Use of oral rehydration therapy in burns year from diarrhoeal diseases (13). The possibility that ORT could be an alternative to IV fluid therapy in replacing fluid losses due to burns has recently been reviewed (14). In the present limited case series, we have shown that ORT decreased the amount of IV fluids needed to maintain adequate hydration in patients with severe burn wounds. By introducing a rice-based ORT—Ceralyte®90, there is the potential to sub- stantially decrease the IV fluid requirement in the resuscitation of the thermally-injured patient, thereby decreasing the risk of such complications as line infection. Furthermore, the absorption of fluid and electrolyte from the intestine is auto- regulated by homeostatic mechanisms, including endocrine and mechano receptors. ORT is, there- fore, less likely to result in fluid overload which can cause significant complications, such as compart- ment syndrome and pulmonary oedema, occasion- ally observed in burned patients receiving IV fluid therapy (15). The use of ORT in burn resuscitation is currently being explored (16-18). In 1950, JAMA stated that “The use of oral saline is adopted as standard pro- cedure in the treatment of shock due to burns, in the event of large scale civilian catastrophe” (19). However, we have found only one study com- paring oral resuscitation with IV fluid therapy in small burns, although it has been demonstrated in animal models that oral resuscitation may be ef- fective in meeting the fluid and electrolyte require- ments following 40% of TBSA burns (20). Paralytic ileus and reduced gastric emptying may limit oral resuscitation. The latter is described in critically-ill and burned patients. Gastric empty- ing may be reduced by opiates and sedation, and systemic inflammatory cytokines derived in ther- mal injury may also limit absorption (21). In our patients, we used a Dobhoff tube to facilitate ad- ministration of oral fluid. Vomiting did not occur, and gastric residuals did not impede the process. Results of studies suggest that vomiting may be re- duced using hypotonic oral replacement solutions and buffering solutions containing citrate, lactate, or bicarbonate (13). However, vomiting is not con- sidered an absolute contraindication to enteral resuscitation. Moreover, tube-feeding is routinely started soon after admission of burned patients and is thought to preserve nutrition, intestinal mucosal integrity, and facilitate healing (17,22). The optimal composition of ORS for resuscitation in burn wounds has not yet been established. Kramer et al. have suggested a therapeutic advantage of the WHO oral rehydration fluid (14). In patients with 650 Milner SM et al. cholera, Ceralyte®90, a rice-based ORS, has been proven superior to the WHO-ORS in increasing fluid absorption of the intestine and reducing di- arrhoea (23). Rice starches provide glucose as sub- strate for the carrier-mediated co-transport mecha- nism without increasing luminal osmolality (24). Compared to fluid losses due to diarrhoea, fluid losses in burn wounds are difficult to measure but contain both extracellular fluid and potassium-rich cellular debris. During administration of Ceralyte to our patients, no electrolyte disturbances were, however, observed. To optimize the composition of ORT solutions for burn injuries, balance studies will be required, such as those that established the present highly-effective standard ORT solutions for fluid losses due to diarrhoea (25). Conclusions The efficacy of ORT in diarrhoeal diseases is well- established. We have demonstrated a significant re- duction in the 24-hour IV fluid requirement of pa- tients with moderate burn injuries by a systematic supplementation with ORT using Ceralyte®90. We are convinced that the concept of this simple treat- ment holds promise in the future of fluid resuscita- tion of the thermally injured. Furthermore, in mass burn casualty situations where IV fluid therapy may be unavailable or delayed and in resource-poor settings, ORT could save many lives and deserves further investigation. The composition of ORS that would be optimal for burn resuscitation is equally worthy of further investigation. ACKNOWLEDGEMENTS Conflict of interest: Dr. Greenough is a founding shareholder of Cera Products, Inc. which manufac- tures the rice-based ORS (Ceralyte®90) used in this study. REFERENCES 1. Ruxin JN. Magic bullet: the history of oral rehydra- tion therapy. Med Hist 1994;38:363-97. 2. Sack RB. History of the development of oral rehydra- tion fluids. J Indian Med Assoc 2003;101:360, 362-4. 3. Mahalanabis D, Choudhuri AB, Bagchi NG, Bhatta- charya AK, Simpson TW. Oral fluid therapy of chole- ra among Bangladesh refugees. Johns Hopkins Med J 1973;132:197-205. 4. Siddique AK, Salam A, Islam MS, Akram K, Majumdar RN, Zaman K et al. Why treatment centres failed to prevent cholera deaths among Rwandan refugees in Goma, Zaire. Lancet 1995;345:359-61. 5. Pham N, Cancio LC, Gibran NS; American Burn Association. American Burn Association practice JHPN