Rice-based Oral Rehydration Solution Research Articles

Zinc-fortified oral rehydration solution improved intestinal permeability and small intestinal mucosal recovery.

A randomized double-blind placebo-controlled study was conducted in children admitted to hospital with gastroenteritis (≥3 loose stools per day). All were treated for 5 days following admission with either zinc (Zn, 3 mg) or without Zn-fortified rice-based oral rehydration solution (ORS). (13)C-sucrose breath test (SBT) and intestinal permeability (lactulose/rhamnose or L/R ratio) were performed concurrently prior to commencement of ORS with or without Zn and at day 5 post-admission. There was a significant improvement in the SBT results in both the Zn-fortified group, median (5th-95th percentile) 2.1% (0.4% to 8.3%) versus 4.4% (0.4% to 10.4%), P < .05, and control group, 1.4% (0.1% to 5.4%) versus 4.3% (0.4% to 11.4%), P < .05, between the day of admission and day 5 post-admission. In the Zn-fortified group, there was also a significant improvement in L/R ratio between the day of admission and day 5 post-admission, 53.0 (19.5-90.6) versus 17.7 (13.4-83.2), P < .05. Low levels of Zn improved intestinal permeability but did not enhance short-term recovery following diarrheal illness.

Rice-Based Electrolyte Drinks More Effective Than Water in Replacing Sweat Losses During Hot Weather Training and Operations

Heat-related injury presents significant threats to the health and operational effectiveness of Soldiers and military operations. In 2012, active component, U.S. Armed Forces experienced 365 incident cases of heat stroke and 2,257 incident cases of ?other heat injury.? Most of these occurred among recruit and enlisted personnel and most were under the age of 30. In conditioned military personnel, a rice-based oral rehydration solution was superior to water alone at maintaining body weight and, by inference, enabled Soldiers to better maintain their the state of hydration during prolonged exercise in high ambient temperatures. In view of the health risks associated with dehydration and their effects on training and operations, this study suggests that the consumption of beverages containing electrolytes and a rice-based carbohydrate is superior to the consumption of water alone in preventing dehydration and heat related illness.

Oral rehydration salt solution for treating cholera: ≤ 270 mOsm/L solutions vs ≥ 310 mOsm/L solutions.

Oral rehydration solution (ORS) is used to treat the dehydration caused by diarrhoeal diseases, including cholera. ORS formulations with an osmolarity (a measure of solute concentration) of ≤ 270 mOsm/L (ORS ≤ 270) are safe and more effective than ORS formulations with an osmolarity of ≥ 310 mOsm/L (ORS ≥ 310) for treating non-cholera diarrhoea. As cholera causes rapid electrolyte loss, it is important to know if these benefits are similar for people suffering from cholera. To compare the safety and efficacy of ORS ≤270 with ORS ≥ 310 for treating dehydration due to cholera. We searched the Cochrane Infectious Disease Group Specialized Register (April 2011), CENTRAL (The Cochrane Library Issue 4, 2011), MEDLINE (1966 to April 2011), EMBASE (1974 to April 2011), and LILACS (1982 to April 2011). We also contacted organizations and searched reference lists. Randomized controlled trials comparing ORS ≤ 270 with ORS ≥ 310 for treating adults and children with acute diarrhoea due to cholera. Two reviewers independently applied eligibility criteria, assessed trial quality, and extracted data. We pooled dichotomous data using risk ratio (RR), pooled continuous data using mean difference (MD) or the standardized mean difference (SMD), and presented the results with 95% confidence intervals (CI). For glucose-based ORS, seven trials (718 participants) met the inclusion criteria. Biochemical hyponatraemia (blood sodium levels < 130 mmol/L) was more common with ORS ≤ 270 (RR 1.67, CI 1.09 to 2.57; 465 participants, four trials), while a higher level of severe biochemical hyponatraemia (blood sodium levels < 125 mmol/L) in the same group was not significant (RR 1.58, CI 0.62 to 4.04; 465 participants, four trials). No instances of symptomatic hyponatraemia or death were noted in the trials that intended to record them. We found no statistically significant difference in the need for unscheduled intravenous infusion. Analyses separating children and adults showed no obvious trends.Two trials also examined rice-based ORS. In the ORS ≤ 270 group, duration of diarrhoea was shorter (MD -11.42 hours, CI -13.80 to -9.04; 102 participants, two trials). In people with cholera, ORS ≤ 270 is associated with biochemical hyponatraemia when compared with ORS ≥ 310, but there are no differences in terms of other outcomes. Although this risk does not appear to be associated with any serious consequences, the total patient experience in existing trials is small. Under wider practice conditions, especially where patient monitoring is difficult, caution is warranted.

