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PubMed1992

Evaluation of malto-dextrin/glycine oral rehydration solution.

The efficacy and safety of malto-dextrin/glycine-based oral rehydration solution (ORS) when compared with the glucose-based oral rehydration solution (WHO) was evaluated in a randomized double-blind clinical trial. Thirty-one subjects and 31 controls were studied. The mean values of the ORS intake, stool output, duration of diarrhoea, urine output, weight gain and serum electrolytes were comparable in both the study and the control groups (p > 0.05). It was found that the malto-dextrin/glycine ORS offered no therapeutic advantage over the standard glucose ORS (WHO). In view of the accidental preponderance of children of significantly lower nutritional status among the control group (p < 0.05), it is likely that the efficacy of malto-dextrin/glycine ORS might actually be less than that of the glucose ORS.

Diarrhea, Infantile↗
PubMed1994

Whole milk and oral rehydration solution for calves with diarrhea of spontaneous origin.

Forty-two calves (mean 10 d of age) that spontaneously contracted diarrhea were used to test the therapeutic value of an oral rehydration solution with or without whole milk. Therapy began on the first feeding after a fecal score was > 2 (five-point scale). Amounts (percentages of BW daily) of milk and oral rehydration solution on d 1 and 2, 3 and 4, 5 and 6, and 7 for treatments 1, 2, and 3 were 1) 0 and 10, 5 and 5, 7.5 and 2.5, 10 and 0% (in two feedings); 2) 2.5 and 10, 5 and 7.5, 7.5 and 5, 10 and 0% (in two feedings); 3) 10 and 10, 10 and 5, 10 and 2.5, 10 and 0% (in three feedings). Oral rehydration solution was fed 15 min after milk. Fecal score, rectal temperature, packed cell volume of whole blood, concentrations of glucose and electrolytes in serum, and strong ion difference of serum were unaffected by treatments. Calves given treatment 3 gained BW throughout the experiment, whereas those given treatments 1 and 2 lost BW during the first 3 d of therapy. Fecal cultures indicated that 70% of calves were infected with Cryptosporidium on d 1 of therapy. No mortality occurred. Whole milk and oral rehydration solution fed to calves did not adversely affect calves or prolong or worsen diarrhea but promoted gain of BW.

Animals↗
PubMed1995

Treatment of acute infantile diarrhoea with a commercial rice-based oral rehydration solution.

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.

Acute Disease↗
PubMed1989

[Treatment of acute diarrhea in infants and young children with a new formulated oral rehydration solution].

49 infants and children with acute diarrhea with mild to moderate dehydration have been rehydrated orally with a newly composed oral rehydration solution. This solution differs from the traditional WHO recommended rehydration solution in a lower sodium content of 60 mval/l and replacement of bicarbonate 25 mval/l by an equimolar amount of citrate. The taste of the solution was improved by addition of flavour. All infants and children - including 8 infants less than 3 months of age - were successfully rehydrated. The solution was well accepted; no side effects have been observed. The sodium content remained normal in all patients.

Bicarbonates↗
PubMed2000

Controlled trial of hypo-osmalar versus World Health Organization oral rehydration solution.

OBJECTIVE: To compare the safety and efficacy of a hyposmolar oral rehydration solution (H-ORS) (245 mmol/liter) with the World Health Organization oral rehydration solution (WHO ORS) in cholera and acute non-cholera diarrhea. DESIGN: Controlled clinical trial. SETTING: Diarrhea training and treatment unit. METHODS: Thirty-five culture proven cholera and 135 acute non-cholera diarrheal patients randomly received H-ORS or WHO-ORS. Intake and output were measured every 4 hours. RESULTS: Analysis of the total cases revealed rehydration phase (p=0.048, 95% CI 0.64-0.99) and overall (p=0.046, 95% CI 0.70-0.99) frequency of stools to be significantly less in the H-ORS group. In the severely malnourished, the rehydration phase (p=0.032, 95% CI 0.55-97), maintenance phase (p=0.035, 95% CI 0.51-0.97) and overall (p=0.011; 0.95% CI 0.55-0.93) stool frequency were significantly decreased in the H-ORS group. The amount of ORS consumed in the maintenance phase of the cholera cases was significantly (p=0.04, 95% CI 0.44-0.98) less in the H-ORS group. All other parameters, despite showing a decreasing trend, were statistically comparable in the cholera, non-cholera and total cases. The amount of intravenous fluid needed was significantly more in the noncholera and total cases on H-ORS. In the non-breastfed cases, under two years of age, the total duration of diarrhea was significantly decreased (p=0.03; 95% CI 11.07-11.45) but the need for intravenous fluids significantly increased (p=0.02; 95% CI 109.8-112.1) in the H-ORS group. The proportion of children vomiting, the weight gain, urine passed in 24 hours, serum sodium, caloric intake and failure rate were comparable. CONCLUSIONS: H-ORS is as safe and effective as the WHO-ORS and may have some additional benefits in malnourished children.

