Standard WHO-ORS versus reduced-osmolarity ORS in the management of cholera patients.

The study compared the safety and efficacy of an oral rehydration salts (ORS) solution, containing 75 mmol/L of sodium and glucose each, with the standard World Health Organization (WHO)-ORS solution in the management of ongoing fluid losses, after initial intravenous rehydration to correct dehydration. The study was conducted among patients aged 12-60 years hospitalized with diarrhoea due to cholera. One hundred seventy-six patients who were hospitalized with acute diarrhoea and signs of severe dehydration were rehydrated intravenously and then randomly assigned to receive either standard ORS solution (311 mmol/L) or reduced-osmolarity ORS solution (245 mmol/L). Intakes and outputs were measured every six hours until the cessation of diarrhoea. During maintenance therapy, stool output, intake of ORS solution, duration of diarrhoea, and the need for unscheduled administration of intravenous fluids were similar in the two treatment groups. The type of ORS solution that the patients received did not affect the mean serum sodium concentration at 24 hours after randomization and the relative risk of development of hyponatraemia. However, patients treated with reduced-osmolarity ORS solution had a significantly lower volume of vomiting and significantly higher urine output than those treated with standard WHO-ORS solution. Reduced-osmolarity ORS solution was as efficacious as standard WHO-ORS solution in the management of cholera patients. The results indicate that reduced-osmolarity ORS solution is also as safe as standard WHO-ORS solution. However, because of the limited sample size in the study, the results will have to be confirmed in trials, involving a larger number of patients.

Sales de rehidratación oral: de osmolaridad reducida y otras sales de rehidratación / Reduced osmolarity oral rehydration salts

La deshidratación por diarrea aguda aún continúa siendo una de las causas más importantes de muerte en niños en Bolivia y el mundo subdesarrollado. Desde hace 20 años las sales de rehidratación oral (SRO) ayudaron a salvar millones de vidas tratando y previniendo la deshidratación provocada por diarreas producidas por el Vibrio cholera y otros agentes etiológicos de diarrea.

Ensayo clínico controlado para evaluar eficacia y seguridad de dos soluciones de hidratación oral con composición OMS y diferente pH / Safety and efficacy of a Worls Health Organization-based oral rehydration solution with acid pH. A clinical, comparative controlled trial

Introducción. La Organización Mundial de la Salud (OMS) recomienda una fórmula única con sabor salado y pH alcalino para el tratamiento de la deshidratación por diarrea. Se ha considerado que el cambio de sabor de la solución de rehidratación oral (SRO) podría mejorar la aceptación de los pacientes. Estas fórmulas, con sabor más agradable a expensas de habérseles agregado ácido cítrico, están disponibles en México. Contienen la misma composición recomendada por la OMS pero con pH ácido, lo que podría aumentar el gasto fecal e incrementar los vómitos. El presente trabajo se diseñó con el objetivo de determinar la eficacia y seguridad de la SRO con pH ácido, en niños deshidratados por diarrea aguda. Material y métodos. Se dividieron al azar, en 2 grupos, 70 niños menores de 2 años de edad: el grupo A se trató con SRO-OMS (pH 8 ñ 0.05) y el grupo B con SRO con pH ácido (4.9 ñ 0.1). Resultados. El gasto fecal promedio (A: 10 ñ 7.9; B: 12 ñ 10.8 g/kg/hora) y la frecuencia de vómitos (A: 11; B 10 pacientes) fueron semejantes en ambos grupos. Trece casos fueron considerados fracasos, 10 del grupo A y 3 del B: por vómitos persistentes (4 del grupo A) o por gasto fecal alto (6 del A y 3 del B), sin mejoría de la deshidratación; todos ellos, excepto uno del grupo A, se hidrataron por sonda nosogástrica o después de la administración de atole de arroz, respectivamente. Conclusiones. El pH ácido de la SRO no se relacionó con mayor frecuencia de vómitos ni con aumento del gasto fecal. La menor frecuencia de fracasos sugiere que es igual o más efectiva que la SRO-OMS para el tratamiento de la deshidratación por diarrea

Concentraçöes de sódio e modo de preparo do "soro caseiro" por mäes de crianças com diarréia aguda, antes e após a orientaçäo do serviço de saúde / Sodium concentrations and management of the \"soro caseiro\" prepared for mothers of children with acute diarrhea, before and after orientation of the service of health

A complicação mais importante da diarréia aguda na criança é a desidratação, cuja prevenção e tratamento dos casos leves e moderados têm como suporte principal a solução de reidratação oral (SRO), composta de H2O,Na, Cl, K, citrato e glicose. Em locais onde as populações não têm acesso à SRO, uma alternativa empregada é o "soro caseiro" (SC), composto de H2O, NaCL e sacarose, cujo preparo está mais sujeito a erros. O objetivo é avaliar a qualidade do preparo do SC por mães de crianças atendidas no Hospital Infantil Lucídio Portela (HILP). Realiza um estudo de intervenção, avaliando o preparo do SC, através da concentração de sódio (Na) deste soro, antes e após orientação do referido serviço. Aponta a necessidade de programas governamentais de educação em saúde que contemplem a prevenção da diarréia e desidratação

Commercial oral rehydration solutions--pitfalls, knowledge, attitude and practices.

Locally available commercial preparations of oral rehydration solutions (ORS) were analyzed for their composition, package instructions and availability. A survey from 50 chemist stores, revealed that ORS packets available belonged to 28 different pharmaceutical companies. None of the shops stored more than five different brands and alternate preparations were handed over the counter freely. Only 48% of the available ORS formulations had the WHO recommended composition. In about one-fourth preparations, the sodium concentration was 30 mEq or less per litre. Forty-one per cent solutions had glucose concentrations more than 2%. The glucose and sodium ration of 1:1 was maintained in only 48% of the formulae. Bicarbonate and citrate both were used with almost equal frequency in these preparations. Cost, flavor, additional ingredients and package instructions varied widely in different packets. ORS formulations most commonly found in the drug stores had low sodium and high glucose concentration. The attitude of doctors and nurses of Pediatric Department and Chemists towards commercial ORS was also studied. While 92% doctors were aware about WHO-ORS, none of the chemists and only 4% nurses had this awareness. All the respondents could remember only up to 3 or 4 brand names and except 30% doctors, none were aware about the composition of those brands of ORS. Regarding importance of composition, preparations and precautions, practically nobody was up to the mark, but doctors were definitely better as compared to nurses and chemists.

Comparative bacterial study of oral rehydration solution (ORS) prepared in plain unboiled and boiled drinking water of Kathmandu valley.

Result of bacterial study on Oral Rehydration Solution (ORS) prepared in plain unboiled and boiled drinking water of Kathmandu valley is reported. Of the total 100 water samples collected from different sources and area all the samples, as a base line study, were subjected for the examination of bacterial presence. Eighty eight percent of the water samples studied were found to be unsatisfactory for drinking. Thirty five percent of the ORS prepared in unboiled water and kept for 24 hours at room temperature showed increased bacterial count whereas none of the ORS prepared in 5 minute boiled water and kept for 24 hour at room temperature showed any bacterial growth. Decreased bacterial count was not found in any of the ORS prepared in unboiled water. Typical coliform bacilli were found grown in 57.0% of the ORS prepared in unboiled water samples.