Cochrane review: Polymer‐based oral rehydration solution for treating acute watery diarrhoea

AbstractBackgroundAcute diarrhoea is one of the principal causes of morbidity and mortality among children in low‐income countries. Glucose‐based ORS helps replace fluid and prevent further dehydration from acute diarrhoea. Since 2004, the World Health Organization has recommended the osmolarity &lt; 270 mOsm/L (ORS ≤ 270 ) over the &gt; 310 mOsm/L formulation (ORS ≥ 310). Glucose polymer‐based ORS (eg prepared using rice or wheat) slowly releases glucose and may be superior.ObjectivesTo compare polymer‐based ORS with glucose‐based ORS for treating acute watery diarrhoea.Search strategyIn September 2008, we searched the Cochrane Infectious Diseases Group Specialized Register, CENTRAL (The Cochrane Library2008, Issue 3), MEDLINE, EMBASE, LILACS, andmRCT. We also contacted researchers, organizations, and pharmaceutical companies, and searched reference lists.Selection criteriaRandomized controlled trials of people with acute watery diarrhoea (cholera and non‐cholera associated) comparing polymer‐based and glucose‐based ORS (with identical electrolyte contents).Data collection and analysisTwo authors independently assessed the search results and risk of bias, and extracted data. In multiple treatment arms with two or more treatment groups, we combined outcomes as appropriate and compared collectively with the control group.Main resultsThirty‐four trials involving 4214 participants met the inclusion criteria: 27 in children, five in adults and two in both. Twelve trials used adequate methods to conceal allocation. Most compared polymer‐based ORS with ORS ≥ 310. There were fewer unscheduled intravenous infusions in the polymer‐based ORS group compared with glucose‐based ORS (ORS ≥ 310 and ≤ 270 groups combined) (RR 0.75, 95% CI 0.59 to 0.95; 2235 participants, 19 trials). Adults positive forVibrio choleraehad a shorter duration of diarrhoea with polymer‐based ORS than with ORS ≤ 270 (MD ‐7.11 hours, SD ‐11.91 to ‐2.32; 228 participants, 4 trials). Wheat‐based ORS resulted in lower total stool output in the first 24 hours compared with ORS ≤ 270 (MD ‐119.85 g/kg, SD ‐114.73 to ‐124.97; 129 participants, 2 trials). Adverse effects were similar for polymer‐based ORS and glucose‐based ORS.Authors' conclusionsPolymer‐based ORS shows some advantages compared to ORS ≥ 310 for treating all‐cause diarrhoea, and in diarrhoea caused by cholera. Comparisons favoured the polymer‐based ORS over ORS ≤ 270, but the analysis was underpowered. If specialists consider a potential role for polymer‐based ORS, further trials against the current standard (ORS ≤ 270) will be required.Plain Language SummaryPolymer‐based oral rehydration solution (ORS) ORS for acute diarrhoeaAcute diarrhoea is a common cause of death and illness in developing countries. Oral rehydration solutions (ORS) have had a massive impact worldwide in reducing the number of deaths related to diarrhoea.Most ORS is in the form of a sugar–salt solution, but over the years people have tried adding a variety of compounds ('glucose polymers') such as whole rice, wheat, sorghum, and maize. The aim is to slowly release glucose into the gut and improve the absorption of the water and salt in the solution. This review updates and expands on a 1998 Cochrane Review of rice‐based ORS, and assesses the available evidence on the use of polymer‐based ORS (both rice and non‐rice based) in comparison with the glucose‐based ORS.The original ORS was based on glucose and had an osmolarity of ≥ 310 mOsm/L (ORS ≥ 310). Glucose‐based ORS with a lower osmolarity was later introduced in attempts to improve efficacy, and is considered better at reducing the amount and duration of diarrhoea.Thirty‐four trials involving 4214 participants met the inclusion criteria: 27 in children; five in adults; and two in both. Most trials compared polymer‐based ORS with a sugar–salt ORS with a particular strength (ORS ≥ 310), which is slightly more salty than the currently agreed best formula (≤ 270 mOsm/L). The trials' methodological quality was variable.Fewer people in the polymer‐based ORS group needed a drip to be rehydrated compared with those in the glucose‐based ORS group. Adverse events were similar for polymer‐based ORS and glucose‐based ORS.The authors conclude that polymer‐based ORS show some advantages compared to glucose‐based ORS for treating diarrhoea of any cause and in diarrhoea caused by cholera. Limited evidence favoured the polymer‐based ORS over ORS ≤ 270. Further trials should compare the efficiency of ORS ≤ 270 with a polymer‐based ORS.

