Efficacy and Safety of Two Oral Solutions as Maintenance Therapy for Acute Diarrhea

Abstract

There is continuing uncertainty about the appropriate level of sodium in oral fluid therapy for children with acute gastroenteritis in developed countries. The present study was undertaken in order to assess whether an oral glucose/electrolyte solution designed for fluid replacement (Na⁺ concentration 75 mmol/l) and an oral glucose/electrolyte solution designed for maintenance of hydration (Na⁺ concentration 45 mmol/1) would be safe and effective in the treatment of acute childhood diarrhea in a developed country. Children aged 3-24 months (n = 54) with acute diarrhea and less than 5 percent dehydration were randomized to receive either maintenance (n . = 27) or rehydration (n = 27) fluid. Outcome was assessed at 24 and 48 hours after entry to the study. Both solutions were found to be equally effective and safe. The fluid was refused by one child in each group. Analysis of efficacy showed that hydration status was maintained in all patients and 98 percent of children showed significant improvement in diarrheal status at 24 hours. We conclude that for well-nourished ambulatory children aged 3-24 months with acute diarrhea and minimal (<5%) or no dehydration, the use of an oral fluid containing 75 mmol/l of sodium is as safe and effective as the use of an oral fluid containing 45 mmol/1 of sodium.

Get full access to this article

View all access options for this article.

References

Tamer AM , Friedman LB , Maxwell Srw , et al. Oral rehydration of infants in a large urban U.S. medical center . J Pediatr 1985;107:14-9.

Hirschhorn N. The treatment of acute diarrhea in children. An historical and physiological perspective. Am J Clin Nutr 1980;33:637-63.

Nalin DR , Cash RA Oral or nasogastric maintenance therapy in pediatric cholera patients. J Pediatr 1971;78:355-58.

Santosham M. , Brown KH , Sack RB Oral rehydration therapy and dietary therapy for acute childhood diarrhea. PIR 1987;8:273-8.

Leung Akc , Darling P. , Auclair C. Oral rehydration therapy —a review. J Roy Soc Health 1987;107:64-7.

World Health Organization. Treatment and prevention of dehydration in diarrheal diseases. A guide for use at the primary level . Geneva: WHO, 1976.

American Academy of Pediatrics—Committee on Nutrition. Use of oral fluid therapy and post-treatment feeding following enteritis in children in a developed country. Pediatrics 1985;75:358-61.

National Center for Health Statistics. NCHS Growth Curves for Children Birth—18 years, United States, US Departmentof Health, Education and Welfare, Public Health Service, DHEW publication No. (PHS) 78-1650, Hyattsville, MD, 1977.

Lifshitz F. , Wapnir RA Oral hydration solutions: Experimental optimization of water and sodium absorption . J Pediatr 1985;106:383-9.

10.

Nalin DR , Harland E. , Ramlal A. , et al. Comparison of low and high sodium and potassium content in oral rehydration solutions. J Pediatr 1980;97:848-53.

11.

Finberg L. Too little water has become too much. AJDC 1986;140:524.

12.

Santosham M. , Burns B. , Nadkarni V. , et al. Oral rehydration therapy for acute diarrhea in ambulatory children in the United States: A double-blind comparison of four different solutions. Pediatrics 1985 ;76:159-66.