Evaluation of Rice-based Reduced Osmolarity Oral Rehydration Solution in Children with Severe Persistent Diarrhoea

Abstract

Objective: Evaluate and compare the efficacy of a standard (WHO) oral rehydration solution (ORS) and a rice-based reduced osmolarity ORS in children with severe persistent diarrhoea. Persistent diarrhoea accounts for 7-21% of all childhood diarrhoeal episodes and 32-62% of all diarrhoea-related deaths in developing countries. Fluid and electrolyte balance is an important part in the management of persistent diarrhoea. Methodology: This randomized controlled clinical trial was conducted on 64 children with severe persistent diarrhoea (duration >14 days, stool output >80 mL.kg.d). After a one-day observation period to confirm the diagnosis and severity, they were assigned to either standard WHO-ORS (sodium 90, potassium 20, chloride 80, citrate 10, glucose 111, osmolarity 311; all in mmol/Lor to a rice-based reduced osmolarity ORS (rice powder 33 g; sodium 60, potassium 14, chloride 57, citrate 6, osmolarity 137; all in mmol/L) for replacement of ongoing stool loss for seven days. Stool output and frequency, ORS, and food intakes were monitored daily. Serum electrolytes were also determined on study day 3 and 7. Daily and total (day 1-7) food intakes were comparable among the study groups. The stool volume (mL.kg.d) mean±SEM) was significantly less in infants receiving rice-based reduced osmolality ORSthantheWHO-ORSonday4(86±ll vs. 44±28, p=0.05), 5 (73±10 vs. 144±31,p=0.04),6(60±9 vs. 139±31 p=0.02), 7(59±11 vs. 120±59, p=0.04), as well as for the entire (1-7 d) study period (523±54 vs. 932±177, p=0.04). The median stool frequency (number/d) during the entire study period in children receiving reduced osmolality ORS was also significantly less than those in the WHO-ORS group (70±5 vs. 92±10, p=0.05). Furthermore, the children belonging to reduced osmolarity ORS required less amount of ORS in total compared to the WHO-ORS groups. Children in both the groups maintained normal serum electrolytes as determined on day 3 and 7. Coadusson: It i* concluded that rice-based reduced osmolarity ORS is more effective than WHO-ORS for replacement and reducing ongoing stool loss, and therefore, may be useful in the management of children with persistent diarrhoea