Monthly Archives: November 2014

Antibiotic Prescribing; Clinicians Know the Recommendations

Clinicians know the recommendations regarding when and when not to prescribe antibiotics, but they do not always follow them, according to in-depth interviews with 36 Physicians, Nurse Practitioners (NPs), and Physician Assistants (PAs).

Guillermo Sanchez, MPH, from the Centers for Disease Control and Prevention, Atlanta, Georgia, and colleagues report the results of their interview-based study in an article published online November 13, 2014 in Emerging Infectious Diseases.

Reasons for straying from the guidelines range from believing that a non-recommended antibiotic will work better for a patient, particularly when considering allergies or complicated medical histories; concern about patient dissatisfaction; fear of related infection; and concerns about legal action.Clinicians indicated that although they are concerned patients could build up a resistance to antibiotics, those concerns do not usually affect their choice of drug.

Researchers Recorded Telephone Interviews

The researchers conducted in-depth interviews via digitally recorded telephone calls and transcribed the recordings to accurately assess primary care providers’ prescribing behaviors. The breakdown of participants was nine pediatricians, nine family medicine physicians, nine internal medicine physicians, five NPs, and five PAs.

Dr. Sanchez and colleagues used a screening questionnaire to recruit potential participants from a nationwide marketing database. Eligible participants spent at least half of their time with patients in a primary care setting and were older than 30 years. The authors excluded clinicians with a board certification outside of primary care or if they had practiced medicine for more than 30 years.

Before the interview, participants filled out a questionnaire that asked them to rank 12 factors on their influence on antibiotic selection, such as illness severity, patient demand, or practice guidelines. They then discussed their answers with trained interviewees during the recorded interviews.

To evaluate clinical decision-making, each participant received a specialty-appropriate clinical vignette about a patient who had a diagnosis of an acute bacterial infection. The participant was asked to explain why he or she chose an antibiotic and why other primary care providers might choose non-recommended antibiotics.

The researchers found that participants had inconsistent definitions of broad- and narrow-spectrum antibiotics. “Although some participants correctly identified amoxicillin as a narrow-spectrum agent, and azithromycin as a broad-spectrum agent, many participants were uncertain of the spectrum of antimicrobial activity for these 2 widely used antibiotics.”

In addition, clinicians often thought broad-spectrum antibiotics would be more successful in curing an infection, although those beliefs are unfounded, the authors say. That thinking may regularly lead to inappropriate selection and should be addressed, the authors note.

Clinicians, however, were more likely to choose narrow-spectrum drugs when the diagnosis was more certain or when they saw a patient’s condition as relatively benign.

The authors have disclosed no relevant financial relationships.

Source: Medscape

To read the article in its entirety :

http://www.medscape.com/viewarticle/834923?nlid=70147_2981&src=wnl_edit_dail&uac=206986BK

C. difficile Infection CDI - European Clinician Consensus Report with Recommendations for Improved Management of CDI

Largest Ever European Clinician Consensus Report on Clostridium Difficile Infection Provides Recommendations for Improved Management of CDI

Clostridium difficile infection (1) ,a potentially fatal disease,[2] is at least twice as common as MRSA infections in hospitals[3],[4]and is estimated to cost the EU EUR3 billion per annum[5]

A first of its kind expert consensus report on Clostridium difficile infection (CDI), contributed to by more than 1,000 healthcare professionals across Europe, has been presented today at the Healthcare Infection Society (HIS) International Congress in Lyon, France.[1]

The consensus report aimed to identify a set of expert views on CDI management, in order to determine attitudes to diagnosis, treatment and outcomes of CDI and to identify perceived unmet clinical needs.[1]

Based on the consensus scores of the 1,047 respondent clinicians, recommendations have been suggested to further develop CDI services to ensure appropriate diagnosis and treatment strategies are applied across all healthcare settings in Europe.

Agreed recommendations include: [1]

- Implementation of clearly defined algorithms for stool specimen selection,
  collection and testing
- Better definition of how optimal CDI treatment can be planned for patients
  with co-morbidities
- Improved antibiotic stewardship, including education for all healthcare
  professionals and ensuring national policies warrant consistent surveillance,
  prevention, diagnosis and treatment of CDI across Europe.

