Optimising Oral Rehydration Solution Composition for the Children of Europe: Clinical Trials

Abstract

Optimising oral rehydration solution composition for the children of Europe: Clinical trials. Acta Paediatr Scand Suppl 364: 40, 1989.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 mmolil are adequate. Glucose may he 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 mmolil), namely the same concentration as found in WHO-ORS. Chloride concentration depends upon other constituents of ORS, namely sodium and potassium, hut the range of 30-90 mmolil is considered to be adequate. Base or base percursors are not required for correction of acidosis except in the severe cases that always need intravenous replacement. A relatively low osmolality seems advisable. Key words: acute gastroenteritis, dehydration, oral rehydration solutions, oral rehydration therapy. Many different oral rehydration solutions (ORS) are currently available and used inEurope. An optimal solution as yet has not been identified for European children. Such a solution must be tailored to meet the demands of that population with its specific environmental and epidemiological characteristics. A number of factors should be considered when attempting to define an ORS for European children: (i) Most European children are well-nourished receiving high protein diets. However, malnutrition is still a problem in some underprivileged communities within developed countries, where diarrhoea1 diseases are more prone to occur. (ii) Despite the fact that acute diarrhoea and dehydration due to gastroenteritis is still a major cause of morbidity in Europe, the incidence is relatively low compared to developing communities ( I ) . (iii) Most European children with acute diarrhoea are otherwise well. (iv) The majority of children with acute diarrhoea in Europe have viral gastroenteritis. cholera and cholera-like diarrhoea being extremely rare (1-4).( v ) The predominant non-cholera aetiology for acute diarrhoea results in a relatively low stool sodium output. certainly much lower than cholera-like diarrhoeas (5-1 I). (iv) Children are generally brought to medical attention before becoming dehydrated or when presenting with mild or moderate dehydration ( 2 -4 , 12, 13).In summary, the ideal solution for the children of Europe should be suitable for ambulatory and hospital treatment of hypo-, normo-or hypernatraemic dehydration of mild and moderate degree or to prevent dehydration, in children of all ages in a fair state of nutrition, suffering from acute non-cholera diarr...

Randomised double blind trial of hypotonic oral rehydration solutions with and without citrate.

“…Although it has also gradually been accepted in developed countries, the optimum composition for an oral rehydration salts solution (ORS) in Europe and the USA is still controversial. [1][2][3][4][5] Findings from perfusion studies in infected rats and in human volunteers have indicated that hypotonic rather than isotonic solutions are optimal for the absorption of water and sodium and are therefore recommended for clinical use.6-9 A hypotonic oral rehydration solution with a sodium concentration of 60 mmolI and an osmolality of 224 mmol/l has been compared with a commercially available oral rehydration solution with an osmolality of 304 mmol/l and it was found that the hypotonic solution was better than the isotonic solution in the treatment of acute diarrhoeal dehydration in young children. I The need for bicarbonate or a base precursor in the ORS has also been questioned.11…”

Clinical experience with a hypotonic oral rehydration solution in acute diarrhoea

“…Oral rehydration therapy (ORT) has revolutionized the management of acute diarrhoea in developing countries, and it has also gained wide acceptance in Europe (1,2). The most commonly used oral rehydration salts (ORS) solution is the formula jointly recommended by the World Health Organization (WHO) and UNICEF; this ORS formula (ORS-WHO) has a sodium concentration of 90 mmol/l and a total osmolality (with citrate rather than bicarbonate) of 31 1 mosmol/l (3).…”