Oral fluid therapy of cholera among Bangladesh refugees

Confirmation of the effectiveness of orally administered electrolyte solutions with glucose in the treatment of cholera without hypovolemic shock was obtained by a crucial field trial during the cholera outbreak that erupted in 1971 among Bangladesh refugees at Bongaon, West Bengal, India. Extremely adverse logistic and administrative conditions prevailed. A total of 3703 patients, including severe cases treated initially by limited supplies of parenteral fluids and mild to moderately severe cases treated by oral therapy alone, were admitted to the Bongaon treatment center; the overall case fatality ratio was 3.6%. A special demonstration unit provided treatment for 1190 of these patients with case fatality ratio of 1%. The oral solution provided sodium 90 mEq, bicarbonate 30 mEq and chloride 60 mEq per liter, along with glucose 22 gm per liter (121 mM), prepackaged for mixing with water in the field. Potassium supplementation was given orally on an individual basis. Advantages of the oral solution included local availability of ingredients, minimal cost of preparation and transport, ease of administration, safety in the hands of inexperienced personnel after only brief instructions, early accessibility of treatment and reasonable effectiveness especially when used very early in the course of the disease prior to extreme dehydration, shock and acidosis. In severe cases, considerable sparing of intravenous fluids resulted from the adjunct use of the oral solution.