Dr Nicola Petrosillo, Italy, commented: “The biggest problem we face in treating CDI is recurrence. Not only does recurrent CDI cause increased patient suffering, but it also significantly raises healthcare costs. A German study has shown that costs for treating CDI patients are over EUR7,000 more than the costs for treating patients without CDI. The recommendations put forward as a result of this survey could help to ensure appropriate diagnosis and treatment strategies are applied at a national and European level to improve patient outcomes and reduce the economic burden of this potentially fatal disease.”

A consortium of leading European experts prepared a series of 29 statements representing their collective views on the diagnosis and management of CDI in Europe. Consensus statements focused specifically on diagnosis of CDI; definitions of severity; treatment failure, recurrence and its consequences; infection prevention and control interventions; antimicrobial stewardship and education; and national CDI clinical guidance and policy.[1]

Questionnaires were completed by 1,047 clinicians involved in managing CDI from Germany, France, Spain, Italy, Sweden and the United Kingdom. The clinicians, from specialities such as infectious diseases, internal medicine and intensive care, indicated their levels of agreement with each of the statements. Levels of agreement exceeded the 66% threshold for consensus for 27 out of 29 statements (93.1%), indicating strong support for the majority. Variance between countries and specialties was analyzed and showed strong alignment with the overall consensus scores.[1]

Other recommendations resulting from the consensus include strengthening the definitions for the severity of CDI, in particular severe and non-severe CDI; increased collaboration of hospitals and community-based health and social care services to improve CDI management; and appropriate resourcing and robust application of infection control interventions to limit the transmission of CDI.[1]

“Patients who suffer from CDI tend to be those who are already extremely vulnerable, such as cancer patients, people who have received immunosuppressants or antibiotics, and those who have had recent surgery,” said Doctor Simon Goldenberg, Guy’s and St Thomas’ NHS Foundation Trust, London. “This survey is important because it identifies the views of healthcare professionals who are actively involved in the day-to-day testing, diagnosis and treatment of CDI and who are responsible for reducing transmission and recurrence rates.”

CDI is one of the most common causes of antibiotic-associated diarrhea and severe cases can lead to bowel surgery and even death.[2] Hospital patients with CDI are up to three times more likely to die in hospital (or within a month of infection) than those without CDI.[6],[7] Recurrence is a major challenge in CDI treatment, 25% of CDI patients suffer a recurrence within one month[8],[9],[10] and patients who have already had one recurrence have a 40% risk of a further episode of CDI.[11]

NOTES TO EDITORS
About Astellas Pharma EMEA

Astellas Pharma EMEA operates in 40 countries across Europe, the Middle East and Africa, and is the EMEA regional business of Tokyo-based Astellas Pharma Inc. Astellas is a pharmaceutical company dedicated to improving the health of people around the world through the provision of innovative and reliable pharmaceuticals. The organisation’s focus is to deliver outstanding R&D and marketing to continue growing in the world pharmaceutical market. Astellas presence in Europe also includes an R&D site and three manufacturing plants. The company employs over 4,500 people across the EMEA region. In 2013 Astellas was awarded SCRIP Pharmaceutical Company of the Year in recognition of its commercial success and pipeline development.

References:

