Clinical experience with a hypotonic oral rehydration solution in acute diarrhoea

A hypotonic oral rehydration salts (ORS) solution with total osmolality of 224 rnosmol/l was compared in an open clinical trial with an isotonic (osmolality 304 mosmol/l) ORS solution for the treatment of dehydration due to acute diarrhoea. Both ORS solutions had the same electrolyte composition with a Na⁺ concentration of 60 mmol/l. Children given the hypotonic ORS solution ( n = 103) passed significantly fewer diarrhoeal stools, and their diarrhoea and hospital stay were shorter than those of children given the isotonic ORS solution ( n= 135). We conclude that hypotonic ORS ("light" ORS) has clinical advantages over the standard ORS currently used in Finland.     

Hypotonic oral rehydration solution in acute diarrhoea: a controlled clinical trial

In a controlled trial, a hypotonic oral rehydration solution (ORS) (Na⁺67, K⁺20, CP66, citrate 7, glucose 89mmol/1 osmolality 249 mosmol/kg) was compared with a standard WHO-ORS (Na⁺90, K⁺20, Cl^-80, citrate 10, glucose lllmmol/1, osmolality 311 mosmol/kg) in 60 children aged 5-24 months with acute watery diarrhoea. In the hypotonic ORS group, stool frequency, proportion of children who vomited, ORS requirements and purging rate over 24-48 h were reduced by 33% ( p = 0.01), 30% ( p = 0.02), 21% ( p = 0.067) and 21% ( p = 0.03), respectively. The proportion of children who vomited and the purging rate over 48 h were reduced by 23% ( p = 0.03) and 10% ( p = 0.097), respectively. Serum electrolytes after 48 h were comparable. The beneficial effect of hypotonic ORS was most marked in, and largely contributed by, the subgroup negative for rotavirus.     

Evaluation of oral hypo-osmolar glucose-based and rice-based oral rehydration solutions in the treatment of cholera in children

In a randomized controlled clinical trial, the efficacy of a low-sodium low-glucose oral rehydration solution (ORS) and a low-sodium rice-based ORS was compared with standard WHO glucose ORS in the treatment of severe cholera in children aged 2-10y. In total, 120 children were evaluated for the study, of whom 58 patients were positive for Vibrio cholerae and were included in the study. Of these 58 cases, 19 received rice-based hypo-osmolar ORS, 20 received WHO-ORS and 19 received glucose-based hypo-osmolar ORS. The clinical characteristics (age, preadmission duration of diarrhoea, frequency of stool before admission, incidence of vomiting, body weight and volume of initial fluid requirement) were comparable in the three treatment groups. All patients received tetracycline in a dose of 50 mg/kg/d of body weight in 4 divided doses for 3 d. CONCLUSIONS: Patients who received rice-based hypo-osmolar ORS had subsequently reduced (p < 0.05) stool output, ORS consumption and diarrhoea duration than the patients who received either WHO-ORS or glucose-based hypo-osmolar ORS.     

Hydrolyzed lactalbumin-based oral rehydration solution for acute diarrhoea in infants

The addition of different organic substrates to standard glucose oral rehydration solution (G-ORS) has been shown to improve the intestinal absorption of sodium and water, and thereby decrease stool losses. Therefore, we evaluated, in infants with acute diarrhoea, the safety and efficacy of three oral rehydration solutions (ORS) which had the same concentrations of electrolytes (with sodium 60 mmol/l) but different substrates of proteins and carbohydrates. One solution (LAD-ORS) contained hydrolyzed lactalbumin (LAD) with maltodextrin and sucrose, a second (MS-ORS) was identical but without LAD and a third (G-ORS) was standard glucose ORS. The three solutions were compared in a double-blind, randomized trial in 74 hospitalized well-nourished children in Panama and the United States. All three oral rehydration solutions were equally efficacious and safe in these children, 54% of whom were infected with rotavirus. There was no suggestion that hydrolyzed lactalbumin or maltodextrin provided any advantage over glucose-ORS in terms of stool output or in duration of diarrhoea. We conclude that all three solutions are efficacious in the therapy of acute diarrhoea in infants.     