Administration, Oral↗
PubMed1989

Efficacy of a standard United Kingdom oral rehydration solution (ORS) and a hypotonic ORS assessed by human intestinal perfusion.

Human triple-lumen intestinal perfusion was used to compare water and solute absorption from the oral rehydration solution (ORS) most widely used in the United Kingdom and a new experimental hypotonic ORS (HYPO-ORS). HYPO-ORS (osmolality 210 mOsm/kg) promoted significantly greater water absorption than UK-ORS (7.03 +/- 1.1 vs 2.73 +/- 1.0 ml cm-1 h-1; P less than 0.01). HYPO-ORS produced net sodium and chloride absorption whereas the low sodium UK-ORS produced a net secretion of these ions. Bicarbonate absorption was also greater from HYPO-ORS although potassium and glucose absorption were similar from both solutions. This study suggests that UK-ORS may not promote optimal water and solute absorption and that clinical studies with HYPO-ORS are indicated.

Adult↗
PubMed1994

Hydrolyzed lactalbumin-based oral rehydration solution for acute diarrhoea in infants.

The addition of different organic substrates to standard glucose oral rehydration solution (G-ORS) has been shown to improve the intestinal absorption of sodium and water, and thereby decrease stool losses. Therefore, we evaluated, in infants with acute diarrhoea, the safety and efficacy of three oral rehydration solutions (ORS) which had the same concentrations of electrolytes (with sodium 60 mmol/l) but different substrates of proteins and carbohydrates. One solution (LAD-ORS) contained hydrolyzed lactalbumin (LAD) with maltodextrin and sucrose, a second (MS-ORS) was identical but without LAD and a third (G-ORS) was standard glucose ORS. The three solutions were compared in a double-blind, randomized trial in 74 hospitalized well-nourished children in Panama and the United States. All three oral rehydration solutions were equally efficacious and safe in these children, 54% of whom were infected with rotavirus. There was no suggestion that hydrolyzed lactalbumin or maltodextrin provided any advantage over glucose-ORS in terms of stool output or in duration of diarrhoea. We conclude that all three solutions are efficacious in the therapy of acute diarrhoea in infants.

Acute Disease↗
PubMed1999

First do no harm: making oral rehydration solution safer in a cholera epidemic.

Oral rehydration solution (ORS) is lifesaving therapy for cholera and pediatric diarrhea. During a cholera epidemic in Guinea-Bissau, we evaluated the microbiologic quality of ORS prepared at a hospital and tested a simple intervention using special vessels for disinfecting tap water with bleach and for preparing, storing, and dispensing ORS. Few coliform bacteria and Escherichia coli were recovered from tap water; however, pre-intervention ORS contained numerous bacteria including E. coli and toxigenic Vibrio cholerae O1. In contrast, ORS samples from intervention vessels had few or no coliform bacteria, no E. coli, and no V. cholerae. Mean pre-intervention counts of coliform bacteria (3.4 x 10(7) colony-forming units [cfu]/100 ml) and E. coli (6.2 x 10(3) cfu) decreased significantly during the intervention period to 3.6 x 10(2) cfu and 0 cfu, respectively (P < 0.001). This simple system using bleach disinfectant and special storage vessels prevents bacterial contamination of ORS and reduces the risk of nosocomial transmission of cholera and other enteric pathogens.

