Oral Rehydration Therapy

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Oral Rehydration Therapy: Current Issues

Dr. A.M.Khan, Dr. S.A.Sarker, Dr. S.A.Jahan, Dr. N.H.Alam, Prof. G.J. Fuchs. ICDDR, B, Centre For Health and Population Research, Bangladesh , GPO Box 128, Dhaka 1000, Bangladesh

Objective: To determine the efficacy and safety of a reduced osmolarity ORS (RO-ORS) compared to WHO ORS in neonates and young infants with acute watery diarrhoea. Methods: In a randomised, double blind controlled clinical trial, 144 neonates and young infants aged up to 2 months with acute watery diarrhoea < 72 h with no or some dehydration were assigned to standard WHO ORS (Na⁺ 90 and osmolarity 311 mmol/L, respectively) or RO-ORS (Na⁺ 75, Osmolarity 245 mmol/L, respectively) and studied for 5 days. Stool output and frequency (number), ORS intake, duration of diarrhoea (days) and proportion of patients developing hyper-or hyponatraemia were the main outcome measures. Results: Base line characteristics were comparable between the two groups. Seventy-one and 73 infants received standard WHO ORS and RO-ORS, respectively. Diarrhoea resolved within 5 days in 66% and 53% infants receiving WHO ORS and RO-ORS, respectively (p=NS). Median total stool volumes (mL/kg) during the entire study period were not significantly different between the groups (WHO ORS vs. RO-ORS; 139 vs. 132, p=0.8). There was no differences in median stool frequency (WHO ORS vs. RO-ORS; 35 vs. 31, p=0.9) or ORS intake (mL/kg) (WHO ORS vs. RO-ORS ; 209 vs. 192 , p=0.7). Duration of diarrhoea was also similar between the two groups (WHO ORS vs. RO-ORS; 2.8 vs. 3.1days, p=0.1). No infant developed hypernatraemia irrespective of group. Two infants receiving WHO ORS and 3 receiving RO-ORS developed mild hyponatraemia. Conclusion: This study indicates that reduced osmolarity ORS and standard WHO ORS are equally efficacious and safe for neonates and young infants in acute watery diarrhoea.

Objective: Fluid and electrolyte balance is important in the management of persistent diarrhoea (PD), defined as an episode of acute diarrhoea that continues for more than 14 days. We evaluated and compared the efficacy of the WHO oral rehydration solution (ORS) and two different formulations of reduced-osmolarity ORS (RORS) in infants with severe PD. Study design: Ninety-five infants with severe PD were randomised to one of the three ORS: WHO-ORS (mmol/L; Na 90, osmolarity 311) (n=32), a glucose-based reduced osmolarity ORS (mmol/L; Na 60 osmolarity 208) (n=30), or a rice-based reduced osmolarity ORS (mmol/L; Na 60, osmolarity 134) (n=31) for replacement of ongoing stool losses for up to seven days. Major outcome measures were stool volume and frequency, ORS intakes, and resolution of diarrhoea. Results: Although, there were variations from one study day to another, the stool volume was approximately 40% less in the RORS groups. Consequently, the children in the RORS groups required less ORS (22% for glucose based RORS and 27% rice-based RORS groups). A higher proportion of children in the rice-based RORS groups had also resolution of diarrhoea during the study period. No children in any of the treatment groups developed hyponatraemia. Conclusion: Reduced osmolarity ORS is clinically more effective than WHO-ORS, and may therefore be advantageous for use in the management of children with persistent diarrhoea.

Introduction: A modified ORS (ReSoMaL) is being promoted for use in severely malnourished children with diarrhoea although superior efficacy has not been documented. Aim: To compare the development of over-hydration and sodium and potassium status during treatment of severely malnourished children suffering from diarrhoea with either ReSoMaL or WHO-ORS. Methods: Double blind, randomised, controlled clinical trial in severely malnourished children (<70% weight-for-length of NCHS standard) aged 6 to 36 months with acute watery diarrhoea. Results: Of 130 patients, 65 received ReSoMaL and 65 WHO-ORS. The number of children who developed over hydration was not significantly different between the groups (WHO-ORS vs. ReSoMaL, 8 vs. 3, p=0.1). ReSoMaL therapy corrected basal hypokalaemia in a greater proportion of children by 24 h (36% vs. 5%, p=0.002) and 48 h (46% vs. 16%, p=0.004) compared to WHO-ORS. More ReSoMaL than WHO-ORS children remained hyponatraemic at 24 h (24 vs. 15, p=0.06) and 48 h (17 vs. 6, p=0.01). Three children in the ReSoMaL group developed severe hyponatraemia by 24 hr, one of whom had a hyponatraemic convulsion (serum sodium 108 mmol/L within 24 hours of therapy). Intake of ORS, water, energy, and output of stool, urine and duration of diarrhoea were similar in two groups during the study period. In a subgroup sodium and potassium balance study shows that positive balance of sodium (Mean) was significantly higher in WHO-ORS than ReSoMaL group. Children receiving WHO-ORS remained with negative potassium balance (Mean) during the 48 h of treatment. Conclusion: These results indicate similar efficacy of WHO-ORS and ReSoMaL in the rehydration of dehydrated severely malnourished children with diarrhoea. ReSoMaL resulted in better potassium status compared to standard WHO-ORS, however there is a risk of development of hyponatraemia with ReSoMaL, including symptomatic hyponatraemia.

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Last modified: December 10, 2001