1) Aguado, J.M et al. The Consensus Views of European Healthcare
  Professionals: Addressing Clostridium difficile infection. Poster presented at HIS
  2014.
2) Ananthakrishnan AN. Clostridium difficile infection: epidemiology, risk
  factors and management. Nat Rev Gastroenterol Hepatol. 2011;8:17-26.
3) UK Health Protection Agency. English national point prevalence survey on
  healthcare-associated infections and antimicrobial use, 2011: preliminary data.
  London; Health Protection Agency, 2012
4) Meyer E, Gastmeier P, Weizel-Kage D, et al. Associations between nosocomial
  meticillin-resistant Staphylococcus aureus and nosocomial Clostridium
  difficile-associated diarrhoea in 89 German hospitals. J Hosp Infect 2012;82:181-6.
5) Kuijper EJ et al. ESCMID study group for Clostridium difficile. Emergence of
  Clostridium difficile associated disease in North America and Europe. Clin Microbiol
  Infect. 2006;12:2-18.
6) Oake N, et al. The effect of hospital-acquired Clostridium difficile
  infection on in-hospital mortality. Arch Intern Med. 2010;170:1804-10.
7) Hensgens MP, et al. All-Cause and disease-specific mortality in hospitalized
  patients with Clostridium difficile infection: a Multicenter Cohort Study. Clin Infect
  Dis. 2013;56:1108-16.
8) Lowy I, et al. Treatment with Monoclonal Antibodies against Clostridium
  difficile Toxins. N Engl J Med. 2010;362;3:197-205.
9) Bouza E, et al. Results of a phase III trial comparing tolevamer, vancomycin
  and metronidazole in patients with Clostridium difficile-associated diarrhoea. Clin
  Micro Infect. 2008;14(Suppl 7):S103-4.
  10) Louie TJ, et al. Fidaxomicin versus vancomycin for Clostridium difficile
  infection. N Engl J Med. 2011;364:422-31.
  11) Kelly CP, LaMont JT. Clostridium difficile - more difficult than ever. N
  Engl J Med. 2008;359(18):1932-1940.
  12) Poutanen SM, et al. Clostridium difficile-associated diarrhoea in adults.
  CMAJ 2004;171:51-8.
  13) Crobach MJ, et al. European Society of Clinical Microbiology and Infectious
  Diseases (ESCMID): Data review and recommendations for diagnosing Clostridium
  difficile-infection (CDI). Clin Micro Infect 2009;15:1053-1066.
  14) Pepin J, et al. Increasing risk of relapse after treatment of Clostridium
  difficile colitis in Quebec, Canada. Clin Infect Dis 2005;40:1591-7.
  15) Bauer MP, et al. European Society of Clinical Microbiology and Infectious
  Disease (ESCMID): treatment guidance document for Clostridium difficile-infection
  (CDI). Clin Micro Infect 2009;15:1067-79.

Date of preparation: November 2014

Contact:

Donna Wright, Ruder Finn, dwright@ruderfinn.co.uk, Tel:
+44(0)20-7438-3085 Mindy Dooa, Astellas Pharma EMEA
To read the article in its' entirety: 
http://www.presseportal.de/pm/115274/2882229/largest-ever-european-clinician-consensus-report-on-clostridium-difficile-infection-provides/rss

General Guidelines For Food Fermentation and Lacto-Fermentation

Fermentation and lacto-fermentation as been around for a very long time mainly and it means preserving food over long periods of time when refrigeration was not available. Today many individuals are rediscovering these methods of preserving food because the taste is amazing, but also because it’s a great way to consume probiotics.

Lacto-fermented foods are fermented by lactobacillus bacteria, which is a category of beneficial bacteria that feeds on sugar and that produces lactic acid as a byproduct. This is why lacto-fermented foods taste acidic.

Just about any vegetables and even fruits can be lacto-fermented, but fruits will need much less fermentation time as they contain much more sugar. You can play around and try all sorts of funky combinations to discover some amazing tastes. Spices and herbs are also often used extensively to give an even greater flavor to the final product. For example, sour pickles are often flavored with dill, garlic and a combination of pickling spices.

Examples of pickling spices are bay leaves, cinnamon sticks, whole cloves, whole peppercorns, coriander seeds and mustard seeds. A popular variation of Sauerkraut (lacto-fermented cabbage) is made with apples and Juniper berries.

General guidelines for lacto-fermentation

Even though the whole process might seem long and complex, fermenting food at home takes nothing but a few basic instruments and ingredients.

At its basis, most lacto-fermented foods are noting more than whole, chopped, sliced or grated vegetables placed in a brine of salt and water for a period of time at room temperature to let the beneficial bacteria develop.

* It is important to keep in mind that the vegetables should stay submerged all along to prevent mold from forming. Lactobacillus bacteria is a facultative anaerobic category of bacteria, meaning that it doesn’t need oxygen for energy production.

If you decide to chop, slice or grate your vegetables, you should add salt as you place the cut vegetables in your chosen fermentation vessel and pound everything heavily with a potato masher to breakup the vegetables, release their juices and to eliminate any pocket of air that may form. When using whole vegetables, like with sour pickles, you’ll simply place them in your vessel and submerge them with a brine.

