ORS Intake Research Articles

Hyponatremia in children hospitalized at Nishtar Hospital, Multan.

Objectives: Acute gastroenteritis is a common illness that leads to significant morbidity and mortality in pediatric population. This study was aimed to determine the frequency of hyponatremia among hospitalized children having acute gastroenteritis. Study Design: Cross-sectional Study. Setting: Unit-ll, Department of Pediatric Medicine, Nishtar Medical College and Hospital, Multan. Period: From 1st January 2018 to 30th June 2018. Material & Methods: A total of 232 children aged 1-12 years of either sex, clinically assessed cases of acute gastroenteritis with duration of illness < 7 days, were considered. Mean and standard deviation was calculated for quantitative variables while frequencies and percentage were tabulated for the qualitative variables. Post stratification chi-square test was applied to see effects of studied variables and P value <0.05 was considered as significant. Results: Mean age of our study cases was 2.33 ± 2.11 years. Majority of patients, 135 (58.2%) were boys, 143 (61.6%) from urban areas and 161 (69.4%) were having poor socioeconomic status. History of hypotonic IV fluid therapy was positive in 18 (7.8%) and history of ORS intake was positive in 71 (30.6%). Mean duration of illness was 4.19 ± 1.27 days. Mean serum sodium level 135.37 ± 2.20 mEq/L. Hyponatremia was present in 90 (38.8%). Male gender, poor socioeconomic status, no use of hypotonic IV fluid therapy, no intake of ORS and disease duration of >3 days were significantly associated (P value < 0.05) with hyponatremia. Conclusion: Frequency of hyponatremia was high in children with AGE. Male children, poor socioeconomic status, no use of hypotonic IV fluid therapy, no intake of ORS and prolonged disease duration were significantly associated with hyponatremia.

English

In response to the high occurrence of diarrhea in Ethiopia, the Federal Ministry of Health employed an effective strategy that included administration of zinc together with oral rehydration salt to treat children suffered diarrhea since 2013. Nonetheless, information on zinc bundled with ORS uptake is limited and thus this study has examined zinc utilization among beneficiaries. A community based cross-sectional study was conducted among 422 households whose under-five- children (U5C) had diarrhea in Akaki sub city from February to March, 2016. Prior to selection of households, participants were identified through health facilities and were traced using their household number. Relevant socio-demographic and other important health information were collected from respective caretakers using a pre-tested structured questionnaire through interview. Data were then entered using Epi Info Version 3.5.4, exported and analyzed using SPSS version 20 software. Both bivariate and multivariate regression analyses were used to identify the factors related to zinc utilization and a p-value below 0.05 was considered as statistically significant. All recruited subjects participated in the study with 100% response rate. Of the 422 participants, 283 (67.1%) caretakers used zinc bundles with ORS when the under-five-child had diarrhea. The majority (82.2%) sought treatment from health centers though their major (80.90%) source for zinc was private pharmacies. Following zinc intake, diarrhea subsided within 1-3 days in most (76.3%) of them. About the same proportion of caretakers recommended the zinc for watery diarrhea and the vast majority (90.5%) were satisfied with zinc supplement. Caregivers' whose child diarrhea stopped were more likely (AOR=10.29; 95% CI=2.52-42.05) to use zinc while those whose child diarrhea stopped after six days (AOR=0.09; 95% CI=0.02-0.45) and had mucoid diarrhea (AOR=0.32; 95% CI=0.10-0.97) were less likely to give their children the zinc than their counterparts. The study thus revealed that slightly over two in three children were given diluted zinc and the major augmenting factors for the zinc bundled with ORS uptake were withholding to administer the full dose, stopping the drug when diarrhea improved and recommending zinc therapy. It is thus essential to consider the above determinants, avail the zinc in the government facilities, improve zinc bundled with ORS intake and ultimately reduce deaths emanating from diarrhea. Key words: Diarrhea, Zinc utilization, determinants, cross sectional community based study, Ethiopia

Association of Maternal Knowledge and Practices Regarding Prevention and Care of Diarrhea at Home for Children less than 5 years of Age: A Study Conducted in Tertiary level Hospitals of Lahore, Pakistan

