ORAL THERAPY WITH GLUCOSE ELECTROLYTE SOLUTION

: Doctors Kahn and Blum based their views on oral rehydration on only 7 cases, and they fail to provide their methodological details. In their letter on oral rehydration with UNICEF/WHO (United Nations International Children's Emergency Fund/World Health Organization) glucose electrolyte solution (GES), they maintain that hyperkalemia is a danger of GES therapy, that hypernatremia will be aggravated, that therapy should not last for longer than 24 hours, that after 24 hours monitoring of plasma potassium will be needed, and that except for developing countries where material milk is used, no plan of treatment has been proposed after the first 24 hours of rehydration. The experience of Kahn and Blum is at variance with extensive data from many carefully monitored balanced studies in infants treated with GES. GES is a potent medication and needs to be used properly. Guidelines for use are listed. Kahn and Blum fail to indicate whether their 7 patients comprised their entire treatment group or only those with biochemical or clinical problems. They also fail to indicate the degree of dehydration of the infants at onset of therapy or the extent of ongoing diarrheal losses, and they do not describe the precise treatment regimen. Their mean time of treatment -- 41 hours -- was particularly long. The hyperkalemia reported by Kahn and Blum may have resulted from excessive GES administration, without a source of free water, to infants having few diarrheal stools. Proper use of GES formula rapidly rehydrates 95-98% of mildly to severely dehydrated infants, irrespective of etiology.