Agglutination Tests↗
PubMed1988

Use and safety of home-made oral rehydration solutions: an epidemiological evaluation from Bangladesh.

Home-made oral rehydration solutions (ORS) have been promoted in developing countries for preventing dehydration due to diarrhoea. Evaluations of this method must take into account the effective usage rates achieved and the safety of the solutions used. A community programme organized by the Bangladesh Rural Advancement Committee (BRAC) has visited over a third of all the households in Bangladesh and taught the preparation and use of an oral rehydration solution made from lobon (common salt) and gur (unrefined sugar)--abbreviated to LGS. An evaluation study based on over 7000 households enabled different usage rates to be calculated for four different diarrhoea types. The overall usage of LGS for all diarrhoea episodes was around 5-10% but for what the people called 'Severe Diarrhoeas' or cholera it was found to be between 25% and 52%. The mother's ability to prepare a safe Lobon-gur solution appeared to deteriorate about six months after training and it was significantly poorer in the Second Phase than the First Phase of the BRAC programme.

Adolescent↗
PubMed1998

Proabsorptive effects of modified tapioca starch as an additive of oral rehydration solutions.

BACKGROUND: Partially hydrolyzed starches from staple cereals, obtained by heat or by enzymatic treatment, are often used in the formulation of homemade or extemporaneously used oral rehydration solutions used in developing countries. Conflicting or anecdotal results obtained thus far could be clarified with a standardized preparation tested under well-controlled laboratory conditions. METHODS: A modified commercial tapioca starch was tested. Textra (National Starch and Chemical Co. Bridgewater, NJ, U.S.A.) added at 0, 5 or 10 g/l to an oral rehydration solution with 90 mM sodium and 111 mM glucose, in 30 rats malnourished by a protein-deficient diet for 3 weeks and in 26 well-fed control animals, using a one-pass jejunal perfusion. RESULTS: In protein-deficient rats, Textra stimulated sodium absorption at 5 and 10 g/l (mean +/- SEM); 0 g/l Textra: 160 +/- 13 nmol/min x cm; 5 g/l Textra: 406 +/- 31 (p < 0.0001); and 10 g/l Textra 230 +/- 27 (p < 0.02). Potassium absorption was comparably increased. Textra also improved net water absorption and the water influx:efflux ratio. Glucose absorption was increased only at 10 g/l Textra. In control rats, Textra improved sodium and net water absorption at 5 g/l, but not at 10 g/l Textra; but the influx:efflux ratio and potassium absorption were unaltered. CONCLUSIONS: These data, obtained in normal and protein-deficient rats, support the view that modified starch is a potentially useful, energy-rich additive for oral rehydration solution, which does not introduce an osmotic penalty.

Animals↗
PubMed1989

The role of human perfusion techniques in the assessment of oral rehydration solutions.

Early human intestinal perfusion studies provided valuable information on gut transport procession in vivo. Subsequently, similar models have proved a useful means of assessing the efficacy of glucose-electrolyte oral rehydration solutions. In contrast to clinical trials they enable quantification of water and solute movement across the small intestine and, unlike animal studies, results are directly applicable to man. However, limitations exist, including the fact that a short, usually normal, segment of intestine is studied. Recent studies confirm the relationship between oral rehydration solution sodium concentration and sodium movement; the stimulatory effect of glucose on sodium and water movement; and the detrimental effect of high glucose content. Glycine, bicarbonate, citrate and acetate provide little additional benefit for water absorption when added to solutions containing glucose. Preliminary comparative studies of results obtained in the rat and in man show parallels between these models suggesting they may be complimentary methods of assessing new oral rehydration solutions.

Humans↗
PubMed2004

Safety and efficacy of a premixed, rice-based oral rehydration solution.

