New strategies for treating watery diarrhea

N Engl J Med. 1977 Nov 17;297(20):1121-2. doi: 10.1056/NEJM197711172972011.


PIP: In cholera, bacteria proliferation in the lumen of the small bowel results in an increase in adenylate cyclase activity and concentration of adenosine 3',5'-cyclic monophosphate (cAMP). Clinical manifestations of cholera can be attributed to the change in cAMP synthesis. Accumulation of cAMP in intestinal epithelial cells lead to the development of 2 separate alterations of active ion transport, both of which contribute to the overall rate of secretion of salt and water. Inhibition of sodium chloride absorption occurs in villus cells, while stimulation of active secretion of anion (chloride and bicarbonate) occurs in secretory cells. Glucose is useful in reinstituting salt and H2O absorption as it does not interfere with the specific effects of cAMP on active ion transport but independently stimulates salt and H2O absorption. If enough of sodium-glucose solution is given, fecal losses can be fully replaced and fluid balance maintained. However, an oral glucose electrolyte therapy does not decrease diarrhea, and it is important to design an oral solution that could stimulate extra fluid absorption. Oral sugar-electrolyte solutions are used world wide to treat diarrhea of diverse and often undetermined causes; theoretically, they should be useful for replacing fluid losses in any form of diarrhea, infectious or noninfectious, as long as the intestine can absorb the ingested glucose. Palmer proposed an interesting variation on the glucose theme by using sucrose. Although oral sugar-electrolyte therapy has proved to be successful, innovations are still needed.

Publication types

  • Editorial

MeSH terms

  • Administration, Oral
  • Child, Preschool
  • Cholera / therapy*
  • Diarrhea / therapy*
  • Diarrhea, Infantile / therapy
  • Glucose / administration & dosage*
  • Humans
  • Intestinal Absorption
  • Solutions


  • Solutions
  • Glucose