Double Blind Fluid Therapy Evaluation in Pediatric Cholera

Pediatric cholera has often had higher morbidity and mortality than adult cholera when treated in the same fashion. Because children have a greater need for free water and, in addition, produce cholera stools which are appreciably lower in sodium concentration than adult stools, the use of isotonic or hypertonic intravenous solutions designed for adults has been held partially responsible for the higher figures. Moreover, such solutions often contain insufficient dextrose, potassium, and alkali for optimal treatment of pediatric cholera. A pediatric cholera replacement solution (PCRS) formulated to overcome these problems was field tested in double blind fashion against lactated Ringer's solution in children with acute cholera. PCRS resulted in more rapid return of normal potassium and bicarbonate values, over-came the tendency toward hypoglycemia, and reduced the need for oral fluids. Despite its hypotonic composition and high potassium content, it produced neither hyponatremia nor hyperkalemia. The utility and safety of plasma specific gravity as a means of objectively quantitating the degree of dehydration in children is emphasized.