Oral rehydration solutions in non-cholera diarrhea: a review

Am J Gastroenterol. 2009 Oct;104(10):2596-604; quiz 2605. doi: 10.1038/ajg.2009.329. Epub 2009 Jun 23.


The use of oral rehydration solution (ORS) has revolutionized the management of acute diarrhea. The implementation of the standard World Health Organization ORS (WHO-ORS) has resulted in decreased mortality associated with acute diarrheal illnesses in children, although in general stool volume and diarrhea durations are not reduced. Decreased morbidity and mortality have occurred because of improved hydration status. Decreased morbidity has also been described in adults who used this therapy. Various modifications to the standard ORS have been derived. These modifications have included hypo-osmolar or hyperosmolar solutions, use of rice-based ORS, zinc supplementation, and the use of amino acids, including glycine, alanine, and glutamine. Some of these variations have been successful, some have not, and others are still under investigation. ORS has been used for travelers' diarrhea and to decrease intravenous (IV) fluid requirements in patients with short bowel syndrome (SBS) who require parenteral nutrition (PN). This paper reviews the standard WHO-ORS and its mechanism of action, followed by more contemporary reduced osmolarity ORS and rice-based ORS in non-cholera diarrhea. Various modifications to improve ORS are also discussed.

Publication types

  • Review

MeSH terms

  • Amino Acids / therapeutic use
  • Animals
  • Bicarbonates
  • Clinical Trials as Topic
  • Diarrhea / mortality
  • Diarrhea / therapy*
  • Flavoring Agents / therapeutic use
  • Fluid Therapy / methods*
  • Glucose
  • Humans
  • Lactoferrin / therapeutic use
  • Muramidase / therapeutic use
  • Oryza
  • Osmolar Concentration
  • Polysaccharides / therapeutic use
  • Potassium Chloride
  • Sodium Chloride
  • Zinc / therapeutic use


  • Amino Acids
  • Bicarbonates
  • Flavoring Agents
  • Polysaccharides
  • World Health Organization oral rehydration solution
  • Sodium Chloride
  • Potassium Chloride
  • maltodextrin
  • Muramidase
  • Lactoferrin
  • Glucose
  • Zinc