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PubMed1989

Optimising oral rehydration solution composition for the children of Europe: clinical trials.

Clinical trials testing different oral rehydration solutions (ORS) are reviewed. The effects of individual components and their concentrations are analysed in order to establish margins of safety for the composition of the ideal ORS for children in Europe. Glucose is the solute of choice for ORS and concentrations of 70-140 mmol/l are adequate. Glucose may be replaced by sucrose or glucose polymers. "Low" sodium concentrations (35-60 mmol/l) are advised for rehydration and maintenance in acute non-cholera diarrhoea, for children of all ages, including neonates, and for any degree of dehydration except shock. Although intended for children who are not malnourished, the European ORS should have an adequate potassium concentration (20-30 mmol/l), namely the same concentration as found in WHO-ORS. Chloride concentration depends upon other constituents of ORS, namely sodium and potassium, but the range of 30-90 mmol/l is considered to be adequate. Base or base precursors are not required for correction of acidosis except in the severe cases that always need intravenous replacement. A relatively low osmolality seems advisable.

Carbohydrates↗
PubMedDate not supplied

Controlled trial of rice powder and glucose rehydration solutions as oral therapy for acute dehydrating diarrhea in infants.

A controlled, randomized trial was conducted in 50 infants (3 to 18 months old) hospitalized with acute noncholera dehydrating diarrhea to compare the safety, efficacy, and acceptability of the standard World Health Organization (WHO) recommended glucose oral rehydration solution (ORS) (Group A: 25 infants) with that of a rice powder ORS (Group B: 25 infants), containing 30 g/L of rice powder instead of glucose (20 g/L). The electrolyte composition of both solutions was identical. The proportion of successfully treated patients in each group was 92%, and the two rehydrating solutions proved comparable in correcting and maintaining the hydration status and the serum sodium and potassium levels. The mean rehydration time, stool output, stool frequency, ORS intake, weight gain, and urine output were comparable (p greater than 0.05) in both groups. It is concluded that rice powder ORS is safe, effective, and acceptable as the standard WHO glucose ORS for the treatment of acute noncholera dehydrating diarrhea in infants.

Acidosis↗
PubMed1994

Intestinal absorption during rest and exercise: implications for formulating an oral rehydration solution (ORS). Proceedings of a roundtable discussion. April 21-22, 1993.

Formulation of oral rehydration solutions (ORS) is reviewed in the context of methods for measuring absorption of water and component substrates, transport mechanisms of substrates and water, requirements of the athlete, and effects of exercise on absorption. The triple lumen tube intubation perfusion method is the optimal technique for obtaining absorption data from the human small intestine during rest and exercise. Factors that must be considered when interpreting absorption data obtained by this technique include the role of the mixing segment in altering composition of the infused solution, defining optimal segment length, effects of ORS osmolality, and absorption of "nonabsorbed" indicators. Absorption data are applicable only to the test segment and may lack relevance to ORS transport proximal and distal to the test segment. Absorption rate of an ORS measured by perfusion may not correlate with absorption rate following ingestion. Transport of water, electrolytes, carbohydrates, and other solutes including glutamine and amino acids is considered in relation to ORS formulation. Factors affecting absorption of an ORS including the unstirred layer, motility, intestinal blood flow, and maximal absorptive capacity of the alimentary tract are considered. Exercise per se at 30-70% VO2max for 60-90 min probably has minimal effects in limiting absorption of an ORS. Consideration relevant to supplying needs of the athlete during prolonged exercise in relation for ORS formulation are discussed.

Animals↗
PubMed1997

Safety and effectiveness of homemade and reconstituted packet cereal-based oral rehydration solutions: a randomized clinical trial.