Treatment of cholera-like diarrhoea with oral rehydration

Cholera diarrhoea remains a major global health problem that has caused seven pandemics. The pathogenesis of cholera is attributable to the production of cholera toxin by the causative pathogen, Vibrio cholerae. The toxin causes increased production of cyclic adenosine monophosphate and this results in massive water and electrolyte secretion into the intestinal lumen. These changes manifest clinically as the painless defecation of voluminous stools that resemble 'rice water', leading to severe dehydration. The cornerstone in the management of cholera diarrhoea is the use of oral rehydration solutions (ORS) to replace the water and electrolytes lost as stools. The World Health Organization recommends the use of ORS of 'reduced osmolarity' for the treatment of acute non-cholera diarrhoea and the use of rice-based ORS for the management of cholera diarrhoea. Although several attempts have been made to improve ORS, studies to evaluate some of the modifications, which include the addition of amylase-resistant starch, the use of amino acids (such as glycine, alanine and glutamine) as sodium cotransporters, and zinc-supplemented ORS, are still needed.

Efficacy of reduced osmolarity oral rehydration solution, rice ... based oral rehydration solution, and standard WHO oral rehydration solution in children with acute diarrhea - a randomized open trial

Background The composition of the WHO's standard oral rehydration solution (ORS) is similar to that of choleric stool. Currently, there are questions about whether the composition is acceptable for treating dehydration caused by diarrhea. Efforts are being made to try and improve the WHO ORS, e.g., to decrease the solution osmolarity to avoid hypertonic side effects.lt is acknowledged that if glucose is used in ORS, the sodium will go through enterocytes and glucose will tum into an absolute substance for the formula. Glucose is less affordable and not widely produced in developing countries, hence researchers are currently exploring substitutes such as rice flour.Objective To compare the efficacy of reduced osmolarity ORS,rice-based ORS and the WHO standard ORS among childrenwith acute diarrhea.Methods A randomized open trial was conducted in children aged6-59 months old admitted for acute diarrhea. One-way AN OVAwas used to compare the three different types of ORS given.Results The mean duration of diarrhea was significantly lower inthe group treated with reduced osmolarity ORS (52.66 h, 95%CI 4 7.13 to 58.18) and rice-based ORS (54.66 h, 95% CI 4 7.97to 61.34) compared to the group treated with the WHO standardORS (67.34 h, 95% CI 61.50 to 73.18). Multivariate analysisshows that intervention had a significant effect on reducing theduration of diarrhea.Conclusions Reduced osmolarity ORS and rice-based ORSsignificantly lower the mean duration of children with acutediarrhea compared with the group treated with the WHO standardORS.

