Abstract
AIMS—To compare the clinical efficacy of hypo-osmolar oral rehydration salt (ORS) solution (224 mmol/l) and standard ORS solution (311 mmol/l) in severely malnourished (marasmic) children having less than 60% Harvard standard weight for age with dehydrating acute watery diarrhoea. METHODS—In a double blind, randomised, controlled trial, 64 children aged 6-48 months were randomly assigned standard (n = 32) or hypo-osmolar ORS (n = 32). RESULTS—Stool output (52.3 v 96.6 g/kg/day), duration of diarrhoea (41.5 v 66.4 hours), intake of ORS (111.5 v 168.9 ml/kg/day), and fluid intake (214.6 v 278.3 ml/kg/day) were significantly less in the hypo-osmolar group than in the standard ORS group. Percentage of weight gain on recovery in the hypo-osmolar group was also significantly less (4.3 v 5.4% of admission weight) than in the standard ORS group. A total of 29 (91%) children in the standard ORS group and 32 (100%) children in the hypo-osmolar group recovered within five days of initiation of therapy. Mean serum sodium and potassium concentrations on recovery were within the normal range in both groups. CONCLUSION—Our findings suggest that hypo-osmolar ORS has beneficial effects on the clinical course of dehydrating acute watery diarrhoea in severely malnourished (marasmic) children. Furthermore, children did not become hyponatraemic after receiving hypo-osmolar ORS.
Full Text
The Full Text of this article is available as a PDF (120.2 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Alleyne G. A. The effect of severe protein calorie malnutrition on the renal function of Jamaican children. Pediatrics. 1967 Mar;39(3):400–411. [PubMed] [Google Scholar]
- Chatterjee A., Mahalanabis D., Jalan K. N., Maitra T. K., Agarwal S. K., Dutta B., Khatua S. P., Bagchi D. K. Oral rehydration in infantile diarrhoea. Controlled trial of a low sodium glucose electrolyte solution. Arch Dis Child. 1978 Apr;53(4):284–289. doi: 10.1136/adc.53.4.284. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Chen L. C., Rahman M., Sarder A. M. Epidemiology and causes of death among children in a rural area of Bangladesh. Int J Epidemiol. 1980 Mar;9(1):25–33. doi: 10.1093/ije/9.1.25. [DOI] [PubMed] [Google Scholar]
- Cleary T. G., Cleary K. R., DuPont H. L., El-Malih G. S., Kordy M. I., Mohieldin M. S., Shoukry I., Shukry S., Wyatt R. G., Woodward W. E. The relationship of oral rehydration solution to hypernatremia in infantile diarrhea. J Pediatr. 1981 Nov;99(5):739–741. doi: 10.1016/s0022-3476(81)80397-6. [DOI] [PubMed] [Google Scholar]
- Dutta P., Bhattacharya S. K., Dutta D., Mitra U., Bhattacharya M. K., Rasaily R., Sen D., Saha M. R., Mukherjee A., Pal S. C. Oral rehydration solution containing 90 millimol sodium is safe and useful in treating diarrhoea in severely malnourished children. J Diarrhoeal Dis Res. 1991 Jun;9(2):118–122. [PubMed] [Google Scholar]
- Finberg L., Harper P. A., Harrison H. E., Sack R. B. Oral rehydration for diarrhea. J Pediatr. 1982 Oct;101(4):497–499. doi: 10.1016/s0022-3476(82)80688-4. [DOI] [PubMed] [Google Scholar]
- Hirschhorn N. The treatment of acute diarrhea in children. An historical and physiological perspective. Am J Clin Nutr. 1980 Mar;33(3):637–663. doi: 10.1093/ajcn/33.3.637. [DOI] [PubMed] [Google Scholar]
- James J. W. Longitudinal study of the morbidity of diarrheal and respiratory infections in malnourished children. Am J Clin Nutr. 1972 Jul;25(7):690–694. doi: 10.1093/ajcn/25.7.690. [DOI] [PubMed] [Google Scholar]
- Kamath K. R., Feldman R. A., Rao P. S., Webb J. K. Infection and disease in a group of South India families. II. General morbidity patterns in families and family members. Am J Epidemiol. 1969 Apr;89(4):375–383. doi: 10.1093/oxfordjournals.aje.a120951. [DOI] [PubMed] [Google Scholar]
- Klahr S., Alleyne G. A. Effects of chronic protein-calorie malnutrition on the kidney. Kidney Int. 1973 Mar;3(3):129–141. doi: 10.1038/ki.1973.21. [DOI] [PubMed] [Google Scholar]
- Mahalanabis D., Faruque A. S., Hoque S. S., Faruque S. M. Hypotonic oral rehydration solution in acute diarrhoea: a controlled clinical trial. Acta Paediatr. 1995 Mar;84(3):289–293. doi: 10.1111/j.1651-2227.1995.tb13630.x. [DOI] [PubMed] [Google Scholar]
- Nichols B. L., Alvarado J., Rodriguez J., Hazlewood C. F., Viteri F. Therapeutic implications of electrolyte, water, and nitrogen losses during recovery from protein-calorie malnutrition. J Pediatr. 1974 May;84(5):759–768. doi: 10.1016/s0022-3476(74)80028-4. [DOI] [PubMed] [Google Scholar]
- Nichols B. L., Soriano H. A. A critique of oral therapy of dehydration due to diarrheal syndromes. Am J Clin Nutr. 1977 Sep;30(9):1457–1472. doi: 10.1093/ajcn/30.9.1457. [DOI] [PubMed] [Google Scholar]
- Rautanen T., Salo E., Verkasalo M., Vesikari T. Randomised double blind trial of hypotonic oral rehydration solutions with and without citrate. Arch Dis Child. 1994 Jan;70(1):44–46. doi: 10.1136/adc.70.1.44. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Rautanen T., el-Radhi S., Vesikari T. Clinical experience with a hypotonic oral rehydration solution in acute diarrhoea. Acta Paediatr. 1993 Jan;82(1):52–54. doi: 10.1111/j.1651-2227.1993.tb12516.x. [DOI] [PubMed] [Google Scholar]
- Samadi A. R., Wahed M. A., Islam M. R., Ahmed S. M. Consequences of hyponatraemia and hypernatraemia in children with acute diarrhoea in Bangladesh. Br Med J (Clin Res Ed) 1983 Feb 26;286(6366):671–673. doi: 10.1136/bmj.286.6366.671. [DOI] [PMC free article] [PubMed] [Google Scholar]
- el-Mougi M., el-Akkad N., Hendawi A., Hassan M., Amer A., Fontaine O., Pierce N. F. Is a low-osmolarity ORS solution more efficacious than standard WHO ORS solution? J Pediatr Gastroenterol Nutr. 1994 Jul;19(1):83–86. doi: 10.1097/00005176-199407000-00013. [DOI] [PubMed] [Google Scholar]