Influence of Sodium Citrate Supplementation after Dehydrating Exercise on Responses of Stress Hormones to Subsequent Endurance Cycling Time-Trial in the Heat.

Background and objectives: In temperate environments, acute orally induced metabolic alkalosis alleviates exercise stress, as reflected in attenuated stress hormone responses to relatively short-duration exercise bouts. However, it is unknown whether the same phenomenon occurs during prolonged exercise in the heat. This study was undertaken with aim to test the hypothesis that ingestion of an alkalizing substance (sodium citrate; CIT) after dehydrating exercise would decrease blood levels of stress hormones during subsequent 40 km cycling time-trial (TT) in the heat. Materials and Methods: Male non-heat-acclimated athletes (n = 20) lost 4% of body mass by exercising in the heat. Then, during a 16 h recovery period prior to TT in a warm environment (32 °C), participants ate the prescribed food and ingested CIT (600 mg·kg-1) or placebo (PLC) in a double-blind, randomized, crossover manner with 7 days between the two trials. Blood aldosterone, cortisol, prolactin and growth hormone concentrations were measured before and after TT. Results: Total work performed during TT was similar in the two trials (p = 0.716). In CIT compared to PLC trial, lower levels of aldosterone occurred before (72%) and after (39%) TT (p ˂ 0.001), and acute response of aldosterone to TT was blunted (29%, p ˂ 0.001). Lower cortisol levels in CIT than in PLC trial occurred before (13%, p = 0.039) and after TT (14%, p = 0.001), but there were no between-trial differences in the acute responses of cortisol, prolactin or growth hormone to TT, or in concentrations of prolactin and growth hormone before or after TT (in all cases p > 0.05). Conclusions: Reduced aldosterone and cortisol levels after TT and blunted acute response of aldosterone to TT indicate that CIT ingestion during recovery after dehydrating exercise may alleviate stress during the next hard endurance cycling bout in the heat.

Inadequate fluid intake in long term care residents: prevalence and determinants.

Dehydration is estimated to be present in half of long term care residents, as many do not consume the recommended levels of fluid intake. This study aims to describe fluid intake in long term care residents and identify the factors associated with fluid intake. Data were collected from 622 long term care residents, with a mean age of 86.8 ± 7.8. Total fluid intake was estimated over three non-consecutive days. Potential resident and unit-level variables risk factors for low fluid intake were collected, such as dementia status, activities of daily living, and eating challenges. Average daily fluid intake ranged from 311-2390 mL (1104.1 ± 379.3). Hierarchical regression analysis revealed that fluid intake was negatively associated with increased age, cognitive impairment, eating challenges and increased dining room staffing. Being male and requiring more physical assistance were positively associated with intake. Variables identified to predict intake could help inform strategies and targeted interventions to improve fluid intake.

Potential prevention by oral DHEA of superficial tears in elderly atrophic skin.

Oral DHEA improves skin hydration and sebum production as well as bone mineral density in older patients while limiting progression of their skin atrophy. Topical DHEA cream stimulates local collagen production. Trials of oral DHEA should be undertaken to examin their potential for preventing tears in fragile aging skin.

Fluid Retention and Utility of Practical Hydration Markers to Detect Three Levels of Recovery Fluid Intake in Male Runners.

Runners are unlikely to consume fluid during training bouts increasing the importance of recovery rehydration efforts. This study assessed urine specific gravity (USG) responses following runs in the heat with different recovery fluid intake volumes. Thirteen male runners completed 3 evening running sessions resulting in approximately 2,200 ± 300 ml of sweat loss (3.1 ± 0.4% body mass) followed by a standardized dinner and breakfast. Beverage fluid intake (pre/postbreakfast) equaled 1,565/2,093 ml (low; L), 2,065/2,593 ml (moderate; M) and 2,565/3,356 mL (high; H). Voids were collected in separate containers. Increased urine output resulted in no differences (p > .05) in absolute mean fluid retention for waking or first postbreakfast voids. Night void averages excluding the first void postrun (1.025 ± 0.008; 1.013 ± 0.008; 1.006 ± 0.003), first morning (1.024 ± 0.004; 1.015 ± 0.005; 1.014 ± 0.005), and postbreakfast (1.022 ± 0.007; 1.014 ± 0.007; 1.008 ± 0.003) USG were higher (p < .05) for L versus M and H respectively and more clearly differentiated fluid intake volume between L and M than color or thirst sensation. Waking (r = -0.66) and postbreakfast (r = -0.71) USG were both significantly correlated (p < .001) with fluid replacement percentage, but not absolute fluid retention. Fluid intake M was reported as most similar to normal consumption (5.6 ± 1.0 on 0-10 scale) after breakfast and equaled 122 ± 16% of sweat losses. Retention data suggests consumption above this level is not warranted or actually practiced by most runners drinking ad libitum, but that periodic prerun USG assessment may be useful for coaches to detect runners that habitually consume low levels of fluids between training bouts in warm seasons.

