Safety of rapid intravenous rehydration and comparative efficacy of 3 oral rehydration solutions in the treatment of severely malnourished children with dehydrating cholera.

Abstract

OBJECTIVES:

Assess the safety of rapid intravenous rehydration of severely malnourished children and compare the efficacy of 3 formulations of oral rehydration salts solutions.

PATIENTS AND METHODS:

A group of 175 severely malnourished children of either sex (weight/length <70% of National Center for Health Statistics median), ages 6 to 36 months with cholera, were randomly assigned to receive 1 of 3 oral rehydration solutions (ORSs): glucose-ORS (n=58), glucose-ORS plus 50 g/L of amylase-resistant starch (n=59), or rice-ORS (n=58). Severely dehydrated children at enrollment were administered 100 mL/kg of an intravenous solution for 4 to 6 hours before randomisation, and those with some dehydration were randomised on enrollment. The electrolytes of the 3 ORSs were identical. In acute and convalescence phases, treatment was similar other than the nature of the ORSs.

RESULTS:

Intravenous fluid (mean) administered to 149 study children was 103 mL/kg (95% confidence interval [CI] 96-109), and all were rehydrated within 6 hours. None of them developed overhydration or heart failure. During the first 24 hours, stool output (31%; 95% CI 14%-42%; P=0.004) and the ORS intake (26%; 95% CI 12%-37%; P=0.002) of children receiving rice-ORS were significantly less compared with children receiving glucose-ORS. The mean duration of diarrhoea in all children (66 hours; 95% CI 62-71), and time to attain 80% of median weight/length (7.15+/-2.81 days) were not different.

CONCLUSIONS:

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.

• Authors: Nur H Alam, Sufia Islam, Samima Sattar, Shirajum Monira, Jehan-François Desjeux
• Journal: Journal of pediatric gastroenterology and nutrition (J Pediatr Gastroenterol Nutr) Vol. 48 Issue 3 Pg. 318-27 (Mar 2009) ISSN: 1536-4801 [Electronic] United States
• PMID: 19274788 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Carbohydrates
• Rehydration Solutions
• Glucose

Topics

• Carbohydrates (therapeutic use)
• Child, Preschool
• Cholera (complications, therapy)
• Defecation
• Dehydration (etiology, therapy)
• Diarrhea (complications, therapy)
• Drug Administration Schedule
• Energy Intake
• Female
• Fluid Therapy (methods)
• Glucose (therapeutic use)
• Heart Failure (prevention & control)
• Humans
• Infant
• Infusions, Intravenous (adverse effects, methods)
• Male
• Malnutrition (complications)
• Oryza
• Rehydration Solutions (therapeutic use)
• Treatment Outcome
• Weight Gain