OBJECTIVES: Parents may be deterred from obtaining commercial oral rehydration solutions (ORS) for their young children with acute diarrheal disease because of its availability and/or cost, especially if they are poor. We conducted a randomized clinical trial to determine 1) whether low-income parents could safely mix and administer cereal-based ORS (CBORS) both from ingredients commonly found in the home and from a premixed packet; 2) whether these CBORS were as effective in maintaining hydration as commercial glucose-based ORS; and 3) whether CBORS were more effective in reducing severity and duration of illness. METHODS: Children 4 to 36 months of age discharged from emergency departments and health centers with acute diarrheal disease were randomized to receive either homemade CBORS, reconstituted packet CBORS, or Pedialyte. A study nurse saw the child at home each day until the illness resolved, and obtained capillary blood for serum sodium at enrollment and at 24 to 48 hours; a sample of CBORS for sodium concentration; stool for pathogen analysis; and daily fluid intake, stool frequency, and weight. RESULTS: A total of 232 children were enrolled, of whom 203 (88%) completed the study. Two parents (3%) in the homemade CBORS group and one parent (1%) in the packet CBORS group made mixing errors resulting in a high sodium concentration (>100 mEq/L); their children refused the solution and had normal serum sodium values. Mean CBORS sodium concentration for the remainder of the homemade CBORS group was 60 +/- 10 mEq/L, and for the packet CBORS group, 54 +/- 13. Eighteen children (11%) had abnormal serum sodium values at presentation, which returned to normal in all groups in most cases. Three children (4.5%) in the homemade CBORS group, 4 (6%) in the packet CBORS group, and 1 child (1.4%) in the Pedialyte group failed therapy. Children refused to take homemade CBORS and packet CBORS (43% and 32%, respectively) more often than Pedialyte (9%), and those in the CBORS groups tended to take less ORS and total fluids. There were no significant differences among the three groups in incidence of daily vomiting or stooling, duration of diarrhea, or weight gain. CONCLUSIONS: CBORS do not offer a clinically significant advantage over glucose-based ORS. Homemade CBORS represent a treatment option in carefully selected cases, but it is not the safest alternative for regular clinical use.

Acute Disease↗
PubMed2000

Oral rehydration solution containing rice maltodextrins in patients with total colectomy and high intestinal output.

Oral rehydration solutions containing rice maltodextrins (R-ORS) have been reported to be more effective than glucose-based ORS in reducing intestinal losses in infectious diarrhea. To evaluate the effect of R-ORS in patients with total colectomy and high intestinal output, a perspective open noncontrolled study was performed on 13 adult patients who consumed 1 l/day of R-ORS for 7 days. Body weight, daily ileal and urinary output, serum electrolytes, aldosterone and renin activity were measured the day before (day 0) and on the last day of the study (day 7). Net changes (mean +/- SE) from day 0-7 showed an increase of urine Na (40 +/- 16 mmol/day, p < 0.04) and K (24 +/- 8 mmol/day, p < 0.02). Body weight increased in seven patients. Serum renin activity decreased (-0.60 +/- 0.26 ng/ml/min) in these patients but not in the six patients in whom body weight remained unchanged (0.19 +/- 0.07 ng/ml/min; p < 0.03). Ileal and urinary volume remained stable. In patients with high ileal output, R-ORS supplementation improved Na and K balance. The association of increased body weight with decreased serum renin concentrations suggests that a positive water balance also occurred.

Adult↗
PubMed1993

Rice-based oral rehydration solution: a controlled trial in Nepal.

The efficacy of rice-based (50 g/l) oral rehydration solution (ORS) was compared with standard glucose ORS in a randomized controlled trial in 148 children under 5 years of age, suffering from acute watery diarrhoea leading to moderate and severe dehydration. The mean ORS intake in the two groups of children were 141.6 and 205.2 ml/kg/24 hours, for rice ORS and glucose ORS, respectively (P < 0.001). The mean number of diarrhoeal stools in the first 24 hours in children of the rice ORS group was less when compared with the glucose ORS group (5.4 and 6.8/24 hours, respectively; P < 0.001). This study suggests that rice ORS is a better alternative to standard glucose ORS in the management of diarrhoeal diseases in children.

Child, Preschool↗
PubMed1987

Hydrolysed wheat based oral rehydration solution for acute diarrhoea.

A randomised three cell study was carried out in 78 children with acute diarrhoea to evaluate the relative efficacy of oral rehydration solution (ORS) made from partially hydrolysed wheat grain, cooked rice powder, or glucose. Twenty six patients with comparable age, body weight, duration of diarrhoea, and degree of dehydration were studied in each of the three groups. Initial rehydration was carried out by using intravenous Dhaka solution within one to two hours followed by administration of oral rehydration solution. The mean ORS intake during the first and second 24 hours of treatment in patients with cholera receiving wheat-ORS and rice-ORS was significantly less compared with those receiving glucose-ORS. The stool output during the same period in patients receiving wheat-ORS and rice-ORS was significantly less compared with those receiving glucose-ORS. Similar trends in both ORS intake and stool output were observed during the next 24 hours.