Background: Diarrhea is second major killer disease for children less than 5 year of age; and maternal lack of sound knowledge and related correct practices inn this regard conflicts with WHO treatment guidelines for diarrhea. Objective: 1) to assess the level of maternal knowledge and practices regarding prevention and management of diarrhea at home; in children below five year of age 2) to identify association between maternal knowledge and practices regarding prevention and care of diarrhea at home. Materials & Methods: It was a cross sectional study conducted in three tertiary level hospitals of Lahore selected randomly. Study population was mothers having children less than 5 year of age coming to pediatric Outdoor in these hospitals. Calculated sample size was 296; and non-probability purposive sampling technique used to recruit the sample. Data was collected from 300 respondents; study instrument was KAP questionnaire adopted and modified and data was taken upon the variables of knowledge and practice. Data analysis plan was: descriptive statistics for all variables, Bivariate analysis upon knowledge and practice scores, Pearson Correlation upon the two variable scores. Results: 61.7% respondents had good knowledge score, whereas 32% and 6.3% had average and poor score respectively. 39.3% were found to have good practice score, whereas 54% and 6.7% were found to have average and poor practice level score. Highly significant association (P- 0.000) was found between knowledge and practice levels; and Pearson correlation of 43.8% was found between the two variables. Conclusion: Health education communication should be conducted by health care workers so as to give the right knowledge about ORS intake and its preparation; and adoption of correct dietary practices by the mothers during diarrheal episode of the child.

Prevalence of hypoglycemia in diarrheal dehydration at hospitalization in severe acute malnutrition

Background: Diarrhea is the major cause of death in children below five years of age. Hypoglycemia has been a potential fatal complication of infectious diarrhea in both well-nourished and poorly nourished children. But prevalence of hypoglycemia in diarrheal dehydration is not exactly known. This study was done to evaluate the glycemic status in children having acute diarrhea with dehydration and specifically associated with severe acute malnutrition (SAM).Methods: This descriptive cross-sectional study was conducted during July 2017 to December 2017 at Bal Chikitsalaya Udaipur, Rajasthan, India. Blood glucose levels were assessed in 150 children of acute diarrhea with dehydration, comprising of 100 SAM and 50 Non SAM children.Results: Average blood glucose of SAM children was 89 mg/dl and of non-SAM, it was 120 mg/dl. Average blood glucose was low in SAM as compared to non-SAM in both some dehydration (116.08±21.26) and severe dehydration (66.69±19.80) as well as with or without ORS intake. Overall 18 (12%) of children had hypoglycemia and all were in severe dehydration and not taking ORS. Blood glucose levels were statistically low in severe dehydration and those who were not taking ORS at the time of hospitalization (p = 0.001). In severe dehydration 25% of children had hypoglycemia means every fourth child had low blood glucose <54 mg/dl.Conclusions: Overall prevalence of hypoglycemia is 12% in diarrheal dehydration and 20% in SAM with dehydration. Twenty five percent of severe dehydration children had hypoglycemia, and all have not started ORS. None of the child started ORS developed hypoglycaemia.

Acceptability and efficacy of a gel hypotonic oral rehydration solution in children with acute gastroenteritis.

Oral rehydration solution remains the mainstay of acute gastroenteritis therapy. The aim of this study was to investigate the acceptability of a new zinc-containing hypotonic super-oral rehydration solution (ORS) in a gel formulation and its efficacy in reducing the duration and severity of diarrhea in children. This was a randomized-controlled trial of children (5-36 months of age) observed for diarrhea lasting less than 24 h. Children were randomized to receive standard hypotonic ORS (group 1) or a gel hypotonic super-ORS containing zinc (group 2). The main study outcome was ORS intake in the first 24 h. ORS intake at 4 h, rate of diarrhea resolution at 72 h of treatment, total duration and severity of diarrhea, hospitalization, and adverse effects were also evaluated. Eighty-three children were enrolled (group 1: 40; group 2: 43). The amount of ORS consumed at 24 h was significantly higher in group 2 than in group 1. A similar result was observed at 4 h. The number of children who refused ORS (<10 ml/kg/day) was lower in group 2 versus group 1 (P=0.001). The number of children presenting diarrhea after 72 h of treatment was lower in group 2 versus group 1 (P=0.028). Also, the mean duration of diarrhea was shorter in group 2 than in group 1 (P=0.001). The hypotonic super-ORS containing zinc in a gel formulation had a positive effect on the severity of diarrhea. No patient required hospitalization. No adverse events were observed in either of the two study groups. The new zinc-containing hypotonic super-ORS in a gel formulation is effective in the management of childhood acute gastroenteritis.

