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Alanine- and glucose-based hypo-osmolar oral rehydration solution in infants with persistent diarrhoea: a controlled
S A Sarker1, N Majid, D Mahalanabis
1International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Dhaka.
Insights
A new hypo-osmolar oral rehydration salt (ORS) solution, containing L-alanine and glucose, proved more effective than standard WHO-ORS in reducing stool output for children with persistent diarrhea. This ORS option demonstrated efficacy comparable to intravenous solutions.
Area of Science:
- Pediatrics
- Gastroenterology
- Clinical Trials
Background:
- Persistent diarrhea poses significant rehydration challenges in children.
- Standard World Health Organization oral rehydration salt (WHO-ORS) solutions are widely used but may have limitations in certain conditions.
- Evaluating alternative ORS formulations is crucial for optimizing treatment outcomes.
Purpose of the Study:
- To compare the efficacy of a hypo-osmolar ORS with L-alanine and glucose against standard WHO-ORS and intravenous solutions in managing persistent diarrhea in children.
- To assess the acceptability and impact on stool output of the hypo-osmolar ORS formulation.
Main Methods:
- A randomized controlled clinical trial involving 55 children with persistent diarrhea.
- Children received one of three solutions for 4 days: standard WHO-ORS (311 mosmol/l), hypo-osmolar ORS with L-alanine and glucose (255 mosmol/l), or intravenous polyelectrolyte solutions (293 mosmol/l).
- Outcomes measured included solution intake, food intake, stool frequency, and stool output.
Main Results:
- The hypo-osmolar ORS containing L-alanine and glucose showed significantly reduced stool output compared to standard WHO-ORS across multiple time points (0-24h, 0-48h, 0-72h, 0-96h).
- Acceptability of the ORS solutions was excellent, with no significant differences in total intake or stool frequency among groups.
- The hypo-osmolar ORS demonstrated efficacy comparable to intravenous solutions for ongoing stool loss replacement.
Conclusions:
- A hypo-osmolar ORS formulation with L-alanine and glucose is a highly effective option for managing persistent diarrhea in children.
- This hypo-osmolar ORS is superior to standard WHO-ORS in reducing stool output and offers an alternative to intravenous therapy.
- The findings support the expanded use of ORS in persistent diarrhea management.
Abstract:
To evaluate the efficacy of a hypo-osmolar and a standard (World Health Organization) oral rehydration salt (ORS) solution in persistent diarrhoea, a randomized controlled clinical trial was conducted in 55 children. After a 1-day observation period the children were assigned to one of three solutions: standard ORS (WHO-ORS) (osmolality 311 mosmol/l), hypo-osmolar ORS containing L-alanine and glucose (osmolality 255 mosmol/l) and i.v. polyelectrolyte solutions (osmolality 293 mosmol/l) for ongoing replacement of stool loss for the next 4 days. Excellent acceptability of ORS (101-160 ml/kg body weight/day) by the children was observed. There were no significant differences in the total intake of solutions and food, and frequency of stools among the groups. Stool outputs were significantly less in infants receiving hypo-osmolar ORS than in those receiving WHO-ORS for 0-24 h (p = 0.04), 0-48 h (p = 0.01), 0-72 h (p = 0.04) and 0-96 h (p = 0.03). The results indicate a sufficient scope of ORS practice in persistent diarrhoea. Furthermore, we found that a hypo-osmolar ORS containing L-alanine and glucose is as efficacious as an iv solution and more effective than WHO-ORS for replacement of ongoing stool loss in persistent diarrhoea.