Acute Disease↗
PubMed1990

Comparison of the effects of an isosmolar and hyperosmolar oral rehydrating solution on the hydration status, glycemia and ileal content composition of healthy neonatal calves.

Isosmolar oral rehydrating solutions (ORS) used to treat diarrheic calves are low in energy. In contrast, hyperosmolar ORS may have a dehydrating effect. This study was designed to compare the net water and glucose absorption from the small intestine of normal calves given isosmolar or hyperosmolar ORS. Six calves were used for the experiment. A reentrant ileal cannula was implanted surgically. Each calf was fed with either the isosmolar or the hyperosmolar solution. The next day, the second solution was given. Both contained chromium EDTA as a nonabsorbable marker. Changes in the hematocrit, total plasma protein, plasma osmolality, plasma glucose concentration, and ileal volume, osmolality, glucose content, and chromium concentration were monitored for 10 hours. The only statistically significant difference was in the post-feeding plasma glucose level: it peaked at the higher level (p less than 0.05) in calves fed the hyperosmolar solution. In normal calves, the hyperosmolar ORS had no effect on the hydration or on the small intestinal fluid composition.

Animals↗
PubMedDate not supplied

Gastric emptying of oral rehydration solutions at rest and after exercise in horses.

We examined the gastric emptying (GE) of oral rehydration solutions (ORS) at rest and after exercise in four Standardbred horses. In one study isotonic, cold isotonic (5 degrees C), isotonic containing glucose and hypertonic fluid were tested at rest. In another study, isotonic fluid was given following a bout of treadmill exercise at 70 per cent VO2 max until exhaustion or at rest. In both studies, a single dose of 8 litres was given via nasogastric tube. GE and electrolyte concentrations (Na+, K+ and Cl-) of the stomach content were measured at 15 minutes intervals for one hour. In both studies, 90 per cent of the fluid was emptied within 15 minutes of administration. There was no treatment effect on electrolyte concentrations in either study but significant changes did occur over time. The data showed that GE is unlikely to significantly affect rehydration.

Animals↗
PubMed1998

Rehydration following exercise: effects of administration of water versus an isotonic oral rehydration solution (ORS).

The effects of administering (1) 6L isotonic oral rehydration solution (ORS), similar in composition to plasma (except for an elevated potassium concentration) and with an osmotic skeleton and (2) 6L water (no osmotic skeleton), were evaluated in five thoroughbred horses following exercise-induced dehydration. The horses were exercised on a treadmill for 10 min at walk (1.7 m.s-1; approximately 15% VO2max), 40 min at trot (3.7 m.s-1; approximately 25% VO2max) and 10 min at walk (1.7 m.s-1; approximately 15% VO2max). Exercise was undertaken on a 3 degrees incline at 30 degrees C/80% RH. Solutions of water or ORS at 20 degrees C were administered by nasogastric tube over 60s 5 min following exercise. Mean weight loss following exercise was 9.2 +/- 1.7 kg (2.0 +/- 0.4% body weight; mean +/- SEM) with water and 9.2 +/- 1.1 kg (2.0 +/- 0.2% body weight) with ORS and was not different between treatments (P > 0.05). Water treatment resulted in a fall in plasma [Na+] (approximately 3 mmol.L-1) and C1- (1-2 mmol.L-1) concentrations by 30 min after administration and the effect persisted until the end of the study (300 min post fluids). There was little change in plasma total protein (TP) from that at the end of exercise, suggesting a failure of water to restore or maintain PV. In contrast, ORS administration resulted in a small increase in plasma [Na+] (1-2 mmol.L-1) and [Cl-] (2-3 mmol.L-1) with a corresponding decrease in plasma TP. By 120 min post ORS, plasma TP and PV were no longer significantly different from rest or pre-exercise (P > 0.05), whilst with water, TP was elevated (approximately 3-4 g.L-1) and PV reduced (approximately 4-5 mL.kg-1). Total urine output was not significantly different between water (1096 +/- 135 mL) and ORS (750 +/- 215 mL, P > 0.05). Estimates of expected plasma volume and electrolyte concentration changes as a result of either treatment compared well with measured changes of TP and PV. On the basis of calculated or measured changes, it was estimated that only 1L of water contributed to rehydration following exercise compared to 4L isotonic, plasma-like ORS. The administration of 6L ORS restored the PV deficit induced by exercise with minimal or no disturbance of plasma electrolyte concentrations. In contrast, water alone resulted in minimal improvement in PV. When fluid intake after periods of fluid loss, such as induced by exercise or transport, is not accompanied by food intake, the present study has clearly demonstrated that water alone is ineffective in promoting rehydration compared with an isotonic, plasma-like ORS.