Comparison of Determinants of Clinical Recovery from Acute Watery Diarrhea of Well-nourished and Malnourished Children in an Urban Hospital

A hospital based cross sectional study was carried out among the under-five children admitted to the longer stay wards (LSU) of the hospital of ICDDR,B to investigate the relationship between children’s nutritional status and clinical recovery as well as sock, economic condition. Nutritional status was determined by anthropometric measurements. The study conducted on 94 children of 6-59 months, of whom 49 were malnourished and 49 were well nourished 64 of them were male and 35 were female. (It means that boy’s are more sufferers in diarrhea than girls.) (Children’s age come within a range of 6-59) month. Mother’s education level was lower, 32.6% mothers were illiterate and 40% mothers of malnourished children were illiterate where, 25% mothers having well nourished child were illiterate. Most of the malnourished children’s Family income was below TK. 5,000 per month for majority of the parents whereas, most of the well nourished children’s family income was 8,000tk. It shows that, children having low family income are more likely malnourished than well nourished children. Family member was within 4 persons for majority of the well nourished children’s households’. On the other hand family member was more than 5 in out of the malnourished households. Within their limited income; it was difficult to maintain a medium size family properly. Our study reveals that knowledge, attitude and practices of dietary pattern, health, sanitation and immunization of the malnourished children’s family were lower than well-nourished children’s family. Their nutritional knowledge was too low, compared with well nourished children’s parents. In our study, Most of the parents of well-nourished children used to feed colostrums (80.6%) but Parents having malnourished children discarded colostrums (93.6%). Our study reveals that 64.4% malnourished children’s mother has started complementary food in &lt;2 months of age ,on the other hand majority of well-nourished children’s mother gave their child complementary food at the age of 6-9 months. It has been seen that, the majority of well nourished children (62%) were immunized by taking all doses of vaccines. where as most of the malnourished children (49%) has not taken all doses as a result there immunity was lesser than well-nourished children. Most of the caregivers of well-nourished children (43.5%) knows that diarrhea causes by not giving immunization, on the other hand majority of caregiver of malnourished patients (31.9%) knows that main cause of diarrhea is infection by germs. The immunization status of well nourished children was quite satisfactory. 62% well nourished children and only 40% Mal nourished children was completely immunized. It has been seen that, ORS intake was higher in well-nourished children (172.2lml-on the 1st day of hospitalization, compare to malnourished children. Stool output was higher in malnourished children 235.48 ml-on the 1st day after admission. It shows that there is a co-relation between ORS intake, stool output and recovery period. It has been seen that, mean duration of diarrhea before hospitalization was lower in well-nourished children group, but duration of fever, vomiting and abdominal pain rate was higher in this group compared to malnourished group. DOI: http://dx.doi.org/10.3329/bjnut.v24i0.14039 Bangladesh J. Nutr. Vol. 24-25 Dec 2011-2012 pp.83-92

A Randomized Controlled Trial of Glucose versus Amylase Resistant Starch Hypo-Osmolar Oral Rehydration Solution for Adult Acute Dehydrating Diarrhea