Oral Rehydration Solutions in Non-Cholera Diarrhea: A Review

The use of oral rehydration solution (ORS) has revolutionized the management of acute diarrhea. The implementation of the standard World Health Organization ORS (WHO-ORS) has resulted in decreased mortality associated with acute diarrheal illnesses in children, although in general stool volume and diarrhea durations are not reduced. Decreased morbidity and mortality have occurred because of improved hydration status. Decreased morbidity has also been described in adults who used this therapy. Various modifications to the standard ORS have been derived. These modifications have included hypo-osmolar or hyperosmolar solutions, use of rice-based ORS, zinc supplementation, and the use of amino acids, including glycine, alanine, and glutamine. Some of these variations have been successful, some have not, and others are still under investigation. ORS has been used for travelers' diarrhea and to decrease intravenous (IV) fluid requirements in patients with short bowel syndrome (SBS) who require parenteral nutrition (PN). This paper reviews the standard WHO-ORS and its mechanism of action, followed by more contemporary reduced osmolarity ORS and rice-based ORS in non-cholera diarrhea. Various modifications to improve ORS are also discussed.

Rice inhibits intestinal secretions.

Rice-based oral rehydration solutions have been found to be effective in decreasing stool output and improving intestinal absorption in acute infectious diarrhea. Recent tests of the ability of a rice extract to inhibit intestinal secretions were undertaken, and it was shown that an isolated fraction of rice extract decreased intestinal losses by actively inhibiting the chloride channel.

Tolerance of a rice-based oral rehydration solution given to normal calves.

The objective of the study was to test the tolerance of a rice-based oral rehydration formula when fed to calves. Six healthy Holstein calves, 1 week of age, were fed the formula instead of milk replacer for 3 days. Pre- and posttreatment results of clinical examination and laboratory parameters were compared. Vital signs, attitude, appetite, clinical hydration status, urine specific gravity, and most routine serum biochemistry test results did not vary and remained within the normal range. Five of the 6 calves developed diarrhea when fed the rice-based formula, which was accompanied by a reduction in fecal pH and presence of reducing sugars in the feces. This effect was reversed when calves were returned to the milk replacer diet at the end of the study. Diarrhea was accompanied by increased water consumption, which allowed the calves to maintain normal hydration status. These results suggest that calves are unable to properly digest the rice-derived carbohydrate, and this type of formula is not recommended for oral rehydration of calves.

Efficacy of Rice‐based Oral Rehydration Solution Containing Recombinant Human Lactoferrin and Lysozyme in Peruvian Children With Acute Diarrhea

To compare glucose and rice-based oral rehydration solution with rice-based oral rehydration solution containing recombinant human lactoferrin and recombinant human lysozyme in diarrhea outcomes. We conducted a randomized, double-blind controlled trial in children with acute diarrhea and dehydration. One hundred and forty children 5 to 33 months old were block randomized to receive low osmolarity WHO-ORS (G-ORS), rice-based ORS (R-ORS), or rice-based ORS plus lactoferrin and lysozyme (Lf/Lz-R-ORS). Intake and output were monitored for 48 h in the ORU, with continued monitoring through home and clinic follow-up for 14 d. The G-ORS and R-ORS groups did not show any differences in diarrhea outcomes and were therefore combined as the control group. Intent-to-treat analysis showed a significant decrease in duration of diarrhea (3.67 d vs 5.21 d, P = 0.05) in the Lf/Lz-R-ORS group as compared with the control group and a significant increase in the number of children who achieved 48 h with solid stool, 85% vs 69% (P < 0.05). There were no significant differences [corrected] in volume of diarrhea or [corrected] the percentage of children who had a new diarrhea episode after achieving the endpoint. Addition of recombinant human lactoferrin and lysozyme to a rice-based oral rehydration solution had beneficial effects on children with acute diarrhea.

