Safety of rapid intravenous rehydration and comparative efficacy of 3 oral rehydration solutions in the treatment of severely malnourished children with dehydrating cholera.
OBJECTIVE
Assess the safety of rapid intravenous rehydration of severely malnourished children and compare the efficacy of 3 formulations of oral rehydration salts solutions.


METHODS
A group of 175 severely malnourished children of either sex (weight/length <70% of National Center for Health Statistics median), ages 6 to 36 months with cholera, were randomly assigned to receive 1 of 3 oral rehydration solutions (ORSs): glucose-ORS (n=58), glucose-ORS plus 50 g/L of amylase-resistant starch (n=59), or rice-ORS (n=58). Severely dehydrated children at enrollment were administered 100 mL/kg of an intravenous solution for 4 to 6 hours before randomisation, and those with some dehydration were randomised on enrollment. The electrolytes of the 3 ORSs were identical. In acute and convalescence phases, treatment was similar other than the nature of the ORSs.


RESULTS
Intravenous fluid (mean) administered to 149 study children was 103 mL/kg (95% confidence interval [CI] 96-109), and all were rehydrated within 6 hours. None of them developed overhydration or heart failure. During the first 24 hours, stool output (31%; 95% CI 14%-42%; P=0.004) and the ORS intake (26%; 95% CI 12%-37%; P=0.002) of children receiving rice-ORS were significantly less compared with children receiving glucose-ORS. The mean duration of diarrhoea in all children (66 hours; 95% CI 62-71), and time to attain 80% of median weight/length (7.15+/-2.81 days) were not different.


CONCLUSIONS
Dehydration in severely malnourished children can safely be corrected within 6 hours. All study ORSs were equally efficient in correcting dehydration. Rice-ORS significantly reduced the stool output and ORS intake, confirming previous reports.
Alam
Nur H
NH
Clinical Sciences Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh. nhalam@icddrb.org
Islam
Sufia
S
Sattar
Samima
S
Monira
Shirajum
S
Desjeux
Jehan-François
JF
D002241:Carbohydrates / Q000627:therapeutic use; D002675:Child, Preschool; D002771:Cholera / Q000150:complications / Q000628:therapy*; D003672:Defecation; D003681:Dehydration / Q000209:etiology / Q000628:therapy*; D003967:Diarrhea / Q000150:complications / Q000628:therapy*; D004334:Drug Administration Schedule; D002149:Energy Intake; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D005947:Glucose / Q000627:therapeutic use; D006333:Heart Failure / Q000517:prevention & control; D006801:Humans; D007223:Infant; D007262:Infusions, Intravenous / Q000009:adverse effects / Q000379:methods; D008297:Male; D044342:Malnutrition / Q000150:complications*; D012275:Oryza; D015532:Rehydration Solutions / Q000627:therapeutic use*; D016896:Treatment Outcome; D015430:Weight Gain
D002241:Carbohydrates; D015532:Rehydration Solutions; D005947:Glucose