BackgroundReduction of gross diarrhea rate in excess of that seen over time with intravenous therapy and appropriate antibiotics is not usually achieved by oral glucose-electrolyte rehydration therapy for cholera and cholera-like diarrheas.Methodology and Principal FindingsThis prospective randomized clinical trial at a tertiary referral hospital in southern India was undertaken to determine whether amylase resistant starch, substituting for glucose in hypo-osmolar oral rehydration solution, would reduce diarrhea duration and weight in adults with acute severe dehydrating diarrhea. 50 adult males with severe watery diarrhea of less than three days' duration and moderate to severe dehydration were randomized to receive hypo-osmolar ORS (HO-ORS) or HO-ORS in which amylase resistant high amylose maize starch 50g/L substituted for glucose (HAMS-ORS). All remaining therapy followed standard protocol. Duration of diarrhea (ORS commencement to first formed stool) in hours was significantly shorter with HAMS-ORS (median 19, IQR 10-28) compared to HO-ORS (median 42, IQR 24-50) (Bonferroni adjusted P, Padj<0.001). Survival analysis (Kaplan-Meier) showed faster recovery from diarrhea in the HAMS-ORS group (P<0.001, log rank test). Total diarrhea fecal weight in grams (median, IQR) was not significantly lower in the HAMS-ORS group (2190, 1160-5635) compared to HO-ORS (5210, 2095-12190) (Padj = 0.08). However, stool weight at 13-24 hours (280, 0-965 vs. 1360, 405-2985) and 25–48 hours (0, 0-360 vs. 1080, 55-3485) were significantly lower in HAMS-ORS compared to HO-ORS group (Padj = 0.048 and P = 0.012, respectively). ORS intake after first 24 hours was lower in the HAMS-ORS group. Subgroup analysis of patients with culture isolates of Vibrio cholerae indicated similar significant differences between the treatment groups.ConclusionsCompared to HO-ORS, HAMS-ORS reduced diarrhea duration by 55% and significantly reduced fecal weight after the first 12 hours of ORS therapy in adults with cholera-like diarrhea.Trial RegistrationCurrent Controlled Trials ISRCTN72841333

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

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.

Safety and Efficacy of a Premixed, Rice‐Based Oral Rehydration Solution

ABSTRACTThe authors compared the safety and efficacy of a ready‐to‐use, premixed, rice‐based oral rehydration solution (R‐ORS) with a glucose‐based oral rehydration solution (G‐ORS), each containing 75 mmol/L sodium, in Mexican children with acute diarrhea for less than 5 days.MethodsOne hundred eighty‐nine boys 3 to 24 months old admitted to the hospital with acute diarrhea and signs of dehydration were randomly assigned to receive either G‐ORS or R‐ORS. Intake and output were measured every 3 hours.ResultsIn the group treated with R‐ORS, significantly fewer patients required supplemental intravenous fluids during the rehydration phase compared to the G‐ORS group (1%v 8.7%; P &lt; 0.01). Mean stool output, percent weight gain, ORS intake, urine output, and number of patients who vomited during rehydration were similar in the two groups. The mean total stool output after the first 24 hours of maintenance phase was significantly lower in the R‐ORS group than in the G‐ORS group.ConclusionsThe authors found rice‐based ORS to be safe, and its use reduced the rate of intravenous fluid therapy in comparison with the use of a glucose‐based ORS.

A Randomized Double‐Blind Clinical Trial of a Maltodextrin‐Containing Oral Rehydration Solution in Acute Infantile Diarrhea

SummaryA double‐blind, randomized controlled study was used to compare the efficacy and safety of an oral rehydration solution either with minimally hydrolyzed maltodextrins or the standard recommended glucose. One hundred twenty pediatric patients with acute watery diarrhea (60 in each group) were studied, but only 116 patients were included in the final analysis. After rehydration, outcome variables did not differ significantly at p &lt; 0.05. Mean duration of diarrhea was 52.5 ± 32.2 h for the control group (median, 50.8 h) and 57.2 ± hours for the study group (median, 45.3 hours). Comparisons of the mean stool output, weight gain, and ORS intake on the 24th h and from admission to discharge were not statistically significant. Differences in laboratory parameters consisting of mean serum sodium, potassium, total C02, hematocrit, plasma total solids, urine specific gravity, and random blood sugar were likewise not significant. Differences in stool pH and reducing sugars were statistically significant; however, the observed values were still within normal range. All laboratory values improved upon rehydration. Replacement of glucose with maltodextrins did not offer added advantages in reducing the duration and severity of diarrhea.