Animals↗
PubMed1990

Studies of oral rehydration solutions in animal models.

Ideas about the optimal composition of oral rehydration solutions (ORS) continue to evolve. A controlled clinical trial is the only way to determine whether a new ORS is superior to an established solution, but attempts have been made to prescreen new ORS in a variety of animal models, most of which involve intestinal perfusion. Most of the work has been performed in the healthy small intestine of rats, either in short segments or in its entirety, or in the diseased small intestine that has been infected with rotavirus or exposed to cholera toxin to induce a secretory state. Despite the marked pathophysiologic differences between these models, the qualitative findings using new and established ORS have been remarkably similar. Overall, these animal models have emphasized the potential benefit of using a hypotonic ORS (osmolality, 240 mosm/kg or less). The optimal sodium concentration has been found to be 50 to 60 mmol/L, and the optimal glucose concentration 90 to 111 mmol/L. These models have also been satisfactorily used to examine the value of glucose polymer and food-based ORS. The findings suggest that for a given substrate load initial osmolality is probably the chief determinant of water absorption, which is substantially greater from the more hypotonic solutions. Results from animal experiments must be interpreted with caution because of their physiologic limitations. Nevertheless, they have provided insight into the physiology of oral rehydration therapy and may be useful in identifying ORS for evaluation by clinical trial.

Animals↗
PubMed1982

A comparison of bottle tops, teaspoons and WHO glucose-electrolyte packets for home made oral rehydration solutions in The Gambia.

Three methods of preparation of oral rehydration solution were taught to Gambian mothers and the sodium concentration and osmolality of the solutions prepared were estimated. Most of the solutions made up using WHO glucose-electrolyte mix had a satisfactory sodium content (70 to 120 mmol/l) and osmolality (200 to 350 mosmoles/kg). Of the sugar and salt mixtures using a teaspoon as a measure, 17% were hypertonic (greater than 120 mmol sodium/l) and 24% were hyperosmolar (greater than 350 mosmol/kg). Nearly all the sugar and salt solutions prepared using a soft drink bottle top as a measure had sodium contents of 30-88 mmol/l and none was hyperosmolar. We suggest that wider trials of this simple, widely available measure are indicated.

Child↗
PubMed1985

Fingers or spoons to make oral rehydration solution?

The accuracy and variability of the composition of oral rehydration solution (ORS) prepared by village health workers using (i) a finger measurement technique and (ii) a special ORS measuring spoon were compared. The sodium and sucrose concentrations were measured in 130 ORSs prepared by each technique. All the spoon-measured ORSs had acceptable levels of sodium and sucrose, compared with 93% of the finger-measured ORSs. Only 2.3% of finger-measured ORSs had hypertonic sodium levels. The variability of sodium and sucrose levels was significantly greater with the finger measurement technique. This comparison should assist programme managers to decide which technique to adopt. Both techniques require careful instruction to ensure accuracy.

Community Health Workers↗
PubMed1997

Evaluation of a glutamine-containing oral rehydration solution for the treatment of calf diarrhoea using an Escherichia coli model.

A high-calorie oral rehydration solution (ORS) with glutamine (n=11) was more effective in correcting plasma, extracellular fluid and blood volume than solutions without (one WHO-type solution, n=6, and two high-glucose but glutamine-free solutions, n=7, n=12). It was the only solution to improve plasma volume significantly within 48 h and sustain the improvement throughout treatment; similarly, it was the only solution to correct packed-cell volume within 48 h and sustain the benefit to the end of treatment. At the end of treatment, the glutamine-treated calves were the only ones to avoid a significant weight loss compared with their pre-diarrhoeic values. The crucial difference between this solution and those used with glutamine previously is that it gave significant nutritional support whereas WHO type solutions did not. It also had more favourable effects on hyponatraemia and metabolic acidosis than a standard ORS. Use of a high-calorie ORS for 4 days (rather than 2 days of 50:50 admixture with milk replacer) brought additional beneficial effects on blood glucose and body weight.

Animals↗
PubMed1989

Efficacy & safety of glycine fortified oral rehydration solution in the treatment of acute dehydrating diarrhoea in children.