You’ll probably come across a lot of recipes calling for fresh whey as a starter for the ferment, but simply using salt gives out the same desired result.

What is Whey? Whey is only a way to bring more lactobacillus bacteria right at the beginning of the process, but that desired bacteria is already present on the surface of the vegetables you’re fermenting and will multiply fast enough when given the opportunity.

You don’t have to use much salt either and in fact you could even ferment food without salt, but using at least some salt prevents undesired bacteria to gain power over the lactobacillus. Using salt also helps the vegetables stay crunchy and helps draw water out of the vegetables. This extracted water can then act as the liquid for the brine. The quantity of salt to use is up to you, but 3 tablespoons per 5 pounds of vegetables is a good ratio to follow.

As an alternative to salt, you can also use a vegetable starter culture like one of those available online at a local health food store. It will ensure that only the desired bacteria ferments the food and they are not necessary at all when using salt.

The other very important element is the fermentation vessel. Choose a large ceramic or glass jar where you can fit a cap or plate on top to be able to press on the vegetables and keep them under the brine at all times. In any case press on the cap or plate by putting a rock or a jug of water on top. The salt will keep on extracting water from the vegetables several hours after you put them in the fermentation vessel, but you should verify that the liquid covers your vegetables the following day and add water if it’s not the case. Some mold can also form on the surface after some time in the form of a white film, but it’s usually not a problem and removing it as best as you can is good enough. It’s also a good idea to place the chosen fermentation pot or jar on a plate or thick towel as the ferment usually expands and spills can happen. *If there are any questions during this process, contact a local Health Food Store for additional assistance.

Some special ceramic pots and glass jars are designed especially for lacto-fermentation and to keep the vegetables submerged under the brine and can be purchased at a local Health Food store or on-line Health Food outlet.

The fermentation time will vary on a lot of factors: temperature, starter used, quantity of salt, nature of the vegetable or fruit, … The best way to go about it when trying original combinations is to taste it along the process and to go with the taste as the best indicator. When it tastes acidic enough - and to your liking - then it is ready to be enjoyed and placed in the refrigerator to stop the fermentation. Taste it after 3 days, then taste it 3 days later and so on. The finished product will keep for months when stored in the refrigerator.

SIMPLE SAUERKRAUT RECIPE:

Sauerkraut originated from Germany and consists of lacto-fermented cabbage. Cabbage is ONE of the most utilized lacto-fermented vegetable because the end result is highly favorable.

Ingredients :

  • 4 or 5 heads of read or green cabbage, shredded; 1/4 cup sea salt;

Preparation

  • Place the shredded cabbage little by little in your fermentation jar, pounding them vigorously and sprinkling some of the sea salt as you go.
  • Make sure the mixture fills the jar up to 1 inch bellow the top (because of the expansion), adding more if needed, and that the extracted water covers the vegetables entirely. If not, create a brine of 2 tablespoons sea salt to 4 cups water and add it to the cabbage.
  • Press the vegetables and keep them under the brine by placing a plate or a lid on top weighted down by a rock or a jug of water. Cover with a clean towel if needed to keep out fruit flies.
  • Place the fermentation jar in a warm spot in your kitchen and allow the Sauerkraut to ferment for 7 to 10 days.
  • Check on it from time to time to be sure that the brine covers the vegetables
  • A good way to know when it’s ready is to taste it during the fermentation process and move it to the refrigerator when you’re satisfied with the taste.
  • * * * If Mold should begin to develop on top of the solution, contact the local Health Food establishment for additional instructions. Do not consume molded food * * *

**** All material on this website is provided for your information only and may not be construed as medical advice or instruction. No action or inaction should be taken based solely on the contents of this information; instead, readers should consult appropriate health professionals on any matter relating to their health and well-being.
The information and opinions expressed here are believed to be accurate, based on the best judgement available to the author, and readers who fail to consult with appropriate health authorities assume the risk of any injuries or health issues.
Food Handling: Please use great caution and sanitary practices when handling food products. Refer to your government’s or health department’s safe food handling guidelines. Wash your hands and surfaces thoroughly before and after handling any food product.
Cooking instructions and directions on this website are offered as guidelines only. Use your best judgment and proper discretion when preparing or consuming any food. We do not advise eating any eggs, meat or seafood that has not been properly handled or cooked. Eating something undercooked or raw is to be done at your own discretion.
We expressly disclaim responsibility for any adverse effect that may result from the use or application of the information contained on this website.

