VIGOROUS REHYDRATION, WITH GLUCOSE, RICE OR AMYLASE-RESISTANT STARCH-CONTAINING ORAL REHYDRATION SOLUTION IN SEVERELY MALNOURISHED CHILDREN WITH CHOLERA

Abstract

Fast rehydration is often considered risky in severely dehydrated and malnourished children. The aim: Of the study was to test in such children the efficacy of a vigorous rehydration, with glucose, rice (both absorbed in the small intestine) or amylase-resistant starch (metabolised in the colon) - containing oral rehydration solution. Methods: In a prospective randomised study, 174 children, mean ± SE age = 27.6 ± 0.9 months, were included as severely malnourished (Weight/Height = 68.5 ± 5.5 with or without pedal oedema) and dehydrated because of cholera. After IV fluid therapy (602 ± 46 ml) for 84% of them, they were randomly assigned one of the three high potassium (40 mEq/l) oral rehydration solutions, containing glucose, rice or amylase-resistant starch. On the main parameters, there was no significant difference between groups at inclusion. Results: Although risk factors of death were frequently present (55% not breast fed; 84% severe dehydration; 9% severe hypoglycaemia), all the children recovered from dehydration. In the first 2 days, stool volume and ORS intake was significantly different in the 3 groups, but number of unscheduled IV therapy (15%), duration of diarrhoea (66.3 ± 2.2 hrs), weight gain (0.8 ± 0.1 kg) and time to recover 80% of the W/H (7.1 ± 0.2 days) were not different.TableConclusion: In severely malnourished children presenting with dehydration secondary to cholera, vigorous rehydration is effective, with full and rapid recovery. In addition, reduction of stool output by rice or amylase-resistant starch in ORS does not alter the speed of recovery for rehydration or renutrition.