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Oral hydration of diarrhoeal dehydration. Comparison of high and low sodium concentration in rehydration solutions
Insights
Oral rehydration therapy using a high-sodium (90 mEq/l) sucrose-electrolyte solution effectively treated most infants with diarrheal dehydration. Intravenous fluids are recommended for infants with high purging rates.
Area of Science:
- Pediatrics
- Gastroenterology
- Public Health
Background:
- Diarrheal dehydration is a significant cause of mortality in infants.
- Oral rehydration therapy (ORT) is a cornerstone of treatment.
- Optimizing ORT solutions, particularly electrolyte concentrations, is crucial for efficacy.
Purpose of the Study:
- To compare the efficacy and safety of two oral sucrose-electrolyte solutions with different sodium concentrations for rehydrating infants with moderate to severe diarrheal dehydration.
Main Methods:
- A double-blind, randomized controlled trial involving infants aged 2-20 months.
- Two groups received either a high-sodium (90 mEq/l) or low-sodium (58 mEq/l) sucrose-electrolyte solution.
- Rehydration assessed clinically and confirmed by body weight, hematocrit, total serum protein, and blood urea nitrogen.
Main Results:
- Successful rehydration was achieved in 80% of infants on the high-sodium solution and 77% on the low-sodium solution.
- Mild hypernatremia occurred in 3 infants on the high-sodium solution; slight hyponatremia in 2 on the low-sodium solution.
- Higher purging rates were associated with treatment failure.
Conclusions:
- Oral sucrose-electrolyte solution with a sodium concentration of 90 mEq/l is safe and effective for most infants with diarrheal dehydration.
- Intravenous fluid availability is essential for infants with high purging rates who may not respond to ORT.
Abstract:
Oral hydration of diarrhoeal dehydration. Acta Paediatr Scand, 72:167, 1983.--Two groups of infants aged 2 to 20 months with moderate to severe dehydration were randomly assigned to either sucrose high sodium (90 mEq/l) or sucrose low sodium (58 mEq/l) solution in a double blind manner. Rehydration was assessed on clinical grounds and confirmed by serial determination of body weight, hematocrit, total serum protein and blood urea nitrogen. Twenty (80%) of 25 patients on sucrose high sodium solution and 20 (77%) of 26 patients on sucrose low sodium solution were successfully hydrated. Only the assigned sucrose-electrolyte solution was given during the average rehydration period of about 7 hours when the serum electrolytes were remeasured. Three patients on high sodium solution developed mild hypernatremia. Slight hyponatremia was encountered in 2 patients on low sodium solution. Purging rate was significantly higher in patients who failed as compared to those who succeeded. The results of this study suggest that oral sugar electrolyte solution with sodium concentration of 90 mEq/l is safe and effective in the majority of infants with diarrhoeal dehydration of diverse causes. However, intravenous fluids must be available particularly for those with a high purging rate as a significant number of them may fail.