Role of cereal-based oral rehydration therapy in persistent diarrhoea in children

A total of 2000 children aged under five and 12,500 diarrhoea episodes were studied prospectively for assessing the efficacies of R-ORS and G-ORS and for comparing them with that of a comparison area using drugs for treatment. Efficacy was evaluated in terms of ORS use rate, consumption of ORS per episode, duration of diarrhoea and rate of recovery. The data were analysed to compare the rate of persistent diarrhoea in the three areas. Mean ORS consumption was 946 ± 576 and 1236 ± 766 ml per episode of watery diarrhoea in the R–ORS and G–ORS areas respectively. The mean durations of watery diarrhoea were 3.3 ± 2.1, 5.4 ± 3.5 and 8.8 ± 5.5 days in the R-ORS, G-ORS and comparison area, respectively. The median durations for dysentery were 7, 9 and 12 days in the three areas respectively. The incidences of persistent diarrhoea following watery diarrhoea were 0.4, 3 and 12% in the R-ORS, G-ORS and comparison area respectively, and, following dysentric episodes, 8, 18 and 40%. The results of the study suggest that R-ORS can hasten recovery from both watery diarrhoea and dysenteries, thus reducing the incidence of persistent diarrhoea.     

Oral rehydration with a plantain flour-based solution in children dehydrated by acute diarrhea: a clinical trial

A clinical trial was conducted in order to prove the efficacy of a solution containing 50 g/1 of plantain flour and 3. 5 g/1 of sodium chloride (NaCl) for the rehydration of children with acute diarrheal diseases. 121 children were given WHO-ORS (Group A) and 117 a plantain flour-based solution (Group B). Rehydration was successful in 85. 9% in Group A and 88. 0% in Group B ( p = 0. 634). Rehydration was completed in 5. 28 h (SD 1. 99) in Group A and in 4. 88 h (SD 2. 11) in Group B ( p = 0. 132). The average solution intake for rehydration was 24. 56ml/kg/h (SD 10. 12) in Group A and 21. 17ml/kg/h (SD 9. 35) in Group B ( p = 0. 00782). The mean stool output during rehydration was 8. 45g/kg/h (SD 9. 72) in Group A and 4. 69 g/kg/h (SD 4. 98) in Group B ( p = 0. 00053). Decrease in blood levels of sodium and potassium occurred in some children in group B. The plantain flour-based solution proved effective for the treatment of dehydration due to acute diarrheal diseases and should be considered as an alternative when standard WHO-ORS is not available.     

口服补液盐的种类及其在儿童急性腹泻中的应用

口服补液盐(0RS)被用于治疗儿童腹泻以来,为了适应临床需要,人们研制了各种不同种类的ORS.从最初世界卫生组织推荐的标准ORS、在此基础上添加不同物质的ORS到低渗性ORS,显示出其在治疗儿童急性腹泻中的疗效及各自的优点.     

Hypo-osmolar sucrose oral rehydration solutions in acute diarrhoea: a pilot study

Based on studies showing improved absorption of hypo-osmolar oral rehydration solutions (ORS) with reduced glucose and sodium concentration, a hypo-osmolar ORS with sucrose replacing glucose (sodium 60, potassium 15, chloride 60, citrate 5, sucrose 58mmoll^?1, calculated osmolality 198mOsmkg^?1) was compared with mildly hyperosmolar glucose ORS (WHO) in 46 children aged 6–30 months with acute diarrhoea and dehydration. In the hypo-osmolar sucrose ORS group (n = 18) faecal output was less by 30% during the initial 24 and 48 h compared with controls, suggesting better absorption. Sucrose may be a suitable alternative to glucose in an absorption-efficient hypo-osmolar ORS.     

口服补液盐治疗儿童直立性低血压的疗效评价

目的 探讨口服补液盐(ORS)治疗儿童直立性低血压(OH)的疗效.方法 选取2009年10月至2012年1月在中南大学湘雅二医院儿童晕厥专科门诊就诊或住院的不明原因晕厥或先兆晕厥且行直立倾斜试验(HUTT)诊断为OH的患儿12例.男5例,女7例;年龄6～14岁[(10.25±2.86)岁].予ORS治疗14 ～493 d[(74.50±134.43) d]后随诊复查HUTT.采用SPSS 16.0软件进行统计学分析.结果 1.血流动力学变化:HUTT开始前平卧位时心率(HR0)、HUTT开始后3 min时心率(HR3)、HUTT开始前平卧位时收缩压(SBP0)、HUTT开始后3 min时收缩压(SBP3)、HUTT开始前平卧位时舒张压(DBP0)治疗前后比较差异均无统计学意义(P均＞0.05),HUTT开始后3 min舒张压(DBP3)治疗后较治疗前明显升高[(68.42±7.01)mm Hg(1 mm Hg=0.133 kPa)比(57.83±13.98) mmHg,t=-2.344,P＜0.05].复查HUTT时OH儿童晕厥、先兆晕厥等症状减轻5例,消失7例.2.血流动力学变化的性别比较:治疗前及治疗后HR0、HR3、SBP0、SBP3、DBP0、DBP3男女比较差异均无统计学意义(P均＞0.05).结论 ORS能明显提高OH患儿舒张压,改善直立不耐受症状.     

