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Ionika is a drug for the preparation of a solution for oral rehydration therapy (PRT) when the body loses fluid. dehydration is most often associated with acute diarrhea with gastroenteritis, but it is also possible in other conditions, for example, in the case of heat stroke or excessive sweating due to increased physical exertion.

Dehydration and GTI

The development of PRT can be traced from the historically established empirical oral use of fluids for the purpose of therapy due to the effects of diarrhea to experimental animal studies. The experimental results allowed us to determine the relationship between glucose and sodium during absorption in the small intestine and, finally, use this knowledge to develop at first glance simple but effective solutions in the treatment of diarrhea (Sack R.B., 2003).

The principles of modern rehydration therapy for patients with acute diarrhea began slowly until the 1970s (Daly W.J., Du Pont H.L., 2008). Although the introduction of PRT was started by pediatricians back in the 1940s with the use of electrolyte solutions as supportive therapy in children with diarrhea, the scientific development of PRT has actually been carried out only in recent decades.

Physiological studies conducted in the 1950s demonstrated the co-transport mechanism of absorption for sodium and organic soluble substances (sugars and amino acids) in the intestinal cells, thereby creating the scientific basis for PRT. The use of PRT, based on the results of scientific observations, was first reported in 1964 by the captain of the American army Robert Phillips. Research laboratories in Dhaka and Calcutta subsequently demonstrated that the mechanism of co-transport of sodium and glucose remains unchanged in patients with cholera, and that oral solutions can successfully rehydrate and maintain the hydration of these patients. Clinical studies conducted in these laboratories confirmed the efficacy of oral rehydration solutions (PRR) and showed that almost 80% of intravenous fluids could be saved if patients were prescribed PRR. Further studies have shown the safety and effectiveness of PRT in patients of all ages with acute diarrhea, regardless of the etiological factor that caused it. PRT, as we know it, took shape in the 1970s and was recognized as the standard treatment for the treatment of dehydration and metabolic acidosis associated with acute diarrhea. The use of PRT has significantly reduced the incidence and mortality from acute diarrhea, especially after the World Health Organization (WHO) recommended and began to promote PRT on a global scale (da Cunha Ferreira R.M., Cash R.A., 1990).

The development of solutions for PRT for the treatment of cholera and other diseases accompanied by diarrhea is considered one of the most important achievements of 20th century medicine. (Sack R.B., 2003). Researchers continue to search for the best PRR formulations in terms of safety, efficacy, affordability and cost. The use of PRT was attributed to the main reason for a significant reduction in the incidence and mortality from acute infectious diarrhea. Despite these successes, the development of optimal formulations for PRT, as well as for the popularization of this method of treatment for acute diarrhea, is underway, since it is believed that it is not widely used either by health professionals or the population. For example, according to a study conducted in France in 2004, there are discrepancies between the clinical recommendations formulated by WHO and the drugs actually prescribed by practitioners: only 63% of pediatricians prescribe ART for their patients with acute diarrhea (Uhlen S. et al., 2004). Acute diarrhea and dehydration as a consequence are still a significant cause of mortality in children, especially in developing countries (Marbet U.A., 1994). It is believed that this is largely due to the inadequate administration of PRT.

WHO has now accepted WHO as the basis for the treatment of diarrhea worldwide.

The composition of the drug Jonica fully complies with the WHO recommended composition for PRT and has a total osmolarity of 245 mOsm / l. The reaction of the resulting solution is slightly alkaline. Its active ingredients are glucose, sodium citrate, sodium chloride and potassium chloride.

The role of PRT in the treatment of acute diarrhea

The optimal treatment of acute diarrhea according to modern concepts includes the urgent administration of PRT (and maintaining hydration) using the appropriate PRR. This method of treatment is effective in the complex treatment of acute diarrhea, especially secretory, of any genesis in patients of any age (Meyers A., 1995). For infants, it is especially important to continue breastfeeding without interruption. Also, depending on the clinical situation, antibacterial drugs, sorbents and probiotics may be used (Allen S.J. et al., 2010).

The effectiveness of PRT is based on the ability of glucose to stimulate the absorption of sodium and fluid in the small intestine through a cyclic AMP-independent process (Binder J.H. et al., 2014).

Gastroenteritis-related dehydration is a serious complication. Dehydration is manifested by symptoms such as dry skin, headache, dizziness, in severe cases, impaired consciousness and even death. Outwardly, such patients have “sunken” eyes, facial features are sharpened. Patients with dehydration caused by diarrhea need rehydration by oral, nasogastric, or intravenous routes.