UNLABELLED: The authors compared the safety and efficacy of a ready-to-use, premixed, rice-based oral rehydration solution (R-ORS) with a glucose-based oral rehydration solution (G-ORS), each containing 75 mmol/L sodium, in Mexican children with acute diarrhea for less than 5 days. METHODS: One hundred eighty-nine boys 3 to 24 months old admitted to the hospital with acute diarrhea and signs of dehydration were randomly assigned to receive either G-ORS or R-ORS. Intake and output were measured every 3 hours. RESULTS: In the group treated with R-ORS, significantly fewer patients required supplemental intravenous fluids during the rehydration phase compared to the G-ORS group (1% v 8.7%; P < 0.01). Mean stool output, percent weight gain, ORS intake, urine output, and number of patients who vomited during rehydration were similar in the two groups. The mean total stool output after the first 24 hours of maintenance phase was significantly lower in the R-ORS group than in the G-ORS group. CONCLUSIONS: The authors found rice-based ORS to be safe, and its use reduced the rate of intravenous fluid therapy in comparison with the use of a glucose-based ORS.

Acute Disease↗
PubMed1990

A comparison of rice-based oral rehydration solution and "early feeding" for the treatment of acute diarrhea in infants.

To compare the use of rice-based oral rehydration solution (R-ORS), with the introduction of food immediately after rehydration ("early feeding"), using standard glucose-based oral rehydration solution (G-ORS) in the management of acute diarrhea, we conducted a four-cell randomized, controlled trial among 200 hospitalized Egyptian infants between 3 and 18 months of age. During the rehydration phase (first 4 hours), three groups were given G-ORS and a fourth group was given R-ORS. During the subsequent maintenance phase, the control group was given a soy-based, lactose-free formula (G-ORS + SF), a second group (G-ORS + RF) was given a rice-based formula, and a third group (G-ORS + rice) was given boiled rice. The fourth group (R-ORS + SF) continued to receive R-ORS for the first 24 hours of the maintenance period, followed by a soy-based lactose-free formula. During the first and second 24 hours of the maintenance period, infants in the three treatment groups had a lower mean stool output in comparison with the control group (p = 0.006 and 0.03, respectively). The mean total stool output in the R-ORS + SF group was significantly lower than in the control group (p = 0.02). There were no statistically significant differences among the four groups in the mean duration of diarrhea. We conclude that (1) infants who were given R-ORS had reduced total stool output (by 35%) compared with the control group and (2) feeding of boiled rice or a rice-based formula immediately after rehydration therapy was as efficacious as treatment with R-ORS alone for 24 hours, followed by feeding with a soy-based, lactose-free formula.

Acute Disease↗
PubMed1994

Factors associated with the use of oral rehydration solution among mothers in west Lombok, Indonesia.

To determine factors associated with the use of oral rehydration solution (ORS) in West Lombok, Indonesia, interviews were conducted among 293 mothers in six villages with a total population of 54,324. This study included mothers of children aged less than 2 years. The children had episode of diarrhoea in the past week during the 3-month survey period of June-August 1991. Questions asked included when ORS was used, how often it was used, how to make ORS, and the availability and accessibility of ORS in the community. Mothers were observed when preparing ORS. More than 66% of the mothers questioned had used oral rehydration therapy for home management of diarrhoea, either as packaged oral rehydration solution (ORS) or as salt-sugar solution (SSS). Fifty-six percent of mothers reported giving ORS and 10% reported giving SSS. Only 37% of mothers, however, were able to prepare ORS properly, and only 9% were able to prepare SSS properly. The following factors significantly increased the likelihood that a mother would use ORS: watching a demonstration of how to prepare ORS (odds ratio 6.34), availability of ORS (odds ratio 2.37), and accessibility of ORS (3.50). However, the ability to prepare ORS properly did not significantly increase the likelihood of feeding ORS. These results indicate that demonstrations of preparation of ORS and availability of ORS are necessary to increase the use of ORS for management of acute diarrhoea in West Lombok.

Acute Disease↗
PubMed2002

Assessment of mother's knowledge and practice in use of oral rehydration solution for diarrhea in rural Bangladesh.

