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Oral rehydration therapy without bicarbonate for prevention and treatment of dehydration: a double-blind controlled
E J Elliott1, J C Armitstead, M J Farthing
1Academic Department of Child Health, Queen Elizabeth Hospital for Children, London, UK.
Insights
Oral rehydration solution (ORS) without bicarbonate is effective for children with acute gastroenteritis in the UK. This formulation simplifies production and reduces costs without compromising hydration or acid-base balance in mild to moderate cases.
Area of Science:
- Pediatrics
- Gastroenterology
- Clinical Nutrition
Background:
- Acute gastroenteritis is a common cause of dehydration in children.
- Oral rehydration solution (ORS) is a standard treatment for dehydration.
- The role of bicarbonate in ORS for non-severe dehydration requires further investigation.
Purpose of the Study:
- To compare the efficacy of ORS with and without bicarbonate in treating acute gastroenteritis in children.
- To evaluate the impact on hydration status, acid-base balance, and clinical outcomes.
- To assess the feasibility of simplifying ORS formulation.
Main Methods:
- Randomized controlled trial involving 40 children (≤2 years) with acute gastroenteritis.
- Comparison of ORS containing bicarbonate versus ORS with chloride replacing bicarbonate.
- Assessment of clinical parameters including dehydration degree, stool frequency, and hospital stay.
- Biochemical analysis of venous pH, serum bicarbonate, urea, and electrolytes.
Main Results:
- No significant differences in clinical outcomes (rehydration speed, duration of diarrhea, hospital stay) between the two ORS groups.
- Similar hydration and acid-base status (venous pH, serum bicarbonate) after 24 hours of treatment.
- Both ORS formulations were safe and effective in managing acute gastroenteritis in hospitalized children.
Conclusions:
- ORS without bicarbonate is a safe and effective alternative for managing mild to moderate dehydration in pediatric acute gastroenteritis.
- Excluding bicarbonate simplifies ORS production, enhances stability, and reduces costs.
- This formulation maintains hydration and acid-base status effectively in the studied population.
Abstract:
Forty children (less than or equal to 2 years of age) were admitted to hospital with acute gastroenteritis and were randomly assigned to receive either an oral rehydration solution (ORS) containing bicarbonate (Na 35, K 20, Cl 37, HCO3 18, glucose 202 mmol litre-1) or an identical solution in which bicarbonate was replaced by chloride ions. Groups were matched for age, sex, ethnic origin, duration of diarrhoea and nutritional status. On admission, degree of dehydration, biochemical and haematological parameters were similar. The majority had minimal or no dehydration and only 30% had moderate to severe dehydration. All children were treated successfully with no complications. Oral rehydration solution intake by each group was similar. Clinical outcome, as judged by speed of rehydration or maintenance of hydration, duration of diarrhoea, stool frequency and length of hospital stay, was the same in both groups. After 24 h of ORS there was no difference between groups in venous pH, serum bicarbonate, urea and electrolytes. In hospitalized children with acute gastroenteritis in the United Kingdom an ORS without bicarbonate is a safe, effective means to prevent dehydration and maintain hydration and acid-base status where dehydration is not severe. Exclusion of bicarbonate would simplify production, increase stability and reduce the cost of ORS without apparent impairment of efficacy.