Effect of electrolyzed high-pH alkaline water on blood viscosity in healthy adults.

BACKGROUND: Previous research has shown fluid replacement beverages ingested after exercise can affect hydration biomarkers. No specific hydration marker is universally accepted as an ideal rehydration parameter following strenuous exercise. Currently, changes in body mass are used as a parameter during post-exercise hydration. Additional parameters are needed to fully appreciate and better understand rehydration following strenuous exercise. This randomized, double-blind, parallel-arm trial assessed the effect of high-pH water on four biomarkers after exercise-induced dehydration. METHODS: One hundred healthy adults (50 M/50 F, 31 ± 6 years of age) were enrolled at a single clinical research center in Camden, NJ and completed this study with no adverse events. All individuals exercised in a warm environment (30 °C, 70% relative humidity) until their weight was reduced by a normally accepted level of 2.0 ± 0.2% due to perspiration, reflecting the effects of exercise in producing mild dehydration. Participants were randomized to rehydrate with an electrolyzed, high-pH (alkaline) water or standard water of equal volume (2% body weight) and assessed for an additional 2-h recovery period following exercise in order to assess any potential variations in measured parameters. The following biomarkers were assessed at baseline and during their recovery period: blood viscosity at high and low shear rates, plasma osmolality, bioimpedance, and body mass, as well as monitoring vital signs. Furthermore, a mixed model analysis was performed for additional validation. RESULTS: After exercise-induced dehydration, consumption of the electrolyzed, high-pH water reduced high-shear viscosity by an average of 6.30% compared to 3.36% with standard purified water (p = 0.03). Other measured biomarkers (plasma osmolality, bioimpedance, and body mass change) revealed no significant difference between the two types of water for rehydration. However, a mixed model analysis validated the effect of high-pH water on high-shear viscosity when compared to standard purified water (p = 0.0213) after controlling for covariates such as age and baseline values. CONCLUSIONS: A significant difference in whole blood viscosity was detected in this study when assessing a high-pH, electrolyte water versus an acceptable standard purified water during the recovery phase following strenuous exercise-induced dehydration.

Increased Milk Protein Concentration in a Rehydration Drink Enhances Fluid Retention Caused by Water Reabsorption in Rats.

A fluid-retention effect is required for beverages that are designed to prevent dehydration. That is, fluid absorbed from the intestines should not be excreted quickly; long-term retention is desirable. Here, we focused on the effect of milk protein on fluid retention, and propose a new effective oral rehydration method that can be used daily for preventing dehydration. We first evaluated the effects of different concentrations of milk protein on fluid retention by measuring the urinary volumes of rats fed fluid containing milk protein at concentrations of 1, 5, and 10%. We next compared the fluid-retention effect of milk protein-enriched drink (MPD) with those of distilled water (DW) and a sports drink (SD) by the same method. Third, to investigate the mechanism of fluid retention, we measured plasma insulin changes in rats after ingesting these three drinks. We found that the addition of milk protein at 5 or 10% reduced urinary volume in a dose-dependent manner. Ingestion of the MPD containing 4.6% milk protein resulted in lower urinary volumes than DW and SD. MPD also showed a higher water reabsorption rate in the kidneys and higher concentrations of plasma insulin than DW and SD. These results suggest that increasing milk protein concentration in a beverage enhances fluid retention, which may allow the possibility to develop rehydration beverages that are more effective than SDs. In addition, insulin-modifying renal water reabsorption may contribute to the fluid-retention effect of MPD.

Hydration Status and Sodium Balance of Endurance Runners Consuming Postexercise Supplements of Varying Nutrient Content.