Antidiarrheal Effects ofl‐Histidine–Supplemented Rice‐Based Oral Rehydration Solution in the Treatment of Male Adults with Severe Cholera in Bangladesh: A Double‐Blind, Randomized Trial

Because of the antisecretory potential of L-histidine in the intestinal tract, its antidiarrheal effects were determined in cholera. In a double-blind trial of 126 adult male patients with cholera, L-histidine (2.5 g/L) was mixed with a rice-based oral rehydration solution (ORS) and administered to 62 patients; 64 patients received the same ORS without L-histidine. All patients received ciprofloxacin at a dosage of 500 mg every 12 h for 72 h. Fluid output (of stool, urine, and vomit) and intake (of ORS, water, and intravenous fluid) were determined every 8 h for 72 h. Administration of ORS with L-histidine significantly (P<.05) reduced the frequency of stool output during 32-64 h after initiation of ORS treatment, compared with that in patients given ORS without L-histidine ([all data are means+/-SD] 32-48 h, 11.5+/-6.9 mL/kg vs. 18.8+/-16.0 mL/kg; 40-48 h, 6.7+/-4.4 mL/kg vs. 11.5+/-9.7 mL/kg; and 56-64 h, 6.3+/-5.8 mL/kg vs. 7.8+/-4.1 mL/kg). An overall reduction of 22% in the volume of stool was observed in patients given ORS without L-histidine. The amount of required unscheduled intravenous fluid was lower in patients given ORS with L-histidine, compared with that in patients given ORS without L-histidine (0-24 h, 82.5+/-44.4 mL/kg vs. 158.6+/-72.2 mL/kg [P<.01]; and 24-48 h, 41.6+/-40.4 mL/kg vs. 52.5+/-22.1 mL/kg [P>.05]). Administration of ORS with L-histidine also significantly reduced (P<.05) the intake of ORS and the duration of illness. No adverse effects were observed in these patients. L-histidine reduces the weight of stool and the frequency of stool output in cholera and could be a useful and safe adjunct treatment that will increase the success rate of ORS and antibiotic therapy in cholera.

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.

Evaluation of oral hypo‐osmolar glucose‐based and rice‐based oral rehydration solutions in the treatment of cholera in children

In a randomized controlled clinical trial, the efficacy of a low-sodium low-glucose oral rehydration solution (ORS) and a low-sodium rice-based ORS was compared with standard WHO glucose ORS in the treatment of severe cholera in children aged 2-10y. In total, 120 children were evaluated for the study, of whom 58 patients were positive for Vibrio cholerae and were included in the study. Of these 58 cases, 19 received rice-based hypo-osmolar ORS, 20 received WHO-ORS and 19 received glucose-based hypo-osmolar ORS. The clinical characteristics (age, preadmission duration of diarrhoea, frequency of stool before admission, incidence of vomiting, body weight and volume of initial fluid requirement) were comparable in the three treatment groups. All patients received tetracycline in a dose of 50 mg/kg/d of body weight in 4 divided doses for 3 d. Patients who received rice-based hypo-osmolar ORS had subsequently reduced (p < 0.05) stool output, ORS consumption and diarrhoea duration than the patients who received either WHO-ORS or glucose-based hypo-osmolar ORS.

Tolerance of a Rice-Based Oral Rehydration Solution Given to Normal Calves

The objective of the study was to test the tolerance of a rice-based oral rehydration formula when fed to calves. Six healthy Holstein calves, 1 week of age, were fed the formula instead of milk replacer for 3 days. Pre- and posttreatment results of clinical examination and laboratory parameters were compared. Vital signs, attitude, appetite, clinical hydration status, urine specific gravity, and most routine serum biochemistry test results did not vary and remained within the normal range. Five of the 6 calves developed diarrhea when fed the rice-based formula, which was accompanied by a reduction in fecal pH and presence of reducing sugars in the feces. This effect was reversed when calves were returned to the milk replacer diet at the end of the study. Diarrhea was accompanied by increased water consumption, which allowed the calves to maintain normal hydration status. These results suggest that calves are unable to properly digest the rice-derived carbohydrate, and this type of formula is not recommended for oral rehydration of calves.