Sources: Probiotics-help.com, Thenourishinggourmet.com, Wikipedia.com

Rebiotix, Inc. PUNCH CD 2 Study - Second Clinical Trial Initiated

Update

24 November 2014

Rebiotix has initiated our second clinical trial (PUNCH CD 2) focusing on the treatment of recurrent C. difficile infection!

REBIOTIX, INC.

The PUNCH CD 2 study is a Phase 2B randomized controlled trial to assess the effectiveness and safety of RBX2660 (microbiota suspension) for the treatment of recurrent Clostridium difficile (C. diff.) infection.

About the Study The PUNCH CD 2 study is the first multicenter prospective, multicenter, randomized, placebo-controlled, double-blind study of a microbiota restoration therapy. It has been designed to provide the highest quality of evidence to-date about this non-antibiotic approach to treating recurrent C. diff. infection.

Approximately 117 patients at over 20 sites in the US and Canada are expected to be enrolled in study.

Patients will be randomized into three different study groups: one group will receive two enemas containing RBX2660; another group will receive two enemas without the active drug; and the third group will receive one enema with RBX2660 and one without. If a patient’s C. diff. infection reoccurs before 8 weeks after treatment, he or she may be eligible to crossover to receive active treatment with RBX2660.

All patients will be followed for 24 months after treatment.

Further Study Details

For more information on the study you may:

Find Out if You Could be Eligible

A physician participating in the PUNCH CD 2 study will determine if you are eligible to participate in the study. However, you can take a brief survey (less than 1 ½ minutes to complete) to learn if you meet the major study eligibility criteria.

How to Enroll as a Participant

If a study physician thinks you may be a good candidate, you will be given complete information about the study including the responsibilities for participation. You can find out if there is a study site near you by reviewing the clinical study site locations for PUNCH CD 2.


Caution: New Drug - Limited by Federal (or United States) law to investigational use.

C. difficile Prevention; Synthetic Biologics Safe-to-Proceed Under IND to Initiate Clinical Trials of SYN-004

Phase 1a and 1b Trials to Use SYN-004 to Protect Microbiome; Intended to Prevent Overgrowth of Potentially Deadly C. difficile Bacteria

Synthetic Biologics, Inc., a developer of pathogen-specific therapies for serious infections and diseases, with a focus on protecting the microbiome, today announced that its Investigational New Drug (IND) application which was submitted to the U.S. Food and Drug Administration (FDA) in October will be proceeding into clinical trials for the development of the Company’s oral beta-lactamase enzyme SYN-004 for the prevention of Clostridium difficile (C. difficile) infection (CDI), antibiotic-associated diarrhea (AAD) and secondary infections with healthcare-acquired, drug-resistant pathogens in patients receiving intravenous (IV) beta-lactam antibiotic therapy. Synthetic Biologics plans to begin Phase 1a and 1b clinical trials shortly, with topline data expected to be reported before year-end.

“We are pleased the FDA completed the 30-day review of our IND and to be initiating clinical trials of the first potential point-of-care preventative therapy for C. difficile, the CDC’s top-ranking public health threat,” said Jeffrey Riley, Chief Executive Officer of Synthetic Biologics. “Taking immediate and aggressive action to develop a therapy that can prevent C. difficile before it starts is critical in addressing this pervasive and life-threatening infection, and IND activation for SYN-004 is a key step toward the development and eventual commercialization of therapy to protect the millions of at risk U.S. patients.”

SYN-004 is Synthetic Biologics’ oral drug candidate designed to be the first and only prophylactic treatment intended to prevent the development of C. difficile infection, by binding with and neutralizing certain common IV beta-lactam antibiotics in the gut. SYN-004 is intended to block the unintended harmful effects of antibiotics within the gastrointestinal (GI) tract, maintaining the natural balance of the bacterial flora (gut microbiome), potentially preventing the 1.1 million C. difficile infectionsii and 30,000 C. difficile-related deathsiii in the U.S. each year.

