Efficacy of reduced osmolarity oral rehydration solution, rice ... based oral rehydration solution, and standard WHO oral rehydration solution in children with acute diarrhea - a randomized open trial
Keywords:
acute diarrhea, reduced osmolarity oral rehydration salts, rice-based oral rehydration salts, efficacy
Abstract
Background The composition of the WHO's standard oral rehydration solution (ORS) is similar to that of choleric stool. Currently, there are questions about whether the composition is acceptable for treating dehydration caused by diarrhea. Efforts are being made to try and improve the WHO ORS, e.g., to decrease the solution osmolarity to avoid hypertonic side effects.lt is acknowledged that if glucose is used in ORS, the sodium will go through enterocytes and glucose will tum into an absolute substance for the formula. Glucose is less affordable and not widely produced in developing countries, hence researchers are currently exploring substitutes such as rice flour.Objective To compare the efficacy of reduced osmolarity ORS,
rice-based ORS and the WHO standard ORS among children
with acute diarrhea.
Methods A randomized open trial was conducted in children aged
6-59 months old admitted for acute diarrhea. One-way AN OVA
was used to compare the three different types of ORS given.
Results The mean duration of diarrhea was significantly lower in
the group treated with reduced osmolarity ORS (52.66 h, 95%
CI 4 7.13 to 58.18) and rice-based ORS (54.66 h, 95% CI 4 7.97
to 61.34) compared to the group treated with the WHO standard
ORS (67.34 h, 95% CI 61.50 to 73.18). Multivariate analysis
shows that intervention had a significant effect on reducing the
duration of diarrhea.
Conclusions Reduced osmolarity ORS and rice-based ORS
significantly lower the mean duration of children with acute
diarrhea compared with the group treated with the WHO standard
ORS.
References
1. King CK, Glass R, Bresee JS, Duggan C. Managing
acute gastroenteritis among children, oral rehydration,
maintenance, and nutritional therapy [cited 2008 Jan
2]. Available from: url: http://www.cdc.gov/mmwr/preview/
mmwrhtml/rr5216al.htm.
2. Kosek M, Bern C, Guerrant RL. The global burden of
diarrhoeal disease, as estimated from studies published
between 1992 and 2000. Bull Who. 2003;81:197-204.
3. Data Bagian/Staf Medik Fungsional Ilmu Kesehatan Anak
Fakultas Kedokteran Universitas Udayana/RSUP Sanglah
Denpasar 2007.
4. Altherly-John YC, Cunningham SJ, Crain EF. A randomized
trial of oral vs intravenous rehydration in a pediatric
emergency department. Arch Pediatr Adolesc Med.
2002; 156:1240-3.
5. World Health Organization 2005. The treatment of diarrhoea
[cited 2008 Jan 2]. Available from: url: http://www.who.int/
erne/diseases/cholera.
6. World Health Organization 2007. Oral rehydration salts
(ORS) [cited 2008 Jan 2]. Available from: url: http://www.
who.int/emc/diseases/cholera.
7. Hahn S, Kim Y, Garner P. Reduced osmolarity oral rehydration
solution for treating dehydration due to diarrhoea
in children: systematic review. BMJ. 2001;323:81-5.
8. World Health Organization 2002. Reduced osmolarity oral
rehydration salts (ORS) formulation- Report from a meeting
of experts jointly organised by UNICEF and WHO, WHO/
CAH/01.22 [cited 2008 Jan 2]. Available from: url: http://
www.who.int/emc/diseases/cholera.
9. Alam NH, Yunus M, Faruque ASG, Gyr N, Sattar S, Parvin
S, et al. Symptomatic hyponatremia during treatment of
dehydrating diarrheal disease with reduced osmolarity oral
rehydration solution. JAMA. 2006;296:567 -73.
10. Neter J, Wasserman W Implementation of AN OVA model.
In: Neter J, Wasserman W, editors. Applied linear statistical
models, analysis of variance and experimental designs. New
York: Addison-Wesley Publishing Co. Inc., 1973; p. 492-
517.
11. Dutta P, Mitra U, Manna B, Niyogi SK, Roy K, Monda! C,
et al. Double blind, randomized controlled clinical trial of
hypo-osmolar oral rehydration alt solution in dehydrating
acute diarrhea in severely malnourished (marasmic) children.
Arch Dis Child. 2001;84:237-40.
