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Can potassium citrate replace sodium bicarbonate and potassium chloride of oral rehydration solution?
Insights
Tripotassium citrate effectively treats diarrheal dehydration and hypokalemia in children. This oral rehydration solution offers a safe and beneficial alternative to standard World Health Organization (WHO) oral rehydration solution.
Area of Science:
- Pediatrics
- Gastroenterology
- Clinical Nutrition
Background:
- Diarrheal dehydration and acidosis are significant health concerns in children under 5.
- Hypokalemia (low potassium) frequently accompanies these conditions.
- Standard World Health Organization (WHO) oral rehydration solution (ORS) is widely used but may not optimally address hypokalemia.
Purpose of the Study:
- To compare the efficacy and safety of a novel oral rehydration solution containing tripotassium citrate with the standard WHO-ORS.
- To evaluate the impact on rehydration, electrolyte balance (specifically potassium), and acidosis correction.
Main Methods:
- A randomized controlled trial involving 94 children under 5 with diarrheal dehydration and acidosis.
- Children received either WHO-ORS or a modified ORS where tripotassium citrate replaced sodium bicarbonate and potassium chloride.
- Key parameters monitored included rehydration status, stool output, body weight, and serum electrolyte levels (potassium) over 48 hours.
Main Results:
- Both solutions were effective in rehydration, with no significant differences in intake, stool output, or weight gain.
- The tripotassium citrate group showed significantly greater improvement in serum potassium levels among hypokalemic children.
- Acidosis correction was satisfactory in both groups by 48 hours, with no hyperkalemia observed in the citrate group.
Conclusions:
- Tripotassium citrate is a safe and effective alternative to sodium bicarbonate and potassium chloride in ORS for treating diarrheal dehydration.
- This modified ORS demonstrates particular benefit in managing associated hypokalemia.
- Tripotassium citrate may offer a more beneficial treatment option for children with diarrhea and hypokalemia.
Abstract:
Ninety four children aged less than 5 years with diarrhoeal dehydration and acidosis were treated randomly with either World Health Organisation (WHO) oral rehydration solution containing sodium chloride, potassium chloride, sodium bicarbonate and glucose or an oral solution with tripotassium citrate monohydrate replacing the sodium bicarbonate and potassium chloride in the WHO solution. Fifty five children (58%) were hypokalaemic (potassium less than 3.5 mmol/l) on admission. All but two in the citrate group were successfully treated. There were no significant differences in rehydration solution intake, stool output, gain in body weight, and fall in plasma specific gravity and haematocrit between the two treatment groups after 48 hours' treatment. Significant improvement in the serum potassium concentration was observed in the hypokalaemic children receiving potassium citrate solution compared with children receiving WHO solution after 24 and 48 hours' treatment. None developed hyperkalaemia. Although children receiving potassium citrate solution corrected their acidosis at a slower rate than the WHO solution group during the first 24 hours, by 48 hours satisfactory correction was observed in all. Tripotassium citrate can safely replace sodium bicarbonate and potassium chloride and may be the most useful and beneficial treatment for diarrhoea and associated hypokalaemia.