According to the latest PRR data, used for dehydration caused by acute diarrhea, which have an osmolarity (a measure of the concentration of solute) ≤270 mOsm / l, are safer and more effective than formulations for PRT with an osmolarity of ≥310 mOsm / l.

So, in children hospitalized with diarrhea, PRR with low osmolarity showed better results compared with PRR with an osmolarity of ≥310 mOsm / l. Fewer unscheduled intravenous fluid infusions, less volume / frequency of stools, fewer cases of vomiting were noted. However, there was no additional risk of hyponatremia in comparison with solutions with high osmolarity. The authors of this study emphasize that it is glucose-salt solutions with low osmolarity (270 mOsm / l) that are optimal for conducting PRR in children (Hans S. et al., 2002).

A relatively recent review of 17 studies showed no clinically important differences between oral and intravenous fluids. According to this review, 1 out of every 25 children who received oral rehydration will not have a clinical improvement in their condition and will need intravenous rehydration (Hartling L. et al., 2006). However, the currently recommended low-osmolarity solutions for PRT WHO has shown a lower incidence of clinical failure with oral rehydration. Oral rehydration should be the first line of treatment for children with mild to moderate severity of dehydration, while intravenous rehydration therapy should be used in patients with a serious condition or in cases of ineffectiveness of PRT and the progression of symptoms of dehydration, despite the oral administration of special solutions. Thus, in accordance with the data obtained, intravenous rehydration has no advantages over oral. In patients receiving PRT, the severity of symptoms of dehydration decreased, the frequency of bowel movements decreased, and the duration of diarrhea decreased. According to the data of this review, the risk of developing paralytic bowel obstruction is slightly higher during the course of GTI, while intravenous rehydration increases the risk of phlebitis.

Oral rehydration is an effective and inexpensive method of treatment and the preference that some doctors give to intravenous rehydration regardless of the severity of the patients condition is unreasonable.

There are various types of PRT solutions, and their effectiveness continues to be discussed. According to one study, RRT solutions based on rice flour or rice dextrin did not demonstrate advantages over glucose-saline solution (Molina S. et al., 1995). In 2016, another review was conducted that compared glucose-salt solutions for PRT with those based on polymers. 27 clinical trials were analyzed (total number of participants - 3532). There were no statistically significant differences in the number of cases of vomiting, hypokalemia, or hyponatremia between patients receiving different types of PRT. In both groups of patients, there were cases of inefficiency of PRT and the need for intravenous fluid infusions. The obvious advantages of polymer-based PRT solutions have not been shown over glucose-salt solutions with low osmolarity; the authors also emphasize the need for further studies with better evidence. However, at the moment, namely since 2004, WHO, relying on the available evidence base, recommends solutions with low osmolarity (270 mOsm / l) for replenishing the fluid during diarrhea (Gregorio et al., 2016). A drug Jonica fully complies with these requirements.

The role of PRT in the treatment of cholera

A recent review evaluated the efficacy of PRR with an osmolarity of 270 mOsm / L in the treatment of cholera (Musekiwa A., Volmink J., 2011).

The causative agents of cholera - representatives of the class of gamma proteobacteria Vibrio cholerae - enter the body with contaminated food or water, this disease is usually associated with poor compliance with sanitary standards. Fortunately, interventions such as PRT and antibiotics / antimicrobials have saved countless cholera patients, and new treatments such as probiotics and phage therapy are also promising in the treatment of this disease. Still, cholera remains a life-threatening disease, as noted during recent outbreaks in Haiti, Ethiopia, and Yemen (Hsueh B. Y., Waters C. M., 2019). Cholera causes intense diarrhea and vomiting, which can lead to deep dehydration and possibly death. This review showed that solutions for PRT ≤270 mOsm / L can lead to an uncritical decrease in sodium level in the blood, however, they are apparently as effective as solutions for PRT ≥310 mOsm / L for rehydration of patients with cholera (Musekiwa A ., Volmink J., 2011).

findings

Jonica - powder for the preparation of a solution to replenish fluid and electrolytes lost as a result of acute diarrhea, as well as due to other physiological or pathological reasons. According to the latest WHO recommendations, the use of solutions for PRT (among which the drug Jonica as meeting WHO criteria) is the cornerstone for treating acute diarrhea, including cholera diarrhea. Particularly important is the timely administration of PRT in children and infants. This easy-to-use and low-cost treatment with minimal side effects has saved a huge number of lives from death due to dehydration during acute diarrhea. One of the most important problems in the treatment of acute diarrhea is the popularization of drugs for PRT (including the drug Jonica) among healthcare professionals and the public.

Tags: Glucose, Potassium Chloride, Sodium Chloride, Sodium Citrate