Is a Low-Osmolarity ORS Solution More Efficacious Than Standard WHO ORS Solution?

El-Mougi, M.; El-Akkad, Nayera Mahmoud; Hendawi, Abdeltawab; Hassan, Mostafa Kamal; Amer, Ahmed F.; Fontaine, Olivier; Pierce, Nathaniel F.

doi:10.1097/00005176-199407000-00013

Cited by 46 publications

(34 citation statements)

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“…The solution contains 90 mM sodium and 111 mM glucose, with a total osmolarity of 311 mosmol/L (2). Recent efforts to improve oral therapy have focused on the use of hypo-osmolar solutions (3)(4)(5)(6)(7)(8)(9). In infants and young children making an ORS solution hypo-osmolar by lowering the concentrations of both glucose and sodium was successful in improving its absorption efficiency (4)(5)(6)(7)(8)(9).…”

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confidence: 99%

Effect of Reducing Sodium or Glucose Concentration in a Hypo-osmolar ORS (Oral Rehydration Salts) on Absorption Efficiency: Marker Perfusion Study in Rat Jejunum

Chakrabarti

Haque

Chakrabarty³

et al. 2005

Dig Dis Sci

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We evaluated the relative absorption efficiency of reducing the sodium or glucose concentration to make an ORS hypo-osmolar in a perfusion model. In nine adult albino rats 30 cm of jejunum was perfused at 0.4 ml/min with three glucose salt solutions for 45 min each, one with 60 mM sodium, 111 mM glucose, and osmolarity 247, one with 90 mM sodium, 60 mM glucose, and osmolarity 250, and one with 90 mM sodium, (111 mM) glucose, and osmolarity 301 (control solution). Each contained 2 g/L polyethylene glycol 4000 as a marker. The net water and sodium absorption were 2.8 (P < 0.001) and 2.6 (P < 0.001) times higher from low-sodium and 1.7 (P < 0.001)- and 1.5 (P < 0.001)-fold higher from low-glucose solutions compared to the control. Net glucose absorption was 2.2 (P < 0.001)-fold higher from low-sodium solutions compared to the control. The net water, sodium, potassium, and glucose absorptions were 1.6 (P < 0.001)-, 1.7 (P < 0.001)-, 1.36 (P < 0.05)-, and 4.15 (P < 0.001)-fold higher from low-sodium compared to low-glucose solutions. The hypo-osmolar ORS with reduced sodium was substantially more absorption efficient compared to the one with reduced glucose.

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confidence: 99%

Effect of Reducing Sodium or Glucose Concentration in a Hypo-osmolar ORS (Oral Rehydration Salts) on Absorption Efficiency: Marker Perfusion Study in Rat Jejunum

Chakrabarti

Haque

Chakrabarty³

et al. 2005

Dig Dis Sci

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“…2 However, the oral glucose-electrolyte rehydration solution such as that recommended by WHO and UNICEF neither shortens the duration of the illness nor reduces the stool loss and may cause an increase in stool volume at least during the first hours in children with acute diarrhoea. 3 Optimization of the standard WHO-ORS solution, by reducing its osmolality; has been shown to reduce diarrhoea duration, total stool output, and the need for unscheduled intravenous therapy. 4 Adjuvant therapy to ORT, based on oral administration of live probiotic bacteria aimed to improve recovery of infants from acute watery diarrhoea, has been under active investigation.…”

Section: Introductionmentioning

confidence: 99%

Role of single and mixed probiotics in acute diarrheal diseases in pediatric population

Gupta

Maheshwari²,

Rao

2017

Int J Basic Clin Pharmacol

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Background: The objective of present study was to analyse the effect of probiotics on various parameters of acute diarrhoeal disease and to compare single and mixed probiotic preparations in context to their role in acute diarrhoeal disease in paediatric population.Methods: A double blind controlled trial was conducted in children suffering from acute diarrhoeal disease at department of paediatrics jointly with department of pharmacology, G. S. V. M. Medical college, Kanpur, U.P., India. All enrolled children were divided into three groups having similar baseline characteristics. One group was given single probiotic preparation another mixed probiotic preparation and the third one (i.e. control group) placebo plus Zinc/ORS to all three groups. Various parameters such as frequency and consistency of stool, duration of diarrhoea were measured after doing intervention over a period of one week.Results: In our study duration of diarrhoea, stool frequency and total duration of hospital stay was found significantly less in probiotic groups compared to control group. However no significant difference was found between single and mixed probiotics in curtailing the acute diarrhoeal illness.Conclusions: Probiotics should be used judiciously in acute diarrhoeal diseases. There is no additional benefit of mixed probiotics in acute diarrhoeal diseases rather than increasing the cost of treatment.