Folic acid in the treatment of acute watery diarrhoea in children: a double-blind, randomized, controlled trial

One-hundred and six male children aged 6-23 months with a history of acute watery diarrhoea of less than 72 h duration were randomized to receive either folic acid in a dose of 5 mg at 8-h intervals or placebo for 5 d. There were 54 children in the folic acid group and 52 in the placebo group. The admission characteristics were comparable between the two groups. No significant differences were observed in the intake of oral rehydration solution or stool output between the groups. The mean ± SD of total stool output (g kg⁻¹) was 532 ± 476 vs 479 ± 354 and the duration (h) of diarrhoea was 108 ± 68 vs 103 ± 53 in the folic acid vs placebo group, respectively. The findings, therefore, should have a positive influence on preventing the inappropriate use of folic acid in acute diarrhoea.     

Double blind, randomised controlled clinical trial of hypo-osmolar oral rehydration salt solution in dehydrating acute diarrhoea in severely malnourished (marasmic) children

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.

     

口服补液盐治疗儿童神经介导性晕厥研究进展

神经介导性晕厥（neurally mediated syncope,NMS）是儿童最常见的不明原因晕厥,口服补液盐是治疗NMS的基础用药,可增加细胞外液和血容量,改变血液的重新分布,避免突然体位变化时左室充盈量不足导致的排空效应,防止迷走神经活性增强诱发晕厥发作,能明显提高NMS儿童的直立不耐受能力.增加水盐摄入纳入NMS儿童日常生活中的行为习惯培养,可减少儿童NMS的出现率,提高其生活质量.     

Randomized, controlled, clinical trial of rice versus glucose oral rehydration solutions in infants and young children with acute watery diarrhoea

A randomized clinical trial was carried out to compare a packaged ready-to-mix rice oral rehydration solution (ORS) to the standard glucose ORS for the treatment of childhood diarrhoea. Children were of either gender, aged 3–35 months, presenting with a history of watery diarrhoea for 72 h or less. The main outcomes examined were stool output, ORS intake, duration of diarrhoea and nutritional recovery during follow-up at 16 d of illness. Stool output in the first 24 h (106 vs 107 g kg^-1), ORS intake in clinic (93 vs 102 ml per motion) and duration of diarrhoea (88 h vs 81 h) were similar in the two treatment groups. The few episodes that became persistent were similar (2%) in the two groups. The weight gain during follow-up was similar in the two ORS groups.     

A field trial of wheat-based oral rehydration solution among Afghan refugee children

A total of 326 Afghan children aged between 6 months and 5 years with uncomplicated nondysenteric diarrhea for the previous 24 h to 5 days were treated at home by their mothers with either wheat-salt solution (WSS) or World Health Organization recommended glucose-oral rehydration salts (G-ORS). For 7 consecutive days the children were examined in the household and the mothers interviewed to assess the progress, feeding practices, and perception of treatment efficacy. Children treated with WSS recovered significantly earlier; the mean duration on treatment was 4.0 days (SD 1.7 days) on WSS compared to 6.4 days (SD 1.7 days) on G-ORS. By the second day of treatment, significantly more mothers using WSS (56%) reported that their children had formed stools versus 11 % of their G-ORS counterparts; the mean stool frequency after 2 days was also significantly reduced; 3 stools day⁻¹ (SD 2.1) on WSS versus 5 (SD 2.9) on G-ORS. The cereal-based solution was not confused with normal food and led to better feeding patterns. By day 2, 74% of the mothers using WSS had resumed their normal feeding frequencies as opposed to 33% of G-ORS mothers. On recovery the WSS group had gained significantly more weight; the WSS group gained 169 g (SD 142 g) while the G-ORS group lost 150g (SD 174 g). This study suggests by subjective and objective measures that WSS could be considered as an effective home fluid for the first-line treatment of diarrhea.     