12. Iyngkaran N, Yadav M. Rice-starch oral rehydration therapy
in neonates and young infants. J Trop Pediatr. 1998;44: 199-
203.
13. Sjarif DR. Pediatric nutritional care. In: Pulungan AB,
Hendarto A, Hegar B, Oswari H, editors. Makalah lengkap
continuing professional development IDAI Jaya 2006
nutrition growth-development. Jakarta: IDAI Cabang
Jakarta, 2006; p. 1-10.
14. Vellaichamy M. Hypernatremia. eMedicine Journal.
2001;2:1-9.
15. Rautanen T, Kurki S, Vesikari T. Randomised double blind
study of hypotonic oral rehydration solution in diarrhoea.
Arch Dis Child. 1997;76:272-4.
16. Bhan MK, Chea WE, Fontame 0, Maulen-Radovan I, Pierce
NF, Ribeiro H. Multicentre evaluation of reduced-osmolarity
oral rehydration salts solution. Lancet. 1995;345:282-5.
17. Soetjiningsih, Madra D, Kari K, Hendra S, Sudaryat S.
Larutan tepung beras elektrolit untuk rehidrasi oral pada
anak dengan diare dehidrasi. Cairan rehidrasi oral: manfaat
dan pengembangannya. In: Sudigbia I, Sumantri AG,
Adinoto S, Sutiarto SK, Raharjani KB, Zain S, editors.
Kumpulan Makalah Pertemuan Ilmiah Berkala VIII Badan
Koordinasi Gastroenterologi Anak Indonesia. FK UNDIP/
RS Dr. Kariadi; 1982 3-4 Desember; Semarang: BKGAI
Komisariat Semarang, 1982.
18. Gore SM, Fontaine 0, Pierce NF. Impact of rice based
oral rehydration solution on stool output and duration
of diarrhoea: meta-analysis of 13 clinical trials. BMJ.
1992;304(6):287 -91.
19. Islam A, Molla AM, Ahmed MA. Is rice based oral
rehydration therapy effective in young infants? Arch Dis
Child. 1994;71:19-23.
20. Sunoto. Glucose polimer. In: Suharyono, Boediarso A,
Halimun EM, editors. Gastroenterologi anak praktis. Jakarta:
Balai Penerbit FKUI, 1988; p. 171-6.
21. Fayad IM, Hirschhorn N, Abu-Zikry M, Kamel M. Hypernatremia
surveillance during a national diarrhoeal disease
control. Lancet. 1992;339(8):S89-93.
22. Segeren S, Soenarto Y, J uffrie M. Cairan rehidrasi oral
tidak tepat merupakan faktor risiko kejadian hipematremia
pada anak balita dengan diare cair akut. Sari Pediatri.
2005 ;3 7:4-8.
23. Michael L, Moritz MD, Ayus JC. Disorders of water
metabolism in children: hyponatremia and hypernatremia.
J Pediatr. 2002; 23: 11.
acute gastroenteritis among children, oral rehydration,
maintenance, and nutritional therapy [cited 2008 Jan
2]. Available from: url: http://www.cdc.gov/mmwr/preview/
mmwrhtml/rr5216al.htm.
2. Kosek M, Bern C, Guerrant RL. The global burden of
diarrhoeal disease, as estimated from studies published
between 1992 and 2000. Bull Who. 2003;81:197-204.
3. Data Bagian/Staf Medik Fungsional Ilmu Kesehatan Anak
Fakultas Kedokteran Universitas Udayana/RSUP Sanglah
Denpasar 2007.
4. Altherly-John YC, Cunningham SJ, Crain EF. A randomized
trial of oral vs intravenous rehydration in a pediatric
emergency department. Arch Pediatr Adolesc Med.
2002; 156:1240-3.
5. World Health Organization 2005. The treatment of diarrhoea
[cited 2008 Jan 2]. Available from: url: http://www.who.int/
erne/diseases/cholera.
6. World Health Organization 2007. Oral rehydration salts
(ORS) [cited 2008 Jan 2]. Available from: url: http://www.
who.int/emc/diseases/cholera.
7. Hahn S, Kim Y, Garner P. Reduced osmolarity oral rehydration
solution for treating dehydration due to diarrhoea
in children: systematic review. BMJ. 2001;323:81-5.
8. World Health Organization 2002. Reduced osmolarity oral
rehydration salts (ORS) formulation- Report from a meeting
of experts jointly organised by UNICEF and WHO, WHO/
CAH/01.22 [cited 2008 Jan 2]. Available from: url: http://
www.who.int/emc/diseases/cholera.