Evaluation of oral hypo-osmolar glucose-based and rice-based oral rehydration solutions in the treatment of cholera in children

Evaluation of oral hypo-osmolar glucose-based and rice-based oral rehydration solutions in the treatment of cholera in children

Rice-based oral rehydration solution for treating diarrhoea.

Oral rehydration therapy is used to treat dehydration caused by diarrhoea. However the rehydration solution does not reduce stool loss or length of illness. A solution able to do this may lessen the use of ineffective diarrhoea treatments as well as improve morbidity and mortality related to diarrhoea. The objective of this review was to assess the effects of rice-based oral rehydration salts solution compared with glucose-based oral rehydration salts solution on reduction of stool output and duration of diarrhoea in patients with acute watery diarrhoea. We searched the Cochrane Infectious Diseases Group trials register, the Cochrane Controlled Trials Register, Medline, Embase, Lilacs and the reference lists of relevant articles. We also contacted researchers in the field. Randomized trials comparing standard World Health Organization oral rehydration solution with an experimental oral rehydration salts solution in which glucose (20 grams per litre) was replaced by 50-80 grams per litre of rice powder, with the electrolytes remaining unchanged. Data were extracted independently by a statistician and a clinician. Twenty-two trials were included. Concealment of allocation was adequate in 15 of these trials. Irrespective of age, people with cholera who were given rice oral rehydration salts solution had substantially lower rates of stool loss than those given oral rehydration salts solution in the first 24 hours. Mean stool outputs in the first 24 hours were lower by 67 millilitres/kg of body weight (weighted mean difference -67.4, 95% confidence interval -94.3 to -41.0) in children, and by 51 millilitres/kg of body weight (weighted mean difference -51.1, 95% confidence interval -65.9 to -36.3) in adults. The rate of stool loss in infants and children with acute non-cholera diarrhoea was reduced by only four millilitres/kg of body weight (weighted mean difference -4.3, 95% confidence interval -9.3 to 0.8). Rice-based oral rehydration appears to be effective in reducing stool output in people with cholera. This effect was not apparent in infants and children with non-cholera diarrhoea.

WITHDRAWN: Rice-based oral rehydration solution for treating diarrhoea.

Oral rehydration therapy is used to treat dehydration caused by diarrhoea. However the rehydration solution does not reduce stool loss or length of illness. A solution able to do this may lessen the use of ineffective diarrhoea treatments as well as improve morbidity and mortality related to diarrhoea. The objective of this review was to assess the effects of rice-based oral rehydration salts solution compared with glucose-based oral rehydration salts solution on reduction of stool output and duration of diarrhoea in patients with acute watery diarrhoea. We searched the Cochrane Infectious Diseases Group trials register, the Cochrane Controlled Trials Register, Medline, Embase, Lilacs and the reference lists of relevant articles. We also contacted researchers in the field. Randomized trials comparing standard World Health Organization oral rehydration solution with an experimental oral rehydration salts solution in which glucose (20 grams per litre) was replaced by 50-80 grams per litre of rice powder, with the electrolytes remaining unchanged. Data were extracted independently by a statistician and a clinician. Twenty-two trials were included. Concealment of allocation was adequate in 15 of these trials. Irrespective of age, people with cholera who were given rice oral rehydration salts solution had substantially lower rates of stool loss than those given oral rehydration salts solution in the first 24 hours. Mean stool outputs in the first 24 hours were lower by 67 millilitres/kg of body weight (weighted mean difference -67.40, 95% confidence interval -94.26 to -41.53) in children, and by 51 millilitres/kg of body weight (weighted mean difference -51.07, 95% confidence interval -65.87 to -36.27) in adults. The rate of stool loss in infants and children with acute non-cholera diarrhoea was reduced by only four millilitres/kg of body weight (weighted mean difference -4.29, 95% confidence interval -9.36 to 0.78). Rice-based oral rehydration appears to be effective in reducing stool output in people with cholera. This effect was not apparent in infants and children with non-cholera diarrhoea.