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“…4 However, solutions with high Na ϩ content can be inconvenient due to reduced tolerance to Na ϩ load in children (resulting in an increased risk for hypernatremia) and an osmotically driven increase in stool output. Solutions with lower osmolarity [5][6][7] have been tested in industrialized and developing countries (where infection with V cholera is endemic 8 ) by replacing glucose with a complex carbohydrate or reducing the concentration of glucose and salts in the solution.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Three Oral Rehydration Strategies in the Treatment of Acute Diarrhea in a Tropical Country

Pignatelli¹,

Musumeci

2003

Current Therapeutic Research

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Background: The administration of hydrating solutions and early refeeding improve recovery for infants and children with diarrhea.Objective: The aim of this study was to assess the efficacy of a low-osmolarity (30 mEq/L Na ϩ ) solution administered after the standard, high-osmolarity (90 mEq/L Na ϩ ) solution via a nasogastric tube (NGT) and followed by early refeeding to achieve more rapid body weight recovery in infants and children with acute diarrhea.Methods: Infants and children aged Ͻ5 years with acute diarrhea and dehydration (body weight loss of Ն10%) observed from January to August 2001 at Saint Camille Medical Center, Ouagadougou, Burkina Faso, were enrolled. Patients were randomized to 1 of 3 treatment protocols. Patients in group A received, via NGT, rehydration with a high-osmolarity solution for 3 hours, followed by a low-osmolarity solution for at least 3 additional hours. Patients in group B were given only a low-osmolarity solution via NGT. In group C, rehydration was carried out using a high-osmolarity solution via NGT.Results: Four thousand consecutively treated infants and children (2010 boys, 1990 mean [SD] age, 3.5 [2.7] years) were enrolled. After the first 6 hours of infusion, 90% of the patients who had received the combined rehydration (group A) showed significant body weight recovery, versus 80% and 79% of the patients in groups B and C, respectively. Stool output significantly decreased for group A compared with groups B and C (114 vs 125 and 120 g/kg, respectively). Only 7% of the patients in group A required prolonged rehydration (Ͼ6 hours) with the low-osmolarity solution, versus 10% and 12% in groups B and C, respectively. A total of 3% of patients treated with combined rehydration required hospitalization, compared with 10% and 9% in groups B and C, respectively. At the end of infusion, 25% of the patients rehydrated only with a lowosmolarity solution showed poor body weight recovery and appeared lethargic, 189CURRENT THERAPEUTIC RESEARCH versus 10% in group A and 15% in group C. Patients who were rehydrated with a high-osmolarity solution showed symptoms of hypernatremia (serum Na ϩ concentration Ͼ140 mEq/L). At the end of rehydration (Ն6 hours), all patients recovered their previous body weight, partially or totally, and refeeding was begun. Rehydration and diet were continued at home, or in neighboring areas for those living far away. Conclusions:In this study population, the administration of a high-osmolarity solution followed by a low-osmolarity solution and early refeeding was effective in the treatment of acute diarrhea and was well tolerated. (Curr Ther Res Clin Exp. 2003;64:189-202)

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Is a Low-Osmolarity ORS Solution More Efficacious Than Standard WHO ORS Solution?

Cited by 46 publications

References 0 publications

Effect of Reducing Sodium or Glucose Concentration in a Hypo-osmolar ORS (Oral Rehydration Salts) on Absorption Efficiency: Marker Perfusion Study in Rat Jejunum

Effect of Reducing Sodium or Glucose Concentration in a Hypo-osmolar ORS (Oral Rehydration Salts) on Absorption Efficiency: Marker Perfusion Study in Rat Jejunum

Role of single and mixed probiotics in acute diarrheal diseases in pediatric population

Comparison of Three Oral Rehydration Strategies in the Treatment of Acute Diarrhea in a Tropical Country

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