Postexercise protein and sodium supplementation may aid recovery and rehydration. Preserved beef provides protein and contains high quantities of sodium that may alter performance related variables in runners. The purpose of this study was to determine the effects of consuming a commercial beef product postexercise on sodium and water balance. A secondary objective was to characterize effects of the supplementation protocols on hydration, blood pressure, body mass, and running economy. Eight trained males (age = 22 ± 3 y, VO2max = 66.4 ± 4.2 ml·kg-1·min-1) completed three identical weeks of run training (6 run·wk-1, 45 ± 6 min·run-1, 74 ± 5% HRR). After exercise, subjects consumed either, a beef nutritional supplement (beef jerky; [B]), a standard recovery drink (SRD), or SRD+B in a randomized counterbalanced design. Hydration status was assessed via urinary biomarkers and body mass. No main effects of treatment were observed for 24 hr urine volume (SRD, 1.7 ± 0.5; B, 1.8 ± 0.6; SRD+B, 1.4 ± 0.4 L·d-1), urine specific gravity (1.016 ± 0.005, 1.018 ± 0.006, 1.017 ± 0.006) or body mass (68.4 ± 8.2, 68.3 ± 7.7, 68.2 ± 8.1 kg). No main effect of treatment existed for sodium intake-loss (-713 ± 1486; -973 ± 1123; -980 ± 1220 mg·d-1). Mean arterial pressure (81.0 ± 4.6, 81.1 ± 7.3, 83.8 ± 5.4 mm Hg) and average exercise running economy (VO2: SRD, 47.9 ± 3.2; B, 47.2 ± 2.6; SRD+B, 46.2 ± 3.4 ml·kg-1·min-1) was not affected. Urinary sodium excretion accounted for the daily sodium intake due to the beef nutritional supplement. Findings suggest the commercial beef snack is a viable recovery supplement following endurance exercise without concern for hydration status, performance decrements, or cardiovascular consequences.

Electrolyte and plasma responses after pickle juice, mustard, and deionized water ingestion in dehydrated humans.

CONTEXT: Some athletes ingest pickle juice (PJ) or mustard to treat exercise-associated muscle cramps (EAMCs). Clinicians warn against this because they are concerned it will exacerbate exercise-induced hypertonicity or cause hyperkalemia. Few researchers have examined plasma responses after PJ or mustard ingestion in dehydrated, exercised individuals. OBJECTIVE: To determine if ingesting PJ, mustard, or deionized water (DIW) while hypohydrated affects plasma sodium (Na(+)) concentration ([Na(+)]p), plasma potassium (K(+)) concentration ([K(+)]p), plasma osmolality (OSMp), or percentage changes in plasma volume or Na(+) content. DESIGN: Crossover study. SETTING: Laboratory. PATIENTS OR OTHER PARTICIPANTS: A total of 9 physically active, nonacclimated individuals (age = 25 ± 2 years, height = 175.5 ± 9.0 cm, mass = 78.6 ± 13.8 kg). INTERVENTION(S): Participants exercised vigorously for 2 hours (temperature = 37°C ± 1°C, relative humidity = 24% ± 4%). After a 30-minute rest, a baseline blood sample was collected, and they ingested 1 mL/kg body mass of PJ or DIW. For the mustard trial, participants ingested a mass of mustard containing a similar amount of Na(+) as for the PJ trial. Postingestion blood samples were collected at 5, 15, 30, and 60 minutes. MAIN OUTCOME MEASURE(S): The dependent variables were [Na(+)]p, [K(+)]p, OSMp, and percentage change in plasma Na(+) content and plasma volume. RESULTS: Participants became 2.9% ± 0.6% hypohydrated and lost 96.8 ± 27.1 mmol (conventional unit = 96.8 ± 27.1 mEq) of Na(+), 8.4 ± 2 mmol (conventional unit = 8.4 ± 2 mEq) of K(+), and 2.03 ± 0.44 L of fluid due to exercise-induced sweating. They ingested approximately 79 mL of PJ or DIW or 135.24 ± 22.8 g of mustard. Despite ingesting approximately 1.5 g of Na(+) in the PJ and mustard trials, no changes occurred within 60 minutes postingestion for [Na(+)]p, [K(+)]p, OSMp, or percentage changes in plasma volume or Na(+) content (P > .05). CONCLUSIONS: Ingesting a small bolus of PJ or large mass of mustard after dehydration did not exacerbate exercise-induced hypertonicity or cause hyperkalemia. Consuming small volumes of PJ or mustard did not fully replenish electrolytes and fluid losses. Additional research on plasma responses pre-ingestion and postingestion to these treatments in individuals experiencing acute EAMCs is needed.