A Randomized Double-Blind Clinical Trial of a Maltodextrin-Containing Oral Rehydration Solution in Acute Infantile Diarrhea

A double-blind, randomized controlled study was used to compare the efficacy and safety of an oral rehydration solution either with minimally hydrolyzed maltodextrins or the standard recommended glucose. One hundred twenty pediatric patients with acute watery diarrhea (60 in each group) were studied, but only 116 patients were included in the final analysis. After rehydration, outcome variables did not differ significantly at p < 0.05. Mean duration of diarrhea was 52.5 +/- 32.2 h for the control group (median, 50.8 h) and 57.2 +/- hours for the study group (median, 45.3 hours). Comparisons of the mean stool output, weight gain, and ORS intake on the 24th h and from admission to discharge were not statistically significant. Differences in laboratory parameters consisting of mean serum sodium, potassium, total CO2, hematocrit, plasma total solids, urine specific gravity, and random blood sugar were likewise not significant. Differences in stool pH and reducing sugars were statistically significant; however, the observed values were still within normal range. All laboratory values improved upon rehydration. Replacement of glucose with maltodextrins did not offer added advantages in reducing the duration and severity of diarrhea.

Alanine-Based Oral Rehydration Solution

This randomized, double-blind trial determined whether adding 90 mmol/L of alanine with a reduction in glucose to 90 mmol/L (alanine ORS) improves the efficacy of the standard oral rehydration solution (WHO-ORS). One hundred twenty-nine males aged 3-48 months with weight for length greater than or equal to 70% of NCHS, diarrheal duration less than or equal to 96 h, and clinical signs of mild to moderate dehydration were randomly allocated to either treatment group. During 0-6 h of treatment, ORS was offered at 120 ml/kg for rehydration without food or water. Beyond 6 h, ORS was offered as a volume-to-volume replacement for stool losses and a mixed diet of uniform composition was offered in amounts standardized for body weight. The most frequently isolated pathogens in alanine ORS and WHO-ORS groups were rotavirus (42 and 48%, respectively) and enterotoxigenic Escherichia coli (15 and 12%, respectively). In the 0-6 h period when food was withheld, median urine output in ml/kg (8;5, p less than 0.05) and percentage decrease in total serum solids (9:7%, p = 0.06) was significantly greater in alanine ORS than in WHO-ORS; median ORS intake and stool output were marginally lower in the alanine group but the differences were statistically not significant. Between 0 h and recovery, although the median values for duration of diarrhea (56.5 and 65.0 h), ORS consumption (260 and 323 ml/kg), and stool output (188.4 and 216.3 g/kg) were lower in the alanine ORS group, these differences with the WHO-ORS group were not statistically significant.(ABSTRACT TRUNCATED AT 250 WORDS)

Alanine‐Based Oral Rehydration Solution

SummaryThis randomized, double‐blind trial determined whether adding 90 mmol/L of alanine with a reduction in glucose to 90 mmol/L (alanine ORS) improves the efficacy of the standard oral rehydration solution (WHO‐ORS). One hundred twenty‐nine males aged 3–48 months with weight for length ≥70% of NCHS, diarrheal duration ≤96 h, and clinical signs of mild to moderate dehydration were randomly allocated to either treatment group. During 0–6 h of treatment, ORS was offered at 120 ml/kg for rehydration without food or water. Beyond 6 h, ORS was offered as a volume‐to‐volume replacement for stool losses and a mixed diet of uniform composition was offered in amounts standardized for body weight. The most frequently isolated pathogens in alanine ORS and WHO‐ORS groups were rotavirus (42 and 48%, respectively) and enterotoxigenic Escherichia coli (15 and 12%, respectively). In the 0–6 h period when food was withheld, median urine output in ml/kg (8;5, p &lt; 0.05) and percentage decrease in total serum solids (9:7%, p = 0.06) was significantly greater in alanine ORS than in WHO‐ORS; median ORS intake and stool output were marginally lower in the alanine group but the differences were statistically not significant. Between 0 h and recovery, although the median values for duration of diarrhea (56.5 and 65.0 h), ORS consumption (260 and 323 ml/kg), and stool output (188.4 and 216.3 g/kg) were lower in the alanine ORS group, these differences with the WHO‐ORS group were not statistically significant. Our findings are consistent with improved efficacy of WHO‐ORS following alanine fortification but the clinical benefits achieved in these mildly dehydrated cases fall short of what may be clinically meaningful and of relevance to public health