Safety and Effectiveness of Homemade and Reconstituted Packet Cereal-based Oral Rehydration Solutions: A Randomized Clinical Trial

Abstract

ABSTRACT. 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. Pediatrics 1997;100(5). URL: http://www. pediatrics.org/cgi/content/full/100/5/e3; diarrhea, dehydration, oral rehydration, cereal.

Oral Rehydration: Toward a Real Solution

“…Risks have been reported for homemade ORS (38). To make rice ORS liquid enough to drink requires an amount of water sufficient to prevent the risk of higher sodium concentrations (39).…”

The World Health Organization Oral Rehydration Solution in US Pediatric Practice

“…29 Dangerous mixing errors were found when homemade solutions were prepared by US innercity families in another clinical trial. 30 Homemade solutions, even when correctly prepared, were of low palatability and were frequently refused by study children. 30 Oral electrolyte solutions sold as packets of powder requiring preparation are produced in the United States by the Jianas Brothers (Kansas City, Mo), Cera Products (Jessup, Md), and Pharmacia & Upjohn Inc (Peapack, NJ) (Table 4).…”

“…30 Homemade solutions, even when correctly prepared, were of low palatability and were frequently refused by study children. 30 Oral electrolyte solutions sold as packets of powder requiring preparation are produced in the United States by the Jianas Brothers (Kansas City, Mo), Cera Products (Jessup, Md), and Pharmacia & Upjohn Inc (Peapack, NJ) (Table 4). Some have the advantages of lower cost, and all have a long shelf life before mixing.…”

“…When evaluated 5 years after introduction, not a single case of hypernatremia had been observed in more than 1500 ambulatory patients with diarrhea given WHO-ORS packets. 31 Meyers et al 30 analyzed the sodium concentration of solution prepared by US inner-city families given packets of a cereal-based ORS. Of 66 families, only 2 prepared a potentially hypernatremic solution.…”

Oral Rehydration Pudding?

“…Rice‐based ORSs have been consistently shown to be no better than glucose ORS in children with a small bowel disease, noncholera diarrhea (6‐8). In the United States, children refuse rice‐based ORS 33% of the time, because of its taste (9). Our own house staff recently had a taste contest, and they greatly preferred glucose ORS to rice cereal ORS.…”