Related Experiment Videos
Reduced osmolarity oral rehydration solution for treating dehydration caused by acute diarrhoea in children
1Department of Paediatrics, Seoul National Univeristy Children's Hospital, 28 Yongon-dong, Chongno-Gu, Seoul, South Korea, 110-774. yaejean kim@yahoo.com
Insights
Reduced osmolarity oral rehydration solution (ORS) is more effective for children with acute diarrhea than the standard World Health Organization (WHO) formulation. This improved ORS reduces unscheduled intravenous infusions, stool volume, and vomiting without increasing hyponatremia risk.
Area of Science:
- Pediatrics
- Gastroenterology
- Public Health
Background:
- Oral rehydration solution (ORS) has significantly reduced childhood mortality from diarrhea globally.
- Emerging evidence suggests the standard World Health Organization (WHO) ORS formulation may not be optimal.
- Lower sodium and glucose concentrations in ORS may offer improved efficacy.
Purpose of the Study:
- To compare the effectiveness of a reduced osmolarity glucose-based ORS with the standard WHO formulation in children experiencing acute diarrhea.
- To evaluate key clinical outcomes, including the need for intravenous fluid therapy and measures of illness severity.
Main Methods:
- A systematic review and meta-analysis of randomized controlled trials (RCTs) were conducted.
- Searches included the Cochrane Collaboration Trials Register, MEDLINE, and EMBASE, supplemented by hand searching and expert consultation.
- Data extraction and analysis involved two independent reviewers, heterogeneity testing, and assessment of publication bias.
Main Results:
- Reduced osmolarity ORS was associated with a significant reduction in unscheduled intravenous infusions compared to standard WHO ORS (OR 0.61; 95% CI 0.47-0.81).
- Evidence indicated less stool output and reduced frequency of vomiting in children receiving reduced osmolarity ORS.
- No significant difference in the incidence of hyponatremia was observed between the two ORS formulations.
Conclusions:
- In hospitalized children with diarrhea, reduced osmolarity ORS demonstrates superior outcomes compared to the WHO formulation.
- Key benefits include fewer unscheduled intravenous infusions, decreased stool volume, and less vomiting.
- Reduced osmolarity ORS does not appear to increase the risk of hyponatremia.
Background:
Oral rehydration solution (ORS) has reduced childhood deaths from diarrhoea in many countries. Recent studies suggest that the currently recommended formulation of ORS recommended by the World Health Organization (WHO) may not be optimal, and solutions that contain lower concentrations of sodium and glucose may be more effective.
Objectives:
In children with acute diarrhoea, to compare reduced osmolarity glucose-based oral rehydration salt solution with international WHO formulation.
Search Strategy:
The Cochrane Collaboration Trials Register, MEDLINE, and EMBASE were searched. Additional trials were identified by hand searching. Content experts were contacted.
Selection Criteria:
Randomised controlled trials comparing reduced osmolarity ORS solution with the WHO formulation. Outcomes sought were unscheduled intravenous fluid infusion therapy and measures of clinical illness.
Data Collection And Analysis:
Data were extracted by two reviewers. We tested for heterogeneity using the chi-square statistic, conducted sensitivity analysis by allocation concealment, and the regression approach to assess funnel plot asymmetry from selective trial publication.
Main Results:
The primary outcome was reported in 12 trials. In a meta-analysis of nine trials, reduced osmolarity ORS was associated with fewer unscheduled infusions compared with standard WHO ORS (Mantel Haenzel odds ratio 0.61, 95% confidence interval 0.47 to 0.81) with no evidence for heterogeneity between trials. No unscheduled intravenous fluid infusion therapy was required in any participant in three trials. Thirteen trials reported stool output, and data suggested less stool output in the reduced osmolarity ORS group. Vomiting was less frequent in the reduced osmolarity group in the six trials reporting this. Six trials sought hyponatraemia, with events in three studies, but no obvious difference between the two arms.
Reviewer'S Conclusions:
In children admitted to hospital with diarrhoea, reduced osmolarity ORS when compared to WHO ORS is associated with fewer unscheduled intravenous infusions, smaller stool volume post randomisation, and less vomiting. No additional risk of developing hyponatraemia when compared with WHO ORS was detected.