Safety of Rapid Intravenous Rehydration and Comparative Efficacy of 3 Oral Rehydration Solutions in the Treatment of Severely Malnourished Children With Dehydrating Cholera

Alam, Nur; Islam, Samia; Sattar, Samima; Monira, Shirajum; Desjeux, Jehan-François

doi:10.1097/mpg.0b013e318180af27

Cited by 45 publications

(107 citation statements)

References 22 publications

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“…One study included children with and without SAM 18 , but reported independently on outcomes for children with SAM. One study included children with cholera only 20 (see Box 1 for further details). There was moderate heterogeneity in the population eligibility criteria, sample size, and methods employed by each study, and in their results.…”

Section: Resultsmentioning

confidence: 99%

“…One study (Alam et al 2009) 20 found that there was no significant difference in time to rehydration (time to attain 80% of weight for length or height) between groups. Two studies evaluating old WHO ORS versus hypo-osmolar ORS (Alam et al 2000 18 and Dutta et al 2001 23 ) found that there was a faster recovery (passage of 2 consecutive formed stools or no diarrhoea for 12 hours) in the group receiving hypo-osmolar ORS compared to old WHO ORS (36 vs. 53 hours, p=0.001).…”

Section: Resultsmentioning

confidence: 99%

“…Included in the first trial by Alam et al , 2009 as a comparator to standard ORS were two additional arms with either amylase-resistant starch or rice added to the glucose ORS 20 . The second trial by Alam et al , 2015 compared hyposmolar WHO ORS to hyposmolar WHO ORS with added partially hydrolysed guar gum) 21 .…”

Section: Discussionmentioning

confidence: 99%

“…This is fine but in this case, one wonders whether two papers now included in the evidence base should not be excluded, namely the Alam 2009 1 and Alam 2015 papers 2 . These two papers compare oral rehydration solutions with identical electrolyte content, and are not really relevant to the hypothesis discussed here.…”

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confidence: 99%

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Oral rehydration of malnourished children with diarrhoea and dehydration: A systematic review

Houston¹,

Gibb²,

Maitland³

2017

Wellcome Open Res

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Background: Diarrhoea complicates over half of admissions to hospital with severe acute malnutrition (SAM). World Health Organization (WHO) guidelines for the management of dehydration recommend the use of oral rehydration with ReSoMal (an oral rehydration solution (ORS) for SAM), which has lower sodium (45mmols/l) and higher potassium (40mmols/l) content than old WHO ORS. The composition of ReSoMal was designed specifically to address theoretical risks of sodium overload and potential under-treatment of severe hypokalaemia with rehydration using standard ORS. In African children, severe hyponatraemia at admission is a major risk factor for poor outcome in children with SAM complicated by diarrhoea. We therefore reviewed the evidence for oral rehydration therapy in children with SAM. Methods: We conducted a systematic review of randomised controlled trials (RCTs) on 18 th July 2017 comparing different oral rehydration solutions in severely malnourished children with diarrhoea and dehydration, using standard search terms. The author assessed papers for inclusion. The primary endpoint was frequency of hyponatraemia during rehydration. Results: Six RCTs were identified, all published in English and conducted in low resource settings in Asia. A range of ORS were evaluated in these studies, including old WHO ORS, standard hypo-osmolar WHO ORS and ReSoMal. Hyponatraemia was observed in two trials evaluating ReSoMal, three children developed severe hyponatraemia with one experiencing convulsions. Hypo-osmolar ORS was found to have benefits in time to rehydration, reduction of stool output and duration of diarrhoea. No trials reported over-hydration or fatalities. Conclusions: Current WHO guidelines strongly recommend the use of ReSoMal based on low quality of evidence. Studies indicate a significant risk of hyponatraemia on ReSoMal in Asian children, none have been conducted in Africa, where SAM mortality remains high. Further research should be conducted in Africa to evaluate optimal ORS for children with SAM and to generate evidence based, practical guidelines

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Oral rehydration of malnourished children with diarrhoea and dehydration: A systematic review

Houston¹,

Gibb²,

Maitland³

2017

Wellcome Open Res

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“…Eight trials [50][51][52][53][54][55][56][57] were included that investigated the efficacy of treatments for children with SAM who also had diarrhoea. Within this section, similar trials have been grouped together for ease of comparison between studies.…”

mentioning

confidence: 99%

The effectiveness of interventions to treat severe acute malnutrition in young children: a systematic review.

