title: Comparison of three oral rehydration strategies in the treatment of acute diarrhea in a tropical country.
abstract: BACKGROUND
  The administration of hydrating solutions and early refeeding improve recovery for infants and children with diarrhea.
  
  
  OBJECTIVE
  The aim of this study was to assess the efficacy of a low-osmolarity (30 mEq/L Na(+)) solution administered after the standard, high-osmolarity (90 mEq/L Na(+)) solution via a nasogastric tube (NGT) and followed by early refeeding to achieve more rapid body weight recovery in infants and children with acute diarrhea.
  
  
  METHODS
  Infants and children aged <5 years with acute diarrhea and dehydration (body weight loss of ≥10%) observed from January to August 2001 at Saint Camille Medical Center, Ouagadougou, Burkina Faso, were enrolled. Patients were randomized to 1 of 3 treatment protocols. Patients in group A received, via NGT, rehydration with a high-osmolarity solution for 3 hours, followed by a low-osmolarity solution for at least 3 additional hours. Patients in group B were given only a low-osmolarity solution via NGT. In group C, rehydration was carried out using a high-osmolarity solution via NGT.
  
  
  RESULTS
  Four thousand consecutively treated infants and children (2010 boys, 1990 girls; mean [SD] age, 3.5 [2.7] years) were enrolled. After the first 6 hours of infusion, 90% of the patients who had received the combined rehydration (group A) showed significant body weight recovery, versus 80% and 79% of the patients in groups B and C, respectively. Stool output significantly decreased for group A compared with groups B and C (114 vs 125 and 120 g/kg, respectively). Only 7% of the patients in group A required prolonged rehydration (>6 hours) with the low-osmolarity solution, versus 10% and 12% in groups B and C, respectively. A total of 3% of patients treated with combined rehydration required hospitalization, compared with 10% and 9% in groups B and C, respectively. At the end of infusion, 25% of the patients rehydrated only with a low-osmolarity solution showed poor body weight recovery and appeared lethargic, versus 10% in group A and 15% in group C. Patients who were rehydrated with a high-osmolarity solution showed symptoms of hypernatremia (serum Na(+) concentration >140 mEq/L). At the end of rehydration (≥6 hours), all patients recovered their previous body weight, partially or totally, and refeeding was begun. Rehydration and diet were continued at home, or in neighboring areas for those living far away.
  
  
  CONCLUSIONS
  In this study population, the administration of a high-osmolarity solution followed by a low-osmolarity solution and early refeeding was effective in the treatment of acute diarrhea and was well tolerated.
authors.affiliation: Saint Camille Medical Center, Ouagadougou, Burkina Faso.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Pignatelli
authors.affiliation: Departments of Pharmacology, Gynecology and Obstetrics, and Pediatrics, University of Sassari, Sassari, Italy ; Institute of Population Genetics, National Research Council, Alghero, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Musumeci
keywords: diarrhea; low-osmolarity rehydration; refeeding