Effect of varying the concentrations of carbohydrate and milk protein in rehydration solutions ingested after exercise in the heat.

The present study investigated the relationship between the milk protein content of a rehydration solution and fluid balance after exercise-induced dehydration. On three occasions, eight healthy males were dehydrated to an identical degree of body mass loss (BML, approximately 1·8%) by intermittent cycling in the heat, rehydrating with 150% of their BML over 1 h with either a 60 g/l carbohydrate solution (C), a 40 g/l carbohydrate, 20 g/l milk protein solution (CP20) or a 20 g/l carbohydrate, 40 g/l milk protein solution (CP40). Urine samples were collected pre-exercise, post-exercise, post-rehydration and for a further 4 h. Subjects produced less urine after ingesting the CP20 or CP40 drink compared with the C drink (P<0·01), and at the end of the study, more of the CP20 (59 (SD 12)%) and CP40 (64 (SD 6)%) drinks had been retained compared with the C drink (46 (SD 9)%) (P<0·01). At the end of the study, whole-body net fluid balance was more negative for trial C (- 470 (SD 154) ml) compared with both trials CP20 (- 181 (SD 280) ml) and CP40 (2107 (SD 126) ml) (P<0·01). At 2 and 3 h after drink ingestion, urine osmolality was greater for trials CP20 and CP40 compared with trial C (P<0·05). The present study further demonstrates that after exercise-induced dehydration, a carbohydrate--milk protein solution is better retained than a carbohydrate solution. The results also suggest that high concentrations of milk protein are not more beneficial in terms of fluid retention than low concentrations of milk protein following exercise-induced dehydration.

Effect of preexercise soup ingestion on water intake and fluid balance during exercise in the heat.

PURPOSE: To determine whether chicken noodle soup before exercise increases ad libitum water intake, fluid balance, and physical and cognitive performance compared with water. METHODS: Nine trained men (age 25 ± 3 yr, VO2peak 54.2 ± 5.1 ml · kg-1 · min-1; M ± SD) performed cycle exercise in the heat (wet bulb globe temperature = 25.9 ± 0.4 °C) for 90 min at 50% VO2peak, 45 min after ingesting 355 ml of either commercially available bottled water (WATER) or chicken noodle soup (SOUP). The same bottled water was allowed ad libitum throughout both trials. Participants then completed a time trial to finish a given amount of work (10 min at 90% VO2peak; n = 8). Cognitive performance was evaluated by the Stroop color-word task before, every 30 min during, and immediately after the time trial. RESULTS: Ad libitum water intake throughout steady-state exercise was greater in SOUP than with WATER (1,435 ± 593 vs. 1,163 ± 427 g, respectively; p < .03). Total urine volume was similar in both trials (p = .13), resulting in a trend for greater water retention in SOUP than in WATER (87.7% ± 7.6% vs. 74.9% ± 21.7%, respectively; p = .09), possibly due to a change in free water clearance (-0.32 ± 1.22 vs. 0.51 ± 1.06 ml/min, respectively; p = .07). Fluid balance tended to be improved with SOUP (-106 ± 603 vs. -478 ± 594 g, p = .05). Likewise, change in plasma volume tended to be reduced in SOUP compared with WATER (p = .06). Only mild dehydration was achieved (<1%), and physical performance was not different between treatments (p = .77). The number of errors in the Stroop color-word task was lower in SOUP throughout the entire trial (treatment effect; p = .04). CONCLUSION: SOUP before exercise increased ad libitum water intake and may alter kidney function.

Adequate oral fluid intake in hospitalized stroke patients: does viscosity matter?

PURPOSE: Sufficient intake of oral fluids to meet hydration needs is a critical recovery issue for patients hospitalized post stroke. Concerns for adequate oral fluid intake are generally focused on dysphagic patients restricted to thickened liquids; however, fluid intake patterns in stroke patients receiving thin liquids are unknown. METHOD: This study examines the oral fluid intake patterns of three groups over 72 hours: community dwelling individuals, patients hospitalized post stroke receiving thin liquids and patients hospitalized post stroke receiving thickened liquids. RESULTS: Mean oral fluid intake differed significantly between the two hospitalized groups (p = .04), with individuals receiving thickened liquids consuming less. Less than 1% of patients hospitalized post stroke met a minimum standard of 1500 mL/day, regardless of liquid viscosity. Conversely, community dwelling participants consumed significantly more fluids on average than their hospitalized counterparts. CONCLUSION: Compliance with beverage preference, frequency of beverage offering, and inaccurate preparation of thickened beverages were identified as factors potentially influencing fluid intake.

