DavidR. Nalin

ORAL MAINTENANCE THERAPY FOR CHOLERA IN ADULTS

Abstract An oral solution containing glucose, sodium chloride, sodium bicarbonate, and potassium chloride or citrate was used as maintenance therapy for acute cholera. In comparison with control patients who received only intravenous replacement of their stool losses, the patients who received the oral solution required 80% less intravenous fluids for cure. This reduction in requirements for intravenous fluids could make therapy for acute cholera in adults more widely available.

FAILURE OF SANITARY WELLS TO PROTECT AGAINST CHOLERA AND OTHER DIARRHŒAS IN BANGLADESH

Within an area of Bangladesh in which the incidence of cholera was high, use of sanitary pipe wells did not protect against cholera or related non-cholera diarrhoeas because well users also used contaminated water sources regularly enough to maintain high infection-rates. Protection was found to correlate with education and wealth.

CHOLERA, NON-VIBRIO CHOLERA, AND STOMACH ACID

Fasting and postprandial stomach acid production were low in 16 of 37 Bangalees convalescing from cholera or non-vibrio cholera. Gastric juice of hypochlorhydric patients did not kill cholera vibrios in vitro, whereas that from normochlorhydric patients rapidly killed vibrios in concentrations up to 10(10)/ml. To determine whether hypoacidity resulted from cholera or was a common predisposing factor, basal and betazole-hydrochloride-stimulated acid production were measured before and after cholera in a second group of patients consisting of American volunteers participating in a vaccine development programme. Cholera did not alter the stomach acid secretion of American volunteers, but low precholera basal acid production predispose to severe cholera. The results indicate that hypochlorhydria observed in convalescent Bangalee cholera patients is not caused by cholera, and must therefore have preceded it. Idiopathic tropical hypochlorhydria may be a major factor accounting for the high incidence of diarrhoea due to acid-sensitive pathogens in developing countries.

COMPARISON OF SUCROSE WITH GLUCOSE IN ORAL THERAPY OF INFANT DIARRHŒA

In a randomised double-blind trial, 51 5--10% dehydrated infants were rehydrated with oral electrolyte solutions containing sucrose or glucose. Most infants in both groups were successfully rehydrated, but the sucrose solution produced a slower correction of electrolyte abnormalities and a higher percentage of patients who needed more than 24 h of therapy. Where there is adequate knowledge of the oral therapy method sucrose can substitute for glucose in many cases; where there is a choice glucose is recommended.

CANNABIS, HYPOCHLORHYDRIA, AND CHOLERA

In 90 volunteers participating in a vaccine-development programme consumption of beer more than 3 days a week was linked with high stomach acid output, and smoking of cannabis greater than 2 days a week was linked with low acid output. In 92 volunteers challenged with Vibrio cholerae or enterotoxigenic Escherichia coli, heavy use of cannabis was associated with more voluminous diarrhoea. Cannabis use may be an important factor predisposing to severe diarrhoea.

ENTEROTOXIGENIC ESCHERICHIA COLI AND IDIOPATHIC DIARRHŒA IN BANGLADESH

Faecal Escherichia coli from Bangalee patients with idiopathic diarrhoea were tested in the Chinese hamster ovary cell (C.H.O.) assay to detect production of thermolabile enterotoxin (L.T.). C.H.O-positive E. coli produce both L.T. and a thermostable toxin (S.T.). C.H.O.-positive strains were found in 19.2% of all cases and in 70% of the most severely ill patients with non-vibrio cholera. E. coli which produce S.T. alone were identified in a third of the C.H.O.-negative cases. Enterotoxigenic E. coli were found in 55% of inpatients with idiopathic diarrhoea and, if an aetiological role is confirmed, may be one of the commonest causes of tropical diarrhoea.

SUCROSE IN ORAL THERAPY FOR CHOLERA AND RELATED DIARRHŒAS

Sucrose was tested as a possible alternative to glucose in oral diarrhoea therapy. Eighteen patients were given oral sucrose plus electrolytes as a maintenance solution. Fifteen of these patients could be maintained using this solution, but three developed massive increases in net fluid losses with increases in plasma specific gravity, necessitating termination of oral therapy. Twelve patients tested all had significant concentrations of stool reducing sugar. The data contrast with the rarity of treatment failures of oral glucose-electrolyte solutions. Glucose, therefore, is preferable to sucrose for oral therapy of diarrhoeal diseases.

RAPID CORRECTION OF ACIDOSIS AND DEHYDRATION OF CHOLERA WITH ORAL ELECTROLYTE AND GLUCOSE SOLUTION

Abstract Five patients with severe acidosis and dehydration secondary to diarrhœa were treated with an oral solution containing sodium chloride, potassium chloride, sodium bicarbonate, and glucose. Dehydration and acidosis were corrected within 6 hours. These findings imply that if a patient with cholera or other severe diarrhœa is treated with an oral solution early in the course of his illness, the need for intravenous fluid may be completely obviated.

ACETATE IN THE CORRECTION OF ACIDOSIS SECONDARY TO DIARRHŒA

Abstract Patients with acute acidosis and dehydration due to diarrhœa were treated with rapid intravenous infusions of electrolyte solutions containing either acetate or bicarbonate, and the rate of correction of arterial pH was monitored. The final pH correction was similar with the two types of solutions, demonstrating that acetate-containing solutions are effective in the treatment of this type of metabolic acidosis.

CHOLERA TRANSMISSION NEAR A CHOLERA HOSPITAL

A review of the incidence of cholera from 1964 through 1974 in Matlab, Bangladesh, revealed that among the villages several had very high incidence-rates. Investigation indicated that high cholera-rates in two of these villages were probably related to water contamination from a nearby cholera hospital established in 1963. The data imply that heavy contamination can overcome any immunity resulting from repeated exposure.