J HEALTH POPUL NUTR 2011 Dec;29(6):648-651 ISSN 1606-0997 | $ 5.00+0.20 SHORT REPORT ©INTERNATIONAL CENTRE FOR DIARRHOEAL DISEASE RESEARCH, BANGLADESH From Cholera to Burns: A Role for Oral Rehydration Therapy S.M. Milner, W.B. Greenough III, M.E. Asuku, M. Feldman, R. Makam, D. Noppenberger, L.A. Price, M. Prosciak, and I.N. van Loon Johns Hopkins University School of Medicine, 5505 Hopkins Bayview Circle, Baltimore, MD 21224, USA ABSTRACT According to the practice guidelines of the American Burn Association on burn shock resuscitation, in- travenous (IV) fluid therapy is the standard of care for the replacement of fluid and electrolyte losses in burn injury of ≥20% of the total body surface area. However, in mass burn casualties, IV fluid resus- citation may be delayed or unavailable. Oral rehydration therapy (ORT), which has been shown to be highly effective in the treatment of dehydration in epidemics of cholera, could be an alternate way to replace fluid losses in burns. A prospective case series of three patients was carried out as an initial step to establish whether oral Ceralyte®90 could replace fluid losses requiring IV fluid therapy in thermal injury. The requirement of the continuing IV fluid therapy was reduced by an average of 58% in the first 24 hours after the injury (range 37-78%). ORT may be a feasible alternative to IV fluid therapy in the resuscitation of burns. It could also potentially save many lives in mass casualty situations or in resource-poor settings where IV fluid therapy is not immediately available. Further studies are needed to assess the efficacy of this treatment and to determine whether the present formulations of ORT for cholera need modification. Key words: Burns; Cholera; Diarrhoea; Hydration; Oral rehydration therapy; Prospective studies; Rehy- dration; Shock; USA INTRODUCTION Oral rehydration therapy (ORT) was formulated for treating cholera in the 1960s (1,2). It was proven as a robust treatment in a mass casualty setting of cholera in refugees fleeing a war in East Pakistan (now Bangladesh) in 1971. In this setting with limi- ted or no intravenous (IV) fluid therapy available, ORT alone decreased deaths from about 40% to 3% and was administered by friends and families of the cholera victims without any prior training (3). Later experiences in mass outbreaks of cholera in Peru and Rwanda confirmed its efficacy (4). Burn injuries often occur as mass casualty events. The initial loss of life is due to rapid loss of fluids and electrolytes into the areas affected by the burn. The current standard of care for burns over 20% of the total body surface area (TBSA) and 10% of the TBSA Correspondence and reprint requests should be addressed to: Dr. S.M. Milner Johns Hopkins Burn Center 4940 Eastern Avenue Baltimore, MD 21224 USA Email: smilner3@jhmi.edu in children is prompt replacement of IV fluid using standardized formulae (5). In this case series, we re- duced the volume of IV fluid replacement needed in three burned patients by starting treatment in the first 24 hours. We have reviewed the relevant literature and suggest that this may be an effective way to reduce the requirements of IV fluid therapy in burns. ORT has the potential of saving many lives in the event of mass thermal casualties or in resource-poor settings where transport, intensive care, and definitive surgical care may be delayed. MATERIALS AND METHODS A prospective study of three patients with burn wounds (20-40% of TBSA) was performed. Fluid requirements were calculated according to the Parkland Formula [(Parkland Formula=4 cc/kg/% of TBSA, administered over 24 hours since the time of injury (50% given during the first eight hours and 50% given during the next 16 hours)] (5-7). For the first two hours, fluids were started at the Park- land goal with lactated Ringer’s solution, minus 250 cc/hour. At the same time, Ceralyte®90 was started at 250 cc/hour via a Dobhoff tube. Fluids were then titrated at an interval of one hour as nec- essary by decreasing the IV fluids and increasing