Blue stage of spasmodic cholera. A girl who died of cholera in Sunderland, November 1831. Lancet 1832.
http://rehydrate.org/ors/solution_for_survival.htm
Fluid Therapy - History |
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| 1832 -- Parenteral saline infusions first used for cholera | Mortality decreased from >60% to <30% |
| 1918 -- intraperitoneal saline infusions for infant diarrheal dehydration | 9 of 9 infants survived |
| 1923 -- Gamble identified the importance of maintaining ECF volume and composition to well-being | Mortality decreased from >80% to <25% |
| 1946 -- Darrow equated deficits of Na, K, Cl and H2O with retentions measured during recovery
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"Deficit therapy" defines the requirements for restoring body composition to normal
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Calculating a deficit therapy regimen and prescribing specific solutions to replace the deficits were complicated
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| 1953 -- Talbot attempted to simplify therapy by combining goals of replacement therapy and maintenance therapy
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This failed because NaCl was low and K of Butler's solution was high; this prevented a rate of infusion sufficient to restore ECF volume and renal perfusion |
| 1956 -- ICF was found not to change in diarrheal dehydration (except in hyperosmolar states)
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K losses are accounted for by cell catabolism and reduced cell K concentration
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| Diarrheal dehydration is recognized as loss of ECF but not ICF
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The case for rapid restoration of ECF volume followed promptly by maintenance therapy containing K was strengthened
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| Hyponatremia was commonly seen
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There was a low concentration of Na in replacement fluids
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| Hypernatremia became commonplace
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Oral solutions contained too much salt and/or too much sugar
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| Deficit therapy model used to guide repair of hypo / hyper-natremia
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These calculations added complexity to the deficit therapy regimen
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| 1973 -- Oral Replacement Therapy (ORT) successful in infant diarrheal dehydration
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Simple and effective. 90% recovered without IV therapy.
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| Hirschhorn recommends rapid ECF restoration (usually with ORT) and early feeding.
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Mortality fell to <3 / 1000
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| Infant diarrhea in the US is associated with mild dehydration and responds to simple ORT
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US still has 200 000 hospitalizations and 400 deaths/ yr (2 per 1000 admissions)
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