Synthetic Biologics has met each milestone for its C. difficile program leading up to the IND submission to the agency. Clinical drug manufacturing of SYN-004 under cGMP guidelines to support Synthetic Biologics’ planned Phase 1 and 2 clinical trials was completed on time to support the IND submission and clinical trial initiation. Most recently, the U.S. Patent and Trademark Office issued a Notice of Allowance for the first composition of matter patent application directly pertaining to SYN-004 in the U.S., which carries a patent term to at least 2031.

About Synthetic Biologics, Inc.

Synthetic Biologics, Inc. (NYSE MKT: SYN) is a clinical-stage biotechnology company developing pathogen-specific therapies for serious infections and diseases, with a focus on protecting the microbiome. The Company is developing an oral biologic to protect the gastrointestinal (GI) microflora from the effects of intravenous (IV) antibiotics for the prevention of C. difficile infection, an oral treatment to reduce the impact of methane producing organisms on constipation-predominant irritable bowel syndrome (C-IBS) and a monoclonal antibody combination for the treatment of Pertussis being developed in collaboration with Intrexon Corporation (XON). In addition, the Company is developing a Phase 2 oral estriol drug for the treatment of relapsing-remitting multiple sclerosis (MS) and cognitive dysfunction in MS. For more information, please visit Synthetic Biologics’ website at www.syntheticbiologics.com.

For the complete Press Release article - click on the following link:

https://ca.finance.yahoo.com/news/synthetic-biologics-safe-proceed-under-115700305.html

A Time For Giving Thanks - Thanksgiving 2014

With Thanksgiving just a few days away, everyone from the C Diff Foundation wishes to send you and yours a heartfelt Thanksgiving greeting.

We are all very grateful for the opportunity to work with dedicated volunteers, healthcare professionals, scientific researchers, and associates from so many worthy organizations.

Thank you for all that you do for others, for their communities – and partnering with the Foundation in “Raising C Diff Awareness” worldwide!

Happy Thanksgiving!

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C. difficile infection; Benefits of Coconut Water and Foods High In Potassium

coconutwater2Potassium is one of the body’s most important minerals. It is present in every cell of the human body. In solution, as it is in the body, potassium carries a positive electrical charge and is one of the body’s four main electrolytes along with sodium, chloride and bicarbonate. As an electrolyte, potassium plays a crucial role in water balance and the maintenance of blood pressure. Potassium is also important for normal muscle and nerve function as well as conduction of the electrical impulses that control the heart. Potassium deficiency, also known as hypokalemia (low Potassium), which can produce various symptoms, which vary in severity depending in the degree of deficiency.

Symptoms of Hypokalemia: (Low Potassium): In order for muscle cells to contract, a marked difference in intracellular and extracellular potassium concentrations must exist. As potassium levels drop, this concentration difference decreases and the muscles are unable to function normally. This causes generalized fatigue and a variety of muscular symptoms including weakness, spasms, twitching and cramping. In cases of extreme hypokalemia, the muscles can go into a sustained involuntary state of contraction called tetany. The involuntary muscles of the stomach and intestines can also malfunction when the potassium level is too low. Low Potassium levels can also cause an excessive loss of water through the kidneys. Frequent urination and extreme thirst are common symptoms when hypokalemia has been present for some time. Symptoms may also develop or include abdominal bloating, pain, and cramping . Constipation may also occur. In the extreme, intestinal activity may virtually stop, a condition called paralytic ileus. Heart Palpitations - The rhythmic, coordinated contractions of the heart are controlled by electrical impulses, which are ferried across the heart muscle by a specialized conduction system. Hypokalemia can disrupt this conduction system, causing heart rhythm abnormalities. The most common symptom is heart palpitations-an awareness of missed beats, extra beats, or a feeling that the heart is pounding too fast or too hard. These rhythm abnormalities can be life- threatening, and cardiac arrest may occur. Additional symptoms of Low potassium may also include numbness, tingling or burning sensation in the hands and feet.

