Page 79 - JSOM Fall 2019

access and large volumes of heavy, sterile fluid may not be fea- FIGURE 1 The oral rehydration solution survery that was handed
sible in these situations. Transport times for burned Warfight- out to active duty Servicemembers. A scale of 1 to 5 was used to rate
ers may last several days, which will exacerbate burn-related each solution on flavor profile (top) and consumer aspects (middle).
complications mentioned earlier. The initial 72 hours are par- Additionally, Servicemembers were asked to rank the solutions from
6
1 to 5 (bottom).
ticularly critical for burn resuscitation, which begets the need
for alternative resuscitation strategies in military relevant PFC
scenarios and multidomain battle arenas.
To this end, oral/enteral resuscitation techniques have been
proposed in other austere environments, 16,17 including PFC.
18
Despite the promise of leveraging the body’s natural mecha-
nism of hydration, there is a large gap in clinical and oper-
ational feasibility. The purposes of the current report are (1)
to review previous studies examining enteral resuscitation in
burn injury and published guidelines on its implementation
and operational advantages in resource-poor settings and (2)
to evaluate enlisted military opinions on the palatability of
currently available oral rehydration solutions.

Methods
Literature Search
A PubMed query to the National Library of Medicine (https://
www.ncbi.nlm.nih.gov/pubmed) was performed on 26 June
2018 to include all combinations of the terms “oral,” “en-
teral,” “resuscitation,” and “burn” as described in the results.
Studies were triaged for their relevance, and publications not
appropriate for discussion (e.g., author line included ‘Burns’)
were omitted. Review papers were examined thoroughly for
their related citations. Emphasis was placed on any guidelines
or logistical /operational suggestions for the implementation
of enteral fluids in burn injury.

Palatability Study
Forty US Army active duty Servicemembers willingly partici- FIGURE 2 The packaging of the different powders for the oral
pated in this study to evaluate the palatability of five oral re- rehydration dirnks are shown at the top. Interestingly, the World
hydration solutions. This study was approved by the US Army Health Organization and the CeraLyte 70 packages are forumlated
for 1L reconstitution, while the others are for 0.50 to 0.59L. The
Institute of Surgical Research, Regulatory Compliance Divi- corresponding table gives osmolarity and ingredients of the different
sion after the research was deemed exempt from human use solutions after they are reconstituted according to the manufacturer’s
oversight in accordance with 32 Code of Federal Regulations instructions. Prices obtained from Amazon.com product listings and
219.101(b)(6). ID numbers were assigned to each individual may be found in bulk packaging or at a lower cost elsewhere.
for deidentification. Clear instructions were given prior to tak-
ing part in the study, which included a station with a pencil,
a survey (Figure 1), and randomized five sample cups (4 oz.)
that were solid colored with a solid colored lid to prevent the
participant from formulating opinions based on the color of
the solutions. No-sodium crackers and a cup of water were
also placed at each station to cleanse the palate before trying
the next sample cup. The comments section shown in Figure 1
proved to be unfruitful.
The five rehydration solutions tested were: the newer formu-
lation of the World Health Organization’s oral rehydration
solution (WHO), Drip-Drop , CeraLyte 70 , CeraSport , and
®
®
®
Gatorade . Gatorade was included as a positive control for
®
palatability, as opposed to suspected optimal efficacy for burn
patients. All of these solutions are commercially available
with varying ingredients and osmolarity when rehydrated as
directed by the manufacturer (Figure 2). The national stock
numbers are 6505-01-197-8809, 6505-01-646-2692, 6505-
01-420-9275, 6505-01-576-2674, and 8960-01-114-2101 for
WHO, Drip-Drop, CeraLyte 70, CeraSport, and Gatorade,
respectively. Only lemon- flavored solutions were chosen to
reduce bias toward a certain flavor choice (only not possible

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