Efficacy and safety of glycine fortified oral rehydration solution (ORS) was compared with a standard ORS (WHO formula) in a randomized clinical trial in children aged between 4 months and 5 yr with moderate degree of dehydration owing to acute watery diarrhoea. No significant differences (P greater than 0.05) were observed in diarrhoeal stool output, duration of diarrhoea and intake of ORS between the study and control groups respectively. Thus glycine fortified ORS does not have any additional advantage over standard ORS. Moreover, two children developed hypernatraemia after receiving glycine fortified ORS in contrast to the control group. It is therefore suggested that glycine supplemented ORS should not be prescribed for the treatment of diarrhoeal dehydration in children.

Child, Preschool↗
PubMed1992

Dominant role for osmolality in the efficacy of glucose and glycine-containing oral rehydration solutions: studies in a rat model of secretory diarrhoea.

The effect of osmolality on the efficacy of oral rehydration solutions (ORS) and the contribution of the amino acid glycine to water absorption from ORS have been studied in an animal model of secretory diarrhoea. After exposure to pure cholera toxin, rat small intestine (excluding the duodenum) was perfused in situ with seven different ORS. All ORS were derived from a "basic" solution containing Na 50, K 25, Cl 75 and glucose 50 mmol/l to which 25 or 50 mmol/l of glycine, glucose, or mannitol was added. All ORS reversed water secretion to absorption, but maximum water absorption was obtained with the "basic" solution with an osmolality of 200 mOsm/kg. When the osmolality of the "basic" solution was raised to 225 and 250 mOsm/kg by adding mannitol, water absorption decreased. At each of these osmolalities, substitution of mannitol by glycine or glucose resulted in similar increases in water absorption, but all modifications compared unfavourably with the "basic" solution. Net sodium secretion occurred with all ORS tested, despite net water absorption. These findings in a perfusion model of rat small intestine suggest that osmolality is a key factor influencing the efficacy of ORS and that addition of a second substrate, such as glycine, has no beneficial effects. Our results suggest that there is a maximal rate for water absorption from the small intestine which is inversely related to the osmolality of the perfusate.

Animals↗
PubMed1996

Hypo-osmolar sucrose oral rehydration solutions in acute diarrhoea: a pilot study.

Based on studies showing improved absorption of hypo-osmolar oral rehydration solutions (ORS) with reduced glucose and sodium concentration, a hypo-osmolar ORS with sucrose replacing glucose (sodium 60, potassium 15, chloride 60, citrate 5, sucrose 58 mmol l-1, calculated osmolality 198 mOsm kg-1) was compared with mildly hyperosmolar glucose ORS (WHO) in 46 children aged 6-30 months with acute diarrhoea and dehydration. In the hypo-osmolar sucrose ORS group (n = 18) faecal output was less by 30% during the initial 24 and 48 h compared with controls, suggesting better absorption. Sucrose may be a suitable alternative to glucose in an absorption-efficient hypo-osmolar ORS.

Acute Disease↗
PubMed1993

Absorption of glucose polymers from rice in oral rehydration solutions by rat small intestine.

BACKGROUND: This study aims to determine the effect of replacing glucose in oral rehydration solution (ORS) with starch hydrolysates from rice on absorption in the small intestine and levels of glucose in portal venous blood and on disaccharidase levels and morphometric measurements in intestines of rats. METHODS: ORS containing standard composition of salts and 2% glucose (WHO ORS) or 2%, 5%, or 10% starch hydrolysates were infused into duodena of 60 Sprague-Dawley rats (250-350 g). Portal venous blood glucose levels were determined at 0, 30, 60, 90, and 120 minutes. RESULTS: Significantly larger areas under the curve of glucose absorption (AUCs) were produced by ORS containing 10% unfractionated starch hydrolysates (123.2 +/- 3.8), 2%, 5%, and 10% starch hydrolysates with long-chain ( > 9 molecules) glucose polymers (109.5 +/- 10.6, 109.3 +/- 7.4, and 115.3 +/- 7.1, respectively), and 5% and 10% starch hydrolysates with short-chain (2-9 molecules) glucose polymers (124.4 +/- 6.1 and 128.1 +/- 6.8). ORS with 2% and 5% unfractionated starch hydrolysates and 2% short-chain glucose polymers produced AUCs comparable with those of WHO ORS (96.48 +/- 5.7). Disaccharidase levels and morphometric measurements were not significantly different. CONCLUSIONS: Starch hydrolysates from rice containing glucose polymers can be used in ORS in higher concentrations than glucose to provide higher caloric density without increased osmolality.

Animals↗