9. Alam NH, Yunus M, Faruque ASG, Gyr N, Sattar S, Parvin
S, et al. Symptomatic hyponatremia during treatment of
dehydrating diarrheal disease with reduced osmolarity oral
rehydration solution. JAMA. 2006;296:567 -73.
10. Neter J, Wasserman W Implementation of AN OVA model.
In: Neter J, Wasserman W, editors. Applied linear statistical
models, analysis of variance and experimental designs. New
York: Addison-Wesley Publishing Co. Inc., 1973; p. 492-
517.
11. Dutta P, Mitra U, Manna B, Niyogi SK, Roy K, Monda! C,
et al. Double blind, randomized controlled clinical trial of
hypo-osmolar oral rehydration alt solution in dehydrating
acute diarrhea in severely malnourished (marasmic) children.
Arch Dis Child. 2001;84:237-40.
12. Iyngkaran N, Yadav M. Rice-starch oral rehydration therapy
in neonates and young infants. J Trop Pediatr. 1998;44: 199-
203.
13. Sjarif DR. Pediatric nutritional care. In: Pulungan AB,
Hendarto A, Hegar B, Oswari H, editors. Makalah lengkap
continuing professional development IDAI Jaya 2006
nutrition growth-development. Jakarta: IDAI Cabang
Jakarta, 2006; p. 1-10.
14. Vellaichamy M. Hypernatremia. eMedicine Journal.
2001;2:1-9.
15. Rautanen T, Kurki S, Vesikari T. Randomised double blind
study of hypotonic oral rehydration solution in diarrhoea.
Arch Dis Child. 1997;76:272-4.
16. Bhan MK, Chea WE, Fontame 0, Maulen-Radovan I, Pierce
NF, Ribeiro H. Multicentre evaluation of reduced-osmolarity
oral rehydration salts solution. Lancet. 1995;345:282-5.
17. Soetjiningsih, Madra D, Kari K, Hendra S, Sudaryat S.
Larutan tepung beras elektrolit untuk rehidrasi oral pada
anak dengan diare dehidrasi. Cairan rehidrasi oral: manfaat
dan pengembangannya. In: Sudigbia I, Sumantri AG,
Adinoto S, Sutiarto SK, Raharjani KB, Zain S, editors.
Kumpulan Makalah Pertemuan Ilmiah Berkala VIII Badan
Koordinasi Gastroenterologi Anak Indonesia. FK UNDIP/
RS Dr. Kariadi; 1982 3-4 Desember; Semarang: BKGAI
Komisariat Semarang, 1982.
18. Gore SM, Fontaine 0, Pierce NF. Impact of rice based
oral rehydration solution on stool output and duration
of diarrhoea: meta-analysis of 13 clinical trials. BMJ.
1992;304(6):287 -91.
19. Islam A, Molla AM, Ahmed MA. Is rice based oral
rehydration therapy effective in young infants? Arch Dis
Child. 1994;71:19-23.
20. Sunoto. Glucose polimer. In: Suharyono, Boediarso A,
Halimun EM, editors. Gastroenterologi anak praktis. Jakarta:
Balai Penerbit FKUI, 1988; p. 171-6.
21. Fayad IM, Hirschhorn N, Abu-Zikry M, Kamel M. Hypernatremia
surveillance during a national diarrhoeal disease
control. Lancet. 1992;339(8):S89-93.
22. Segeren S, Soenarto Y, J uffrie M. Cairan rehidrasi oral
tidak tepat merupakan faktor risiko kejadian hipematremia
pada anak balita dengan diare cair akut. Sari Pediatri.
2005 ;3 7:4-8.
23. Michael L, Moritz MD, Ayus JC. Disorders of water
metabolism in children: hyponatremia and hypernatremia.
J Pediatr. 2002; 23: 11.
Published
2009-07-01
How to Cite
1.
Sundari T, Soetjiningsih S, Soenarto S, Karyana IPG. Efficacy of reduced osmolarity oral rehydration solution, rice . based oral rehydration solution, and standard WHO oral rehydration solution in children with acute diarrhea - a randomized open trial. PI [Internet]. 1Jul.2009 [cited 22Nov.2024];49(3):169-. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/547
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Received 2016-09-10
Accepted 2016-09-10
Published 2009-07-01
Accepted 2016-09-10
Published 2009-07-01
