think that the content of this article is sufficiently important to allow all the leeway we can about providing information.  When Wikipedia gets to the point that we have to self-censor to not provide information that can save lives because some hypothetical misuse might cause litagable harm to someone, we should just give up and go home.  — Preceding unsigned comment added by NReitzel (talk • contribs) 18:16, 11 November 2011 (UTC)