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Bicarbonate versus citrate in oral rehydration therapy in infants with watery diarrhea: a controlled clinical trial
Insights
This study found that citrate-containing oral rehydration solution is as effective as bicarbonate-containing solution for treating infantile diarrheal dehydration and acidosis. Both formulations successfully rehydrated infants without requiring intravenous fluids.
Area of Science:
- Pediatrics
- Gastroenterology
- Clinical Trials
Background:
- Infantile diarrhea is a common cause of dehydration and metabolic acidosis.
- Oral rehydration therapy (ORT) is the standard treatment.
- The World Health Organization (WHO) recommends specific ORT formulations.
Purpose of the Study:
- To compare the efficacy of bicarbonate-containing vs. citrate-containing ORT in infants.
- To evaluate treatment success rates and correction of acidosis.
- To determine if sodium citrate can replace sodium bicarbonate in WHO-recommended ORT.
Main Methods:
- A double-blind, randomized controlled trial was conducted.
- Ninety-seven infants (3-24 months) with diarrheal dehydration and acidosis were enrolled.
- Infants received either bicarbonate-containing or citrate-containing ORT.
Main Results:
- Oral rehydration was successful in 85% of patients, with similar rates in both groups.
- Both solutions effectively increased serum total CO2 concentration towards normal levels within 48 hours.
- No significant differences were observed between the bicarbonate and citrate groups.
Conclusions:
- Sodium citrate is a viable and effective substitute for sodium bicarbonate in ORT formulations.
- Citrate-containing ORT can be used interchangeably with bicarbonate-containing ORT for infantile diarrheal dehydration and acidosis.
- This finding supports the flexibility in formulating WHO-recommended ORT solutions.
Abstract:
In a double-blind, randomized trial, we compared the efficacy of bicarbonate-containing oral rehydration solution vs citrate-containing solution in the treatment of infantile diarrheal dehydration and acidosis. Ninety-seven infants 3 to 24 months of age were entered in the study; 49 received bicarbonate-containing solution and 48 citrate-containing solution. The two groups were similar in all respects at the beginning of the study. Oral rehydration was successful (i.e., no intravenously administered fluids were required) in 85% of study patients; the success rate was similar in both treatment groups. Serum total CO2 concentration increased in a similar fashion in both groups, reaching near normal values at 48 hours after admission. We conclude that sodium citrate can be substituted for sodium bicarbonate in the formulation of the orally administered rehydration solution recommended by the World Health Organization for treatment of diarrheal dehydration in infants.