Citrate can effectively replace bicarbonate in oral rehydration salts for cholera and infantile diarrhoea

Abstract

This study investigated the therapeutic effectiveness of oral rehydration salt (ORS) solutions containing trisodium citrate (ORS-citrate) in place of sodium bicarbonate (ORS-bicarbonate). 74 children with cholera and 34 infants and children under 2 years of age with infantile diarrhea, all of whom had moderate to severe dehydration, were randomly assigned to 1 of the 2 treatment solution groups. Children with severe dehydration were 1st rehydrated with intravenous fluid followed by maintenance therapy with ORS solution (bicarbonate or citrate), while those with moderate dehydration received either ORS-bicarbonate or ORS-citrate during both the initial and the maintenance phases of therapy. Treatment effectiveness was assessed by comparing the success rates, stool output, ORS intake, gain in body weight, changes in erythrocyte volume fraction and plasma specific gravity, correction of acidosis, and maintenance of electrolyte balance. Of the children with cholera, 92% of those who received ORS-citrate and 86% of those who received ORS-bicarbonate were successfully treated. Of the children under 2 years of age with infantile diarrhea, 100% of those who received ORS-citrate and 94% of those who received ORS-bicarbonate were treated successfully. The results indicated that treatment with ORS-citrate is as successful as that with ORS-bicarbonate in terms of its ability to rehydrate, correct the acidosis, and maintain electrolyte concentrations. Thus, trisodium citrate dihydrate, which has the a advantage of a longer shelf-life in hot and humid climates, can effectively replace sodium bicarbonate in the standard ORS solution if used as an adjunct to standard hydration and antibiotic therapy in children with severe cholera or as the only treatment in children with infantile diarrhea assocated with less severe dehydration