High Sodium Rehydration Solutions in Well‐Nourished Outpatients

Herzog, Lynn W.; Bithoney, William G.; Grand, Richard J.

doi:10.1111/j.1651-2227.1987.tb10465.x

Cited by 5 publications

(8 citation statements)

References 14 publications

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“…In our study hypernatraemia was not a problem with solution C even though the children took little other fluid. This is consistent with a study from the USA where solution C was used for outpatient treatment of patients with diarrhoea (21).…”

Section: Discussionsupporting

confidence: 92%

Safety and Efficacy of Three Oral Rehydration Solutions for Children with Diarrhoea (Edinburgh 1984–85)

et al. 1989

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Of 357 children with acute diarrhoea admitted to the City Hospital, Edinburgh, over a 12-month period, only 5 (1.4%) required IV infusions. Three hundred and nineteen were treated with oral rehydration (OR). Of these 269 were studied in detail and 43% had signs of dehydration, but in none of them was it severe. There were no fatalities. Patients were randomly allocated to treatment with one of three OR solutions in a double blind trial. The solutions had sodium concentrations of 35, 50 and 90 mmol (mEq)/l, and dextrose of 200 (36 g/l), 111 (20 g/l) and 110 (19.8 g/l) mmol/l, respectively. Hypernatraemia was not a clinical problem and only 5 children (2%) were biochemically hypernatraemic on admission. Treatment did not cause clinical hypernatraemia. At the second assessment only 3 children were biochemically hypernatraemic, one from each treatment group, and no one had clinical signs. All three solutions were safe and effective in the relatively mildly dehydrated patients currently seen in the UK.

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Section: Discussionsupporting

confidence: 92%

Safety and Efficacy of Three Oral Rehydration Solutions for Children with Diarrhoea (Edinburgh 1984–85)

et al. 1989

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“…Nonetheless, treatment failure rates were similarly low for the three treatment groups and within the range of failure rates reported in other trials of outpatient ORT in the United States. [27][28][29][30][31][32] The three solutions studied were found to be equally effective in maintaining hydration and correcting both hypernatremia and hyponatremia. We did not find any advantage in treatment outcome among children in the CBORS groups compared with those assigned glucose-based ORS.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 1997

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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.

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“…Solutions used in clinical trials have included glucose concentrations from 70 to 280 mmolil. Most of the solutions commercially available in Europe and in the United States have glucose concentrations at the top of the range, containing between 200 and 280 mmolil (9,12,13,(24)(25)(26)(27). Solutions with high carbohydrate concentrations were generally designed to improve caloric intake and taste, as occurred in ORS designed prior to the discovery of glucose-sodium coupled transport mechanism (21,281, or merely to render solutions ioosmotic, with no consideration for the risk of osmotic diarrhoea (12,29,30) and of hypernatraernia (24).…”

Section: Curhohydratementioning

confidence: 99%

“…In Queen Elizabeth Hospital for Children in London, where low sodium solutions have been in use since 1952, both to prevent dehydration and to treat mild dehydration, morbidity has fallen and mortality has been zero since 1979 (1). Reported complications related to the sodium concentration of ORS containing 30-65 mmolil sodium in 17 clinical trials include the following: (i) asymptomatic hyponatraemia is referred to in 5 of 17 clinical trials, but in most cases it affected less than 10% of the patients (10,13,27,60,61); (ii) periorbital oedema is mentioned in reports of 2 clinical trials occurring in one patient (4%) receiving an ORS with 60 mmol/l sodium in one trial (26) and in 15 ' % of the patients receiving ORS with 50 mmolil sodium, in another trial, in this instance being unrelated to hypernatraemia (59). The worsening of the diarrhoea associated with low sodium ORS (29) has been attributed to the high carbohydrate content rather than to the sodium concentration (12).…”

Section: Sodillrnmentioning

confidence: 99%

“…In view of these data the use of WHO-ORS with YO mmol/l sodium can only be justified in our European environment if it offers a significant advantage over lower sodium OKs. Clinical trials with solutions with 90 mmol/l sodium showed that these solutions are effective for the treatment of acute non-cholera diarrhoea, when correctly administered (12,13,25,27,59,62,(67)(68)(69)(70)(71)(72). Moreover, when compared with solutions with 30-75 mmolil sodium for the treatment of non-cholera diarrhoea, they have proven equally effective (9-13, 25.…”

Section: Sodillrnmentioning

confidence: 99%

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Optimising Oral Rehydration Solution Composition for the Children of Europe: Clinical Trials

Ferreira

1989

Acta Paediatrica

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Optimising oral rehydration solution composition for the children of Europe: Clinical trials. Acta Paediatr Scand Suppl 364: 40, 1989.Clinical trials testing different oral rehydration solutions (ORS) are reviewed. The effects of individual components and their concentrations are analysed in order to establish margins of safety for the composition of the ideal ORS for children in Europe. Glucose is the solute of choice for ORS and concentrations of 70-140 mmolil are adequate. Glucose may he replaced by sucrose or glucose polymers. "Low" sodium concentrations (35-60 mmol/l) are advised for rehydration and maintenance in acute non-cholera diarrhoea, for children of all ages, including neonates, and for any degree of dehydration except shock. Although intended for children who are not malnourished, the European ORS should have an adequate potassium concentration (20-30 mmolil), namely the same concentration as found in WHO-ORS. Chloride concentration depends upon other constituents of ORS, namely sodium and potassium, hut the range of 30-90 mmolil is considered to be adequate. Base or base percursors are not required for correction of acidosis except in the severe cases that always need intravenous replacement. A relatively low osmolality seems advisable. Key words: acute gastroenteritis, dehydration, oral rehydration solutions, oral rehydration therapy. Many different oral rehydration solutions (ORS) are currently available and used inEurope. An optimal solution as yet has not been identified for European children. Such a solution must be tailored to meet the demands of that population with its specific environmental and epidemiological characteristics. A number of factors should be considered when attempting to define an ORS for European children: (i) Most European children are well-nourished receiving high protein diets. However, malnutrition is still a problem in some underprivileged communities within developed countries, where diarrhoea1 diseases are more prone to occur. (ii) Despite the fact that acute diarrhoea and dehydration due to gastroenteritis is still a major cause of morbidity in Europe, the incidence is relatively low compared to developing communities ( I ) . (iii) Most European children with acute diarrhoea are otherwise well. (iv) The majority of children with acute diarrhoea in Europe have viral gastroenteritis. cholera and cholera-like diarrhoea being extremely rare (1-4).( v ) The predominant non-cholera aetiology for acute diarrhoea results in a relatively low stool sodium output. certainly much lower than cholera-like diarrhoeas (5-1 I). (iv) Children are generally brought to medical attention before becoming dehydrated or when presenting with mild or moderate dehydration ( 2 -4 , 12, 13).In summary, the ideal solution for the children of Europe should be suitable for ambulatory and hospital treatment of hypo-, normo-or hypernatraemic dehydration of mild and moderate degree or to prevent dehydration, in children of all ages in a fair state of nutrition, suffering from acute non-cholera diarr...

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High Sodium Rehydration Solutions in Well‐Nourished Outpatients

Cited by 5 publications

References 14 publications

Safety and Efficacy of Three Oral Rehydration Solutions for Children with Diarrhoea (Edinburgh 1984–85)

Safety and Efficacy of Three Oral Rehydration Solutions for Children with Diarrhoea (Edinburgh 1984–85)

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

Optimising Oral Rehydration Solution Composition for the Children of Europe: Clinical Trials

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