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

Abstract

Hypotonic oral rehydration salts solutions (ORS) have been proved to be better than isotonic solutions with respect to water absorption. To establish whether a base precursor is essential in the composition of a hypotonic ORS with improved absorption properties, a randomised double blind clinical trial was conducted comparing two formulas of hypotonic ORS, each with an osmolality of 224 mmol/l, with or without citrate, in a group of 107 children admitted to hospital with acute diarrhoea. The two solutions were effective in the correction of dehydration and there was no difference between the treatments in the duration of diarrhoea.The patients receiving the hypotonic ORS with citrate consumed less of the solution, however, and their metabolic acidosis was corrected earlier. It is concluded that citrate is clinically advantageous in a hypotonic ORS, but a hypotonic formula without a base precursor is also effective.

Hypo‐osmolar oral rehydration salts solution in dehydrating persistent diarrhoea in children: double‐blind, randomized, controlled clinical trial

“…As in acute diarrhoea (8)(9)(10)(11)(12), it has also been documented in the present study that hypo-osmolar ORS significantly decreases the mean duration of diarrhoea, stool output and need for maintenance therapy compared to the standard ORS in persistent diarrhoea. Weight gain is a vital parameter for recovery along with less diarrhoea and less stool output.…”

“…Hypoosmolar solution rather than standard solution results in greater intestinal absorption of water and sodium by inducing rapid gastric emptying, making the hypoosmolar ORS available quickly to the jejunum for maximum glucose linked water and sodium absorption (11) and is therefore recommended for clinical use. Hypo-osmolar ORS with low sodium and glucose concentrations has also been compared with standard ORS, which shows that hypo-osmolar solution is better than standard ORS solution in the treatment of acute diarrhoea in young children (8)(9)(10)(11)(12). Our present study further complements the superiority of hypo-osmolar ORS over standard ORS in the treatment of persistent diarrhoea in children prone to develop dehydration.…”

An integrated approach to the safety assessment of food additives in early life

“…While three studies indicated that citrate at 98-500 mg/kg bw/d for 24 h to 3 weeks added to formula was not associated with safety concerns, one smaller scale study utilizing gavage (not along with food) in infants suggested that a total citric acid exposure of 400-700 mg/kg bw divided over 24 h was associated with diarrhea in 4 out of the 8 infants. 77, [86][87][88] Various citrate salts are routinely used per os to actually treat infantile diarrhea, urinary tract infections, and kidney stones at comparable dosages (108-430 mg/kg bw/d), with diarrhea listed as a seldom side effect in the latter two cases. 77 Citric acid was nevertheless considered to be the main limiting metabolite in driving the tolerance and safety of CITREM exposure in infants.…”

“…77, [86][87][88] Various citrate salts are routinely used per os to actually treat infantile diarrhea, urinary tract infections, and kidney stones at comparable dosages (108-430 mg/kg bw/d), with diarrhea listed as a seldom side effect in the latter two cases. 77 Citric acid was nevertheless considered to be the main limiting metabolite in driving the tolerance and safety of CITREM exposure in infants.…”

Efeito de soluções eletrolíticas enterais com diferentes osmolaridades sobre o perfil eletrolítico e bioquímico de equinos

“…Possivelmente esse achado deveu-se a hemodiluição ocasionada pela expansão do volume plasmático decorrente da hidratação enteral como relatou Alves et al (2005) , respectivamente. Estudos experimentais demonstraram (Hunt et al 1992, Rautanen et al 1993, 1994, Nishinaka et al 2004) que soluções hipotônicas proporcionam melhor absorção de água do que as isotônicas, confirmando os resultados da presente pesquisa. Os principais benefícios das soluções eletrolíticas com baixa osmolaridade são: reduz o risco de hipernatremia, aumenta a absorção de água e reduz a produção fecal (Ribeiro Filho 2011), o que as torna uma boa opção nos pacientes com diarreia.…”