Double blind, randomised controlled clinical trial of hypo-osmolar oral rehydration salt solution in dehydrating acute diarrhoea in severely malnourished (marasmic) children.

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.     

Alanine- and glucose-based hypo-osmolar oral rehydration solution in infants with persistent diarrhoea: a controlled trial

To evaluate the efficacy of a hypo-osmolar and a standard (World Health Organization) oral rehydration salt (ORS) solution in persistent diarrhoea, a randomized controlled clinical trial was conducted in 55 children. After a 1-day observation period the children were assigned to one of three solutions: standard ORS (WHO-ORS) (osmolality 311 mosmol/1), hypo-osmolar ORS containing L-alanine and glucose (osmolality 255 mosmol/1) and iv polyelectrolyte solutions (osmolality 293 mosmol/1) for ongoing replacement of stool loss for the next 4 days. Excellent acceptability of ORS (101-160 ml/kg body weight/day) by the children was observed. There were no significant differences in the total intake of solutions and food, and frequency of stools among the groups Stool outputs were significantly less in infants receiving hypo-osmolar ORS than in those receiving WHO-ORS for 0-24h (p = 0.04), 0-48h (p = 0.01), 0-72h (p = 0.04) and 0-96h (p = 0.03). The results indicate a sufficient scope of ORS practice in persistent diarrhoea. Furthermore, we found that a hypo-osmolar ORS containing L-alanine and glucose is as efficacious as an iv solution and more effective than WHO-ORS for replacement of ongoing stool loss in persistent diarrhoea. Alanine-glucose ORS, hypo-osmolar solution, oral rehydration solution, persistent diarrhoea     

A trial in the Karelian Republic of oral rehydration and Lactobacillus GG for treatment of acute diarrhoea

In a controlled trial in Petrozavodsk, Karelia, the effects of oral rehydration and Lactobacillus strain GG (LGG) on recovery from acute diarrhoea (27% rotavirus, 21% bacterial aetiology) were studied in 123 children aged between 1 and 36 months of age. On admission to hospital, the patients were first randomized to receive either isotonic oral rehydration solution (ORS) with osmolality 311mosmol/l and sodium 90mmol/l (WHO-ORS), or a hypotonic ORS with osmolality 224mosmol/l and sodium 60mmol/l (Light-ORS), and thereafter randomized to receive either 5 × 10⁹ colony forming units of LGG or a matching placebo. The two ORS performed equally for acute rehydration, and oral rehydration with either ORS was associated with a shorter duration of diarrhoea than intravenous rehydration ( p = 0.036). Patients receiving LGG had a significantly shorter duration of watery diarrhoea [mean (SD) 2.7 (2.2) days] than those receiving the placebo [3.7 (2.8) days, p = 0.03]. LGG significantly shortened the duration of rotavirus diarrhoea but not diarrhoea with confirmed bacterial aetiology.     

低渗口服补液盐治疗儿童急性腹泻轻中度脱水的疗效和安全性评价

目的评价国产低渗口服补液盐（ROORS）治疗脱水患者的临床疗效和安全性。方法采用多中心、随机双盲、阳性药物（口服补液盐Ⅱ）平行对照试验,共治疗17岁及以下急性腹泻脱水患儿125例,其中试验组62例,使用ROORS;对照组63例,使用口服补液盐Ⅱ（ORSⅡ）。结果试验组和对照组的总有效率分别为96．8％和96．8％;试验组全身症状、脱水症状及腹泻症状的改善率分别为96％、97％和78％,对照组分别为96％、98％和85％。两组上述指标的差异及需静脉补液人数差异均无统计学意义（P〉0．05）,但试验组静脉补液量较对照组少。试验组治疗前后血清Na^＋浓度差异无统计学意义,但对照组治疗后血清Na^＋均值高于治疗前。两组患儿经治疗后,总体病情严重程度均改善明显,但两组间比较,差异无统计学意义（P〉0．05）。试验组1例受试者出现轻度腹胀,未停药自行消失。未发生其他不良事件。结论ROORS在治疗急性腹泻病导致的轻、中度脱水的疗效和安全性方面与ORSⅡ相似,且能减少静脉补液量,降低发生高钠血症的风险。