Intervention with flaxseed and borage oil supplements modulates skin condition in women.

Ingestion of selected nutrients modulates dermal properties. In the present study, two groups of women ingested flaxseed or borage oil for 12 weeks. The control group received a placebo containing medium-chain fatty acids. Dose was 2.2 g total fatty acids/d with alpha-linolenic acid and linoleic acid as major constituents in the flaxseed oil group; in the borage oil group linoleic and gamma-linolenic acid were predominant. In the flaxseed oil group, the contribution of alpha-linolenic acid to total fatty acids in plasma was significantly increased on weeks 6 and 12, whereas there was an increase in gamma-linolenic acid in the borage oil group (P < 0.05). Skin irritation was performed by nicotinate treatment, and changes in skin reddening and blood flow were monitored. Compared to week 0, skin reddening was diminished in both groups; blood flow was also lowered. Skin hydration was significantly increased after 12 weeks of treatment compared to week 0, with flaxseed or borage oil (P < 0.05). Transepidermal water loss was decreased in both oil groups by about 10 % after 6 weeks of supplementation. A further decrease was determined after 12 weeks in the flaxseed oil group. Surface evaluation of living skin revealed that roughness and scaling of the skin were significantly decreased with flaxseed and borage oil comparing week 0 and week 12 (P < 0.05). Except for hydration, none of the parameters was affected in the placebo group. The present data provide evidence that skin properties can be modulated by an intervention with dietary lipids.

Milk as an effective post-exercise rehydration drink.

The effectiveness of low-fat milk, alone and with an additional 20 mmol/l NaCl, at restoring fluid balance after exercise-induced hypohydration was compared to a sports drink and water. After losing 1.8 (sd 0.1) % of their body mass during intermittent exercise in a warm environment, eleven subjects consumed a drink volume equivalent to 150 % of their sweat loss. Urine samples were collected before and for 5 h after exercise to assess fluid balance. Urine excretion over the recovery period did not change during the milk trials whereas there was a marked increase in output between 1 and 2 h after drinking water and the sports drink. Cumulative urine output was less after the milk drinks were consumed (611 (sd 207) and 550 (sd 141) ml for milk and milk with added sodium, respectively, compared to 1184 (sd 321) and 1205 (sd 142) ml for the water and sports drink; P < 0.001). Subjects remained in net positive fluid balance or euhydrated throughout the recovery period after drinking the milk drinks but returned to net negative fluid balance 1 h after drinking the other drinks. The results of the present study suggest that milk can be an effective post-exercise rehydration drink and can be considered for use after exercise by everyone except those individuals who have lactose intolerance.

Provision of small, frequent meals does not improve energy intake of elderly residents with dysphagia who live in an extended-care facility.

Malnutrition and dehydration are potential consequences of dysphagia, a common swallowing disorder among elderly individuals. Providing smaller, more frequent meals has been suggested (but not demonstrated) to improve energy intake among this group. Accordingly, this study was designed to assess whether the same energy content in five vs three daily meals would improve energy intake. Thirty-seven residents of an extended-care facility, aged older than 65 years, previously evaluated for dysphagia, and receiving a texture-modified diet, agreed to participate in a crossover study with random assignment to three or five meals during an initial 4-day study period, followed by the opposite meal pattern in a second period. Six were excluded from analysis, as their medical condition deteriorated before or during the study. Food and fluids consumed by participants during each study period were weighed before and after each meal. Average energy intakes were similar between the three- and five-meal patterns (1,325+/-207 kcal/day vs 1,342+/-177 kcal/day, respectively; P=0.565); fluid intake was higher with five meals (698+/-156 mL/day) vs three (612+/-176 mL/day; P=0.003). Because offering five daily feedings did not improve energy intakes when compared with three, dietitians caring for this vulnerable group might need to consider other nutrition intervention strategies.

Evaluation of yogurt effect on acute diarrhea in 6-24-month-old hospitalized infants.

