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. 2001 Nov 3;323(7320):1068.

Oral rehydration solution

Rice water is cheap and effective

Ting Fei Ho 1,2, William C L Yip 1,2
PMCID: PMC1121559  PMID: 11713745

Editor—Hahn et al report that reduced osmolarity rehydration solution is associated with a better outcome with regard to use of intravenous infusion, stool output, and vomiting than is standard WHO (World Health Organization) oral rehydration solution in acute diarrhoea.1 As Fuchs points out in the accompanying editorial, output and duration of diarrhoea are important clinical outcomes when the efficacy of an oral rehydration fluid is considered.2

Rice water decreases stool output and can be used in mild to moderate gastroenteritis. Cheap and easily available, it is a common home or folk remedy for mild gastroenteritis in infants and children in many South East Asian families. It has also been used in hospital paediatric practice with good results.3 Almost 20 years ago Wong highlighted the superior efficacy of rice water compared with WHO oral electrolyte solution for gastroenteritis in children.3 Rice water significantly decreased the number of stools a day, and intravenous intervention was not necessary.

One notable property of rice water that may be responsible for its efficacy is its low osmolality when compared with oral electrolyte solution (P<0.0001).4 In a study of two infants with ileostomies fed either oral humanised milk or rice water, rice water led to significantly lower ileal fluid osmolality and volume than did milk (P<0.02).5 It is believed that hypo-osmotic solutions result in increased luminal absorption of water and thus may lead to lower ileal fluid volume. Furthermore, in gastroenteritis absorption of monosaccharide (glucose) may be affected more than that of polysaccharide (starch).3

Many of the infants and children who are at increased risk of gastroenteritis and susceptible to complications of dehydration live in underdeveloped or developing countries. Rice water should be considered as an option for a rehydration fluid, since it combines the theoretical advantage of low osmolality and the proved efficacy of reduction of stool output.

References

  • 1.Hahn S, Kim Y, Garner P. Reduced osmolarity oral rehydration solution for treating dehydration due to diarrhoea in children: systematic review. BMJ. 2001;323:81–85. doi: 10.1136/bmj.323.7304.81. . (14 July.) [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 2.Fuchs GJ. A better oral rehydration solution? BMJ. 2001;323:59–60. doi: 10.1136/bmj.323.7304.59. . (14 July.) [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 3.Wong HB. Rice water in treatment of infantile gastroenteritis. Lancet. 1981;ii:102–103. doi: 10.1016/s0140-6736(81)90462-1. [DOI] [PubMed] [Google Scholar]
  • 4.Ho TF, Yip WCL, Tay JSH, Wong HB. Rice water and dextrose-saline solution: a comparative study of osmolality. J Singapore Paediatr Soc. 1982;24:87–91. [PubMed] [Google Scholar]
  • 5.Ho TF, Yip WCL, Tay JSH, Vellayappan K. Rice water and milk: effect on ileal fluid osmolality and volume. Lancet. 1982;i:169. doi: 10.1016/s0140-6736(82)90418-4. [DOI] [PubMed] [Google Scholar]
BMJ. 2001 Nov 3;323(7320):1068.

Doctors must increase use and acceptance of oral rehydration solution

Christopher Duggan 1

Editor—Rice water, mentioned in Ho and Yip's rapid response (www.bmj.com/cgi/eletters/323/7304/81#EL4, and printed as the letter above), has insufficient electrolytes to replace sodium and potassium losses during acute diarrhoea, in contrast to rice based oral rehydration solutions (to which these and other electrolytes are added). Moreover, the superiority of cereal-based solutions has been proved only in patients with cholera infections; children with non-cholera diarrhoea given cereal-based oral rehydration solution do not have a reduction in stool output when compared with children treated with standard glucose-based oral rehydration solution.1-1

The low level of use and acceptance of oral rehydration solution by clinicians in all countries of the world is a tragedy in the light of the widespread evidence of its efficacy.1-2 I hope that the data presented by Hahn et al will help to reinvigorate efforts by policymaking bodies to establish oral rehydration solution as the standard of care for all patients with diarrhoea.

References

  • 1-1.Fontaine O, Gore SM, Pierce NF. Rice-based oral rehydration solution for treating diarrhoea. Cochrane Database Syst Rev 2000;(2):CD001264. [DOI] [PubMed]
  • 1-2.Hahn S, Kim Y, Garner P. Reduced osmolarity oral rehydration solution for treating dehydration due to diarrhoea in children: systematic review. BMJ. 2001;323:81–85. doi: 10.1136/bmj.323.7304.81. . (14 July.) [DOI] [PMC free article] [PubMed] [Google Scholar]
BMJ. 2001 Nov 3;323(7320):1068.

Doctors in India still seem not to be convinced

Vipin M Vashishtha 1

Editor—I agree that reduced osmolarity oral rehydration solution is “an important step, but not a leap forward.” (1) Now there are enough studies to suggest the superiority of low osmolarity oral rehydration solution over the standard WHO (World Health Organization) solution. The issue in India, however, is not which one is a better product but how to make existing oral rehydration solutions more popular among doctors.

A recent survey, conducted among doctors all over India in June 1999 by the large marketing company ORG-MARG, found that only 18% were prescribing oral rehydration solution for children aged under 3 with acute diarrhoea whereas prescriptions for antidiarrhoeals were written for 49% of cases. In certain parts of the country the rate of prescription of oral rehydration solution was just 8.3%. These were startling findings in a country where 600 000 children die annually because of acute diarrhoea. The question arises, “Why are the doctors, especially in this part of the world, still prescribing drugs, not oral rehydration solution, for acute diarrhoea in children?” Several factors play a part:

  • Lack of a proper understanding of the pathophysiology of diarrhoea among most doctors

  • Lack of faith in the product

  • Fear of losing patients to some other doctor if drugs are not prescribed

  • Children's acceptance of oral rehydration solution is poor (because of its taste and colour)

  • Lack of enough time to explain and educate mothers about oral rehydration solution and diarrhoea

  • Peer pressure

  • Pressure from the pharmaceutical industry

  • Lack of a flexible approach among the practitioners

  • Lack of initiatives by the government and professional bodies engaged in child health promotional activities.

The lack of any initiative is appalling. Even the Indian Academy of Paediatrics, the sole representative body of paediatricians in India, was slow to address this critical issue. It needed aid from a Western agency to spur it on to pursue the matter further. PACT/CRH, the programme for advancement of commercial technology/child and reproductive health, was launched by the United States Agency for International Development in the middle of 1999 but was taken up by the academy only in 2000. Health comes quite low in the priorities of the establishment. To expect a government that is wasting money in patrolling deserted hills around Kashmir to give substantial funds for the purpose is definitely asking for too much.

References

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