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In: Jelliffe DB, Jelliffe EF, ed. Advances in international maternal and child health. Vol. 1. New York, Oxford University Press, 1981. 82-97.Diarrheal disease is the major cause of death among children under 5 years of age; over 6 million deaths annually (the estimates range up to 18 million) from diarrhea are estimated to occur worldwide to children under 5 years of age. In terms of lives lost, nutritional impact or economic costs (both in health services and lost opportunity costs), diarrhea is a top priority in world health. The necessity of continuous fluid replacement in patients with diarrheal diseases was not recognized until 1947, when Egyptian cholera patients were treated with large volumes of intravenous saline throughout the entire duration of diarrhea. Later studies of fecal electrolyte losses and of the absorbability of a polyelectrolyte solution containing glucose led to the 1st successful clinical trial of oral fluid replacement in children using 2% glucose. Subsequent studies used a wide range of sodium concentration that has given acceptable results in trials around the world. A recent Scientific Working Group by the World Health Organization examined the composition of oral rehydration mixtures and suggested a sodium level of 90 meq/l as the optimum for a solution to be used worldwide; recommended concentrations for other solutes are 20 meq/l for potassium and 30 meq/l for bicarbonate. Field trials worldwide have demonstrated the safety and efficacy of this single solution for diarrheal treatment of all etiologies in all age groups. Oral rehydration therapy avoids certain risks of intravenous fluids such as inadvertent rapid overrehydration leading to cardiac failure, sepsis due to contaminated fluids, or electrolyte imbalances which can overwhelm renal and respiratory compensatory mechanisms. ORS (oral rehydration solution) should be freshly mixed in clean drinking water. Initial rehydration (5-10% of body weight) should be replaced, ideally using measured stool output to gauge volume needs. Once rehydration is completed (4-6 hours), regular food should be given to patients. When ORS is initiated early in the disease, there is substantial reduction in death rate and hospitalization. Although provision of packaged ORS in every home is the ideal, cost and logistical constraints make it impractical in many countries. Homemade solutions may provide the prospect of far wider coverage as well as an early start to rehydration.