OBJECTIVE: To assess mothers' knowledge, attitude and use of oral rehydration solution (ORS) for diarrhea management at home, and feeding practices during diarrhea for children under 5-years of age, in a rural Health Development Project, Bangladesh. METHODS: This was a cross-sectional survey. This study was carried out in Cox's Bazar district, South Bangladesh, over a 2-week period, during May 1994. A sample of 300 households in the project area and a similar one in a control area were randomly selected using a multistage stratified technique. Data was collected by interviewing mothers at home using a standard questionnaire and through practical demonstration of how to prepare and use ORS correctly. Project and control households were compared regarding differences in knowledge and practice. RESULTS: More mothers in the project area received information regarding ORS than in the control area (63% versus 59%). The majority of mothers in both project and control areas recognized ORS packets (97% versus 95%). A significantly higher proportion of mothers in the project area knew how to prepare ORS correctly (64% versus 55%). Mothers' skill of using ORS was significantly associated with having seen a packet of ORS and mothers' education. The ORS use rate was lower in the project area compared with the control area (74% versus 84%). No significant differences in feeding practices during diarrhea were detected. CONCLUSION: The study showed that a significantly higher proportion of mothers in the project area knew how to prepare and use ORS correctly. However, the ORS use rate was inadequate. Repeated health education of mothers regarding diarrhea management is needed. Oral rehydration solution should be made available at health posts and households.

Bangladesh↗
PubMed1989

Disease-related animal models for optimising oral rehydration solution composition.

To optimise the composition of oral rehydration solutions (ORS) for European children is not a simple task. Although controlled clinical trial is ultimately the only way to determine whether a new solution is superior to an established ORS, testing many different formulations is neither feasible nor ethical. Several groups of investigators have evolved the concept of using animal models to test new ORS formulations. Disease-related animal models using perfusion of cholera toxin-treated rat small intestine or experimental rotavirus infection of neonatal rats suggest that optimal water absorption will be obtained by using a hypotonic ORS with a sodium concentration of 50-60 mmol/l and a glucose concentration of 50-100 mmol/l. Addition of citrate or bicarbonate had no benefit with respect to the promotion of water absorption.

Animals↗
PubMed2004

The effect of flavoring oral rehydration solution on its composition and palatability.

OBJECTIVE: As a number of mild to moderately dehydrated children refuse to drink oral rehydration solution (ORS) because of its strong salty taste, many parents and health workers flavor ORS with the childs favorite juice. The effects of flavoring ORS on electrolyte content and osmolality were assessed and the palatability of various solutions were compared with commercially flavored ORS. METHODS: Osmolality, sodium, potassium, chloride and glucose content after flavoring with varying concentrations of apple juice, orange juice or orangeade was determined. Two of the solutions were offered to 30 children and adults to assess palatability. RESULTS: All additions to ORS (apple juice, orange juice or orangeade) caused a decrease of sodium (-30 to -53 mmol/L) and chloride (-27 to -47 mmol/L) content, whereas osmolality increased to greater than 311 mOsm/kg. These homemade oral rehydration solutions did not fulfill ESPGAN criteria for ORS, and rehydration will therefore be less effective. The majority of subjects also preferred the commercially flavored ORS. CONCLUSION: Only very small amounts of apple juice or orange juice can be added to the ORS without significantly altering electrolyte composition and osmolality. Palatability, however, does not improve compared with commercially flavored ORS. We therefore recommend using commercially flavored ORS, the composition of which fulfills ESPGAN criteria.

Beverages↗
PubMed1991

Isotonic high-sodium oral rehydration solution for increasing sodium absorption in patients with short-bowel syndrome.

We compared the effect of a standard oral rehydration solution and a high-sodium polymeric-glucose solution on sodium absorption in short-bowel syndrome. Six patients with high jejunostomy were tested in a random order with the standard solution or a solution containing maltodextrins (18 g Glucidex 12/L) enriched with 2.5 g NaCl/L. Solutions were administered via a nasogastric tube at a rate of 2 mL/min. Jejunal effluent was collected during an 8-h period. The net 8-h fluid absorption was not significantly different in the two periods. Glucose absorption was greater than 90% of the administered amount for both solutions. Net sodium absorption was greater for the maltodextrin solution than for the standard solution (56 +/- 12 vs 24 +/- 20 mmol, P less than 0.05). We conclude that replacement of glucose with maltodextrins and addition of sodium in the standard oral rehydration solution results in improved sodium absorption in short-bowel syndrome.

Absorption↗