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Multicentre evaluation of reduced-osmolarity oral rehydration salts solution. International Study Group on
Insights
Reduced-osmolarity oral rehydration salts (ORS) solution is more effective for children with acute diarrhea in developing countries. It led to less stool output, lower ORS intake, and shorter diarrhea duration compared to standard ORS.
Area of Science:
- Pediatrics
- Gastroenterology
- Public Health
Background:
- Standard oral rehydration salts (ORS) solutions carry a risk of hypernatremia in developed countries.
- Reduced-osmolarity ORS is recommended in developed countries due to potential risks associated with standard ORS.
Purpose of the Study:
- To compare the clinical efficacy of reduced-osmolarity ORS versus standard ORS in children with acute diarrhea in developing countries.
- To evaluate the impact of ORS osmolarity on stool output, ORS intake, diarrhea duration, and need for intravenous infusion.
Main Methods:
- A randomized controlled trial involving 447 boys aged 1-24 months with acute diarrhea and dehydration.
- Participants received either standard ORS (311 mmol/L) or reduced-osmolarity ORS (224 mmol/L).
- Clinical outcomes including stool output, ORS intake, diarrhea duration, and need for intravenous infusion were monitored.
Main Results:
- Standard ORS group had 39% greater stool output, 18% greater ORS intake, and 22% longer diarrhea duration.
- The risk of requiring intravenous infusion was higher with standard ORS, particularly in non-breastfed children.
- Mean 24-hour sodium concentration was significantly lower in the reduced-osmolarity ORS group.
Conclusions:
- Reduced-osmolarity ORS demonstrates beneficial effects on the clinical course of acute diarrhea in children.
- Findings support the use of reduced-osmolarity ORS for non-cholera diarrhea in developing countries.
- Further research is needed to optimize formulation and assess efficacy in cholera treatment.
Abstract:
In developed countries, use of oral rehydration salts (ORS) solution with osmolarity lower than that of plasma has been recommended because of the risk of hypernatraemia. We compared the clinical efficacy of reduced-osmolarity ORS and standard ORS solutions in children with acute diarrhoea in four developing countries. 447 boys aged 1-24 months, admitted to hospitals in four countries with acute diarrhoea and signs of dehydration, were randomly assigned either standard ORS (311 mmol/L) or reduced-osmolarity ORS (224 mmol/L) solution. Total stool output was 39% greater (95% CI 11-75), total ORS intake 18% greater (3-33), and duration of diarrhoea 22% longer (2-45) in the standard ORS group than in the reduced-osmolarity ORS group. The risk of requiring intravenous infusion after completion of the initial oral rehydration was greater in children given standard ORS solution than in those given reduced-osmolarity ORS solution in three of the four countries (all-country relative risk 1.4 [0.9-2.4]). This relative risk was significantly increased only in non-breastfed children (2.0 [1.0-3.8], p < 0.05). In breastfed children, the relative risk of requiring intravenous infusion was not affected by the ORS solution (0.9 [0.4-2.0]). The mean sodium concentration 24 h after admission was significantly lower in the reduced-osmolarity ORS group than in the standard ORS group (135 [134-136] vs 138 [136-139] mmol/L, p < 0.01). Reduced-osmolarity ORS solution has beneficial effects on the clinical course of acute diarrhoea. Our findings support the use of reduced-osmolarity ORS solution in children with acute non-cholera diarrhoea in developing countries. Further studies are needed to find the best formulation and whether such a solution would be satisfactory for the treatment of cholera.