Studies of water and electrolyte movement for oral rehydration solutions (rice- and glucose-based) across a normal and secreting gut using a dual isotope tracer technique in a rat perfusion model.

To establish a model to measure bidirectional flow of water from a glucose oral rehydration to solution (G-ORS) and a newly developed rice-based oral rehydration solution (R-ORS) using a dual isotope tracer technique in a rat perfusion model. To measure net water, sodium and potassium absorption from the ORS. In vivo steady-state perfusion studies were carried out in normal and secreting (induced by cholera toxin) rat small intestine (n = 11 in each group). To determine bidirectional flow of water from the ORS the animals were initially with tritium, and deuterium was added to the perfusion solution. Sequential perfusate and blood samples were collected after attainment of steady-state conditions and analysed for water and electrolyte content. There was significant increase in net water absorption from the R-ORS compared to the G-ORS in both the normal (P < 0.02) and secreting intestine (P < 0.05). Water efflux was significantly reduced in the R-ORS group compared to the G-ORS group in both the normal (P < 0.01) and the secreting intestine (P < 0.01). There was an increase in sodium absorption in the R-ORS group compared to the G-ORS. The G-ORS produced a significantly greater blood glucose level at 75 min compared to the R-ORS (P < 0.03) in the secreting intestine. This study demonstrates the improved water absorption from a rice-based ORS in both the normal and secreting intestine. Evidence that the absorption of water may be influenced by the osmolality of the ORS was also demonstrated.

Amylase-Treated Rice Flour Oral Rehydration Solution with Enhanced Energy Density. I. in Vitro Studies of Viscosity, Osmolality, and Stability

Recent studies on the dietary management of dehydrated children with oral rehydration solution (ORS) showed that maximizing nutrient intake during treatment can curtail the nutritional deterioration of an episode of acute diarrhoea. The viscosity of a 10% or 15% (w/v) rice flour solution can be reduced to that of a drinkable solution by appropriate incubation and partial hydrolysis of rice starch with a commercial -amylase. Cooking the solution for 5 minutes at 90°C inactivates the enzyme. When 0.32 ml of -amylase enzyme was added, the viscosity of a 10% rice-based oral rehydration solution (RB-ORS) measured at 0.3 revolution per minute declined from 50,539 to 636 centipoise (cp), and when 0.96 ml of enzyme was added to a 15% RB-ORS, the viscosity declined from 170,258 to 1,283 cp. The osmolality of enzyme-treated RB-ORS without electrolytes was 5 mOsm; that of the electrolyte mixture alone was 160 mOsm; that of 10% RB-ORS with electrolytes was 225 mOsm; and that of 15% RB-ORS with electrolytes was 295 mOsm. The 10% and 15% rice flour solutions incubated with -amylase can be converted to easy-to-drink solutions that could potentially be used as ORS with greater nutritional value than current glucose-based solutions. Clinical trials are necessary to test the safety and efficacy of these enzyme-treated RB-ORS.

Cereal-based oral rehydration solutions in Sudanese children with diarrhoea: a comparative clinical trial of rice-based and sorghum-based oral rehydration solutions

A randomized controlled study was carried out at the Children's Emergency Hospital, Khartoum to evaluate the acceptability, safety and efficacy of (rice or sorghum) cereal-based oral rehydration solutions (ORS) relative to that of the standard WHO ORS formulation in children with acute diarrhoea. Ninety-six children whose ages ranged from 6 to 40 months were enrolled in the study. Thirty-two of them were allocated to the rice-based ORS group, 34 to the sorghum-based ORS group and 30 to the control group. Cereal-based ORS solutions were found to shorten the duration of diarrhoea and to reduce both the stool volume and the frequency of diarrhoea and vomiting as well as the mean total ORS intake. These effects were more marked with the sorghum-based ORS than with the rice-based ORS. By the end of day 3, 50% of patients in the rice ORS group and 67.6% in the sorghum ORS group had recovered compared with 40% from the standard ORS group.