Picot

Hartwell²,

Harris³

et al. 2012

Health Technol Assess

107

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How to obtain copies of this and other HTA programme reports An electronic version of this title, in Adobe Acrobat format, is available for downloading free of charge for personal use from the HTA website (www.hta.ac.uk). A fully searchable DVD is also available (see below).Printed copies of HTA journal series issues cost £20 each (post and packing free in the UK) to both public and private sector purchasers from our despatch agents.Non-UK purchasers will have to pay a small fee for post and packing. For European countries the cost is £2 per issue and for the rest of the world £3 per issue. How to order:-fax (with credit card details) -post (with credit card details or cheque) -phone during office hours (credit card only).Additionally the HTA website allows you to either print out your order or download a blank order form. Contact details are as follows:Synergie UK (HTA Department) Digital House, The Loddon Centre Wade Road Basingstoke Hants RG24 8QW Email: orders@hta.ac.uk Tel: 0845 812 4000 -ask for 'HTA Payment Services' (out-of-hours answer-phone service) Fax: 0845 812 4001 -put 'HTA Order' on the fax header Payment methods Paying by chequeIf you pay by cheque, the cheque must be in pounds sterling, made payable to University of Southampton and drawn on a bank with a UK address.Paying by credit card You can order using your credit card by phone, fax or post. SubscriptionsNHS libraries can subscribe free of charge. Public libraries can subscribe at a reduced cost of £100 for each volume (normally comprising 40-50 titles). The commercial subscription rate is £400 per volume (addresses within the UK) and £600 per volume (addresses outside the UK). Please see our website for details. Subscriptions can be purchased only for the current or forthcoming volume.How do I get a copy of HTA on DVD?Please use the form on the HTA website (www.hta.ac.uk/htacd/index.shtml). HTA on DVD is currently free of charge worldwide.The website also provides information about the HTA programme and lists the membership of the various committees. HTAThe effectiveness of interventions to treat severe acute malnutrition in young children: a systematic review NIHR Health Technology Assessment programmeThe Health Technology Assessment (HTA) programme, part of the National Institute for Health Research (NIHR), was set up in 1993. It produces high-quality research information on the effectiveness, costs and broader impact of health technologies for those who use, manage and provide care in the NHS. 'Health technologies' are broadly defined as all interventions used to promote health, prevent and treat disease, and improve rehabilitation and long-term care. The research findings from the HTA programme directly influence decision-making bodies such as the National Institute for Health and Clinical Excellence (NICE) and the National Screening Committee (NSC). HTA findings also help to improve the quality of clinical practice in the NHS indirectly in that they form a key component of the 'National Knowledge Service' . The HTA programme is needs ...

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Polymer-based oral rehydration solution for treating acute watery diarrhoea

Gregorio

Gonzales

Dans

et al. 2016

Cochrane Database of Systematic Reviews

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BackgroundAcute diarrhoea is one of the main causes of morbidity and mortality among children in low-income countries. Glucose-based oral rehydration solution (ORS) helps replace fluid and prevent further dehydration from acute diarrhoea. Since 2004, the World Health Organization (WHO) has recommended the osmolarity of less than 270 mOsm/L (ORS ≤ 270) versus greater than 310 mOsm/L formulation (ORS ≥ 310). Polymer-based ORS (for example, prepared using rice or wheat) slowly releases glucose and may be superior to glucose-based ORS.ObjectivesTo compare polymer-based oral rehydration solution (polymer-based ORS) with glucose-based oral rehydration solution (glucose-based ORS) for treating acute watery diarrhoea.Search methodsWe searched the following sources up to 5 September 2016: the Cochrane Infectious Diseases Group (CIDG) Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library 2016, Issue 9), MEDLINE (1966 to 5 September 2016), EMBASE (1974 to 5 September 2016), LILACS (1982 to 5 September 2016), and mRCT (2007 to 5 September 2016). We also contacted researchers, organizations, and pharmaceutical companies, and searched reference lists.Selection criteriaWe included randomized controlled trials (RCTs) of people with acute watery diarrhoea (cholera and non-cholera associated) that compared polymer-based and glucose-based ORS (with identical electrolyte contents).Data collection and analysisTwo review authors independently assessed the search results and risk of bias, and extracted data. In multiple-treatment arms with two or more treatment groups, we combined outcomes as appropriate and compared collectively with the control group.Main resultsThirty-five trials that included 4284 participants met the inclusion criteria: 28 trials exclusively included children, five included adults, and two included both adults and children.Polymer-based ORS versus glucose-based ORS (osmolarity ≤ 270)Eight trials (752 participants) evaluated this comparison, and seven trials used rice as a polymer source. Polymer-based ORS may decrease mean stool output in the first 24 hours by 24 mL/kg (mean difference (MD) −24.60 mL/kg, 95% CI −40.69 to −8.51; one trial, 99 participants, low quality evidence). The average duration of diarrhoea may be reduced by eight hours (MD −8.24 hours, 95% CI −13.17 to −3.30; I² statistic = 86%, five trials, 364 participants, low quality evidence) with polymer ORS but results are heterogeneous. Limited trials showed no observed difference in the risk of unscheduled use of intravenous fluid (RR 0.66, 95% CI 0.43 to 1.02; I² statistic = 30%; four trials, 376 participants, very low quality evidence), vomiting (very low quality evidence), and hyponatraemia (very low quality evidence).Polymer-based ORS versus glucose-based ORS (osmolarity ≥ 310)Twenty-seven trials (3532 participants) evaluated this comparison using a variety of polymers. On average, polymer ORS may reduce the total stool output in the first 24 hours by around 65 mL/kg (MD −65.47 mL/kg, 95% CI −83....

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Safety of Rapid Intravenous Rehydration and Comparative Efficacy of 3 Oral Rehydration Solutions in the Treatment of Severely Malnourished Children With Dehydrating Cholera

Abstract: Dehydration in severely malnourished children can safely be corrected within 6 hours. All study ORSs were equally efficient in correcting dehydration. Rice-ORS significantly reduced the stool output and ORS intake, confirming previous reports.

Cited by 45 publications

References 22 publications

Oral rehydration of malnourished children with diarrhoea and dehydration: A systematic review

Oral rehydration of malnourished children with diarrhoea and dehydration: A systematic review

The effectiveness of interventions to treat severe acute malnutrition in young children: a systematic review.

Polymer-based oral rehydration solution for treating acute watery diarrhoea

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