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Treatment of acute infantile diarrhoea with a commercial rice-based oral rehydration solution
E Guiraldes1, X Triviño, M I Hodgson
1Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago.
Insights
Rice-based oral rehydration solution (ORS) was not more effective than standard glucose-based ORS for infants with watery diarrhea. Some cases showed increased stool loss with rice-ORS, indicating potential risks.
Area of Science:
- Pediatrics
- Gastroenterology
- Infectious Diseases
Background:
- Acute watery diarrhea is a significant cause of dehydration in infants.
- Oral rehydration solution (ORS) is the standard treatment for dehydration.
- WHO/UNICEF recommends glucose-based ORS, but alternative formulations are being explored.
Purpose of the Study:
- To compare the efficacy of a rice powder-based ORS with the standard glucose-based ORS.
- To evaluate the impact on stool output and duration of diarrhea in infants.
Main Methods:
- Randomized clinical trial involving 48 inpatients aged 3-24 months.
- Comparison of rice-ORS (50 g/l) versus glucose-based WHO/UNICEF ORS.
- Monitoring of stool output and duration of diarrhea.
Main Results:
- No significant difference in stool output or duration of diarrhea between rice-ORS and glucose-ORS groups.
- Rice-ORS group showed numerically higher stool output, though not statistically significant.
- 22% of patients required additional intravenous rehydration.
Conclusions:
- Rice-based ORS is not superior to standard glucose-based ORS for non-cholera watery diarrhea in infants.
- Commercial cereal-based ORS may increase stool losses in some high-output cases.
- Standard glucose-based ORS remains the recommended treatment.
Abstract:
This randomized clinical trial compared the efficacy of an oral rehydration solution (ORS) formulated with commercial rice powder, 50 g/l, with that of a glucose-based WHO/UNICEF-recommended ORS in the management of 48 inpatients aged 3-24 months, with acute dehydrating watery diarrhoea. Stool outputs were generally high in these patients, and 11 patients (22%) required additional intravenous rehydration solutions. The stool output (ml/kg) in the first 24 hours was [geometric mean, (95% confidence intervals)] 213 (153-353) in the rice-ORS group versus 146 (108-232) in the glucose-ORS group, while the total stool output was 455 (298-933) versus 307 (209-625); (p value not significant). The mean (+/- SD) duration of diarrhoea in hospital was: 72 +/- 10 hours in the study group versus 77 +/- 12 hours in the control group (p value NS). Enteropathogens were found in 94% of the patients, rotavirus being prevalent in 85% of the cases. It is concluded that the rice-ORS used in this trial is no more efficacious than the standard glucose-ORS advocated by WHO/UNICEF in the treatment of infants with watery non-cholera dehydrating diarrhoea. In some cases, ORS formulated with the commercial cereal-based products might actually increase the stool losses in infants with high-output non-cholera diarrhoea.