Yogurt helps in treatment and prevention of diarrhea. The aim of this study was to determine the efficacy of consumption of local factory yogurt, which is made with pasteurized milk, on moderately dehydrated hospitalized infants aged 6-24 months with acute non-bloody and non-mucoid diarrhea. Eighty moderately dehydrated breast-feeding children aged between 6-24 months with acute non-bloody and non-mucoid diarrhea for fewer than four days were included in the study. Patients were randomly separated into two groups according to their treatment. Infants in the case group received at least 15 ml/kg/day of pasteurized cow milk yogurt orally plus routine hospital treatment. Infants in the control group received routine hospital treatment as in the case group. Weight gains, period of hospitalization, and reduction in diarrhea frequency during hospitalization period of the two groups were compared. Mean duration of hospitalization (days), weight gain, and reduction in diarrhea frequency were 2.7 +/- 0.91 vs 3.1 +/- 0.74 days, 435 +/- 89.20 vs 383 +/- 98.9 g, and 4.30 +/- 1.74 vs 3.60 +/- 1.23 times for case and control groups, respectively. Significant differences were observed in mean hospitalization days (p=0.035), reduction in diarrhea frequency (p=0.049) and weight gain (p=0.017). This study recommends universal use of yogurt in acute non-bloody diarrhea.

The role of oral fluid intake following adeno-tonsillectomy.

OBJECTIVE: To compare the incidence of complications following pediatric adeno-tonsillectomy (T&A) in patients who are encouraged to drink oral liquid versus patients who drink on a voluntary basis. METHODS: This is a prospective, randomized, non-blinded study performed in a tertiary care medical center. Ninety-three otherwise healthy pediatric patients aged 2-12 years undergoing ambulatory T&A by a single surgeon were included in the study. Forty four patients were encouraged to drink 240 ml of clear liquid prior to discharge while 49 patients drank on a voluntary basis. Patients were followed prospectively for the incidence of emesis, dehydration and other complications. RESULTS: Overall, emesis was experienced by 18% of patients in the post anesthesia care unit (PACU) and by 20% at home. Fifty percent of patients in the encouraged group versus 31% in the voluntary group reached the goal volume of oral liquids (p<0.05). The incidence of emesis was higher in both the encouraged (41% versus 14%) and voluntary group (40% versus 26%) when the goal volume of 240 ml was reached. There was no statistically significant difference between the two groups in terms of duration of PACU stay, incidence of emesis, number of episodes of emesis or volume of emesis. Further, there was no difference between the two groups in terms of post-operative complications including dehydration. CONCLUSIONS: The current practice of a mandatory trial of oral fluid intake in the post-operative period may not be a necessary requirement for discharge. Further, mandatory oral fluids may result in a higher incidence of emesis.

Effectiveness of forced rehydration and early re-feeding in the treatment of acute diarrhoea in a tropical area.

BACKGROUND: The administration of oral re-hydration solution (ORS) via continuous infusion through a nasogastric (NG) tube and early refeeding facilitates delivery in hospitalised children and the return back home. DESIGN: the observation was made during a one-year stage in the Camillian Medical Centre (CMC) of Ouagadougou in Burkina Faso. 4,131 infants and children under 5 years old, affected by acute diarrhoea and severe dehydration (loss of weight > 10%) were studied. Those children having difficulties for oral re-hydration were hydrated by continuous infusion through naso-gastric (NG) tube; the NG tube was put in by the nurses and connected to a 500 ml bottle, in which a mixture of glucose and electrolytes was dissolved according to the formula (glucose 20 g + NaCl 3.5 g + NaHCO3 2.5 g KCl 1.5 g in 1 litre of water). The infusion rate was 20-30 drops/minute. No sedative or anti-emetic drug was given, unless in the presence of uncontrolled vomiting. At the end of infusion, flour of millet (60%), soy bean (20%), peanut butter (10%), sugar (10%) and salt (1%) was administered and continued at home or in the nearby areas available for the night. RESULTS: After 4-5 hrs of infusion 3,717 children (90%) showed a significant gain of weight, although the weight prior to the acute event preceding hospitalisation was never reached during their stay at the CMC. Only 413 children (10%) required a longer period of forced infusion: at the end of the day, however, they were fed with this flour. CONCLUSIONS: A simple strategy, based on a NG infusion plus an oral administration of flour has proven safe and effective in encompassing those difficulties encountered in the treatment and prevention of dehydration in developing countries where the therapy, in children affected by diarrhoea, still represents a major daily occupation.