Coconut water is a very refreshing drink to beat tropical summer thirst. Its liquid is packed with simple sugars, electrolytes, and minerals to replenish dehydration within the human body. Research studies suggest that cytokinins (e.g., kinetin and trans-zeatin) in coconut water found to have significant anti-ageing, anti-carcinogenic, and anti-thrombotic (anti-clot formation) effects. (ndb.nal.usdagov)

Coconut water has been generally offered to patients with diarrhea in many tropic regions to replace the fluid loss from the gastrointestinal tract and to reduce the need for intravenous therapy. The osmolarity of tender coconut water is slightly greater than that of WHO recommended ORS (Oral Rehydration Therapy) solution. Presence of other biological constituents like amino acids, enzymes, minerals, and fatty acids may account for this higher osmolarity. Nonetheless, unlike WHO-ORS, its water is very low in sodium and chlorides, but rich in sugars and amino acids. This well-balanced fluid composition, along with much-needed calories, would be an ideal drink instead of any other kind of soft drink beverages to rectify dehydration conditions.

Coconut water is composed of many naturally occurring bioactive enzymes such as acid phosphatase, catalase, dehydrogenase, diastase, peroxidase, RNA-polymerases etc. In effect, these enzymes help in the digestion and metabolism. Despite being very light in consistency, its water has proportionately better composition of minerals like calcium, iron, manganese, magnesium, and zinc than some of the fruit juices like oranges. (Compare the mineral composition of oranges). Its liquid is also a very good source of B-complex vitamins such as riboflavin, niacin, thiamin, pyridoxine, and folates. These vitamins are essential in the sense that the human body requires them from external sources to replenish. Coconut water contains very good amount of electrolyte potassium. 100 ml (3.1 oz) of coconut water has 250 mg of potassium and 105 mg of sodium. Together, these electrolytes help replenish electrolyte deficiency in the body due to diarrhea (loose stools).

(6.2 oz) = 200 ml - Coconut water = 500 milligrams Potassium

The adequate intake of potassium as established by the Food and Nutrition Board of the Institute of Medicine is 4,700 mg per day for * males and females over the age of 14 * Children between the ages of 9 and 13 need 4,500 mg per day of potassium * Children between the ages of 4 to 8 require 3,800 mg of potassium every day. * Toddlers between 1 and 3 years old need 3,000 mg daily. * Babies between 7 months and 1 year old need 700 mg * Babies under 6 months require 400 mg daily, which can be supplied through breast milk or fortified baby formula. * Pregnant women also 4,700 mg * Breastfeeding mothers need 5,100 mg a day

Less than half of adults in the United States meet the daily recommendation for potassium. Increasing your consumption of potassium-rich foods will help you do so.

CAUTION: Dietary Intake- In individuals with kidney failure or people on certain types of diuretic medications, excess intake of potassium can overwhelm the kidneys, so much so that they cannot process it out of the bloodstream. This leads to a condition called hyperkalemia (high Potassium) , which can cause symptoms of tingling extremities, muscle weakness or cardiac arrest caused by heart arrhythmia. Healthy individuals normally do not experience problems from high levels of potassium in the diet, so the Food and Nutrition Board of the Institute of Medicine has not set an upper tolerable limit for this mineral. However, some people experience hyperkalemia when they take over 18 g (18,000 milligrams) of potassium a day, even when they have no kidney problems. Always discuss Potassium dietary needs with healthcare professionals and report any physical changes immediately to Physicians and/or seek medical attention at a local clinic/hospital as soon as possible.

Potassium varies in amounts in many foods and beverages.
Fruits and vegetables contain high levels of potassium and should be the main dietary source of this mineral. One banana has about 422 mg of potassium. A baked potato with the skin contains 926 mg of this mineral. There are 637 mg of potassium in 1/2 cup of prunes. A 6-oz. cup of orange juice contains 372 mg of potassium. Other good fruit and vegetable sources include tomatoes, raisins, artichokes, broccoli, peas, apricots, cantaloupe, kiwis, lima beans, spinach and acorn squash. Seeds and nuts, such as sunflower seeds and almonds, are other potassium sources in the diet. Fish, such as salmon, cod and sardines, also contain potassium. Beverages providing potassium include milk, orange juice, prune juice, carrot juice and tomato juice. Eating a variety of these foods and beverages can help you get enough potassium.

References: University of Maryland Medical Center: Potassium, Linus Pauling Institute: Potassium, MedlinePlus: Potassium in Diet, Academy of Nutrition and Dietetics: Potassium, Harvard School of Public Health: Shifting the Balance of Sodium and Potassium in Your Diet