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Reduced osmolarity oral rehydration solution for treating dehydration caused by acute diarrhoea in children

  1. Seokyung Hahn1,*,
  2. Yaejean Kim2,
  3. Paul Garner3

Editorial Group: Cochrane Infectious Diseases Group

Published Online: 21 JAN 2002

Assessed as up-to-date: 27 NOV 2001

DOI: 10.1002/14651858.CD002847

How to Cite

Hahn S, Kim Y, Garner P. Reduced osmolarity oral rehydration solution for treating dehydration caused by acute diarrhoea in children. Cochrane Database of Systematic Reviews 2002, Issue 1. Art. No.: CD002847. DOI: 10.1002/14651858.CD002847.

Author Information

  1. 1

    Seoul National University Hospital, Medical Research Collaborating Center, Seoul, Korea, South

  2. 2

    Fred Hutchinson Cancer Research Centre, Department of Infectious Diseases, Seattle, USA

  3. 3

    Liverpool School of Tropical Medicine, International Health Group, Liverpool, Merseyside, UK

*Seokyung Hahn, Medical Research Collaborating Center, Seoul National University Hospital, 2nd Floor, 28 Yongon-dong Chongno-gu, Seoul, 110-744, Korea, South. hahns@snu.ac.kr.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 21 JAN 2002

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Oral rehydration solution (ORS) has reduced childhood deaths from diarrhoea in many countries. Recent studies suggest that the currently recommended formulation of ORS recommended by the World Health Organization (WHO) may not be optimal, and solutions that contain lower concentrations of sodium and glucose may be more effective.

Objectives

To compare reduced osmolarity ORS with WHO standard ORS in children with acute diarrhoea.

Search methods

CENTRAL (The Cochrane Library, Issue 3, 2004), MEDLINE (1966 to July 2004), EMBASE (1988 to July 2004), and Current Contents (July 2004) were searched. Additional trials were identified by hand searching. Content experts were contacted.

Selection criteria

Randomized controlled trials comparing reduced osmolarity ORS with the WHO standard ORS formulation. The primary outcome was unscheduled intravenous fluid infusion. Secondary outcomes were measures of clinical illness.

Data collection and analysis

Two reviewers extracted data. We tested for heterogeneity using the Chi-square statistic, conducted sensitivity analysis by allocation concealment, and the regression approach to assess funnel plot asymmetry from selective trial publication.

Main results

The primary outcome, unscheduled intravenous fluid infusion, was reported in 11 trials. In a meta-analysis of 8 trials, reduced osmolarity ORS was associated with fewer unscheduled intravenous fluid infusions compared with WHO standard ORS (Mantel Haenzel odds ratio 0.59, 95% confidence interval 0.45 to 0.79) with no evidence for heterogeneity between trials. No unscheduled intravenous fluid infusion therapy was required in any participant in three trials.

Eleven trials reported stool output, and data suggested less stool output in the reduced osmolarity ORS group. Vomiting was less frequent in the reduced osmolarity group in the six trials reporting this. Six trials sought hyponatraemia, with events in three studies, but no obvious difference between the two arms.

Authors' conclusions

In children admitted to hospital with diarrhoea, reduced osmolarity ORS when compared to WHO standard ORS is associated with fewer unscheduled intravenous fluid infusions, lower stool volume post randomization, and less vomiting. No additional risk of developing hyponatraemia when compared with WHO standard ORS was detected.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Reduced osmolarity oral rehydration solution for treating dehydration caused by acute diarrhoea in children

Children with diarrhoea lose body water and sometimes become dehydrated. A solution of sugar and salt dissolved in water is widely used to treat dehydration caused by diarrhoea. This reviews shows that a solution of lower osmolarity than the current international standard means fewer children subsequently require an intravenous drip.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

減少口服電解質溶液的滲透壓來治療兒童因急性腹瀉造成的脫水

在許多國家口服電解質溶液(ORS) 減少了兒童因腹瀉的死亡率。最近研究建議,當前由世界衛生組織(WHO) 所推薦的ORS配方不是理想的,而含量是低鈉和低葡萄糖的溶液也許是更加有效的。

目標

比較低滲透壓的ORS與世界衛生組織標準的ORS 用於治療兒童急性腹瀉。

搜尋策略

搜尋了CENTRAL (The Cochrane Library, Issue3, 2004), MEDLINE (1966 to July 2004), EMBASE(1988 to July 2004), and Current Contents (July 2004) 。額外的試驗是用徒手搜尋。與書刊目錄專家聯繫。

選擇標準

隨機化控制試驗用較低滲透壓ORS 與世界衛生組織標準ORS配方比較。初步結果是非預期的靜脈內水份給予。次要結果是臨床疾病程度。

資料收集與分析

二個評論者擷取了資料。我們對於異質性測試使用卡方測定統計、隨機分派進行靈敏度分析和選擇性研究刊物回歸方法評估漏斗散佈圖不對稱性。

主要結論

在11 次試驗中報告了初步結果,非預期的靜脈內給予水份。在8 項統合分析的試驗,較少滲透壓的ORS與世界衛生組織標準ORS作比較有較少量非預期的靜脈內注射 (Mantel Haenzel 勝算比0.59,95% 信賴區為0.45 到0.79) 沒有證據顯示在這些試驗之間有差異性。在三次試驗中任一受試者皆不需要非預期的靜脈內注射。11項試驗報告了大便排出,而且資料建議了在較少滲透壓的ORS 組別有較少大便排出。在六項試驗報告中嘔吐在較少滲透壓組別中是較少的。六項試驗中搜尋低血鈉,在三項研究中有低血鈉發生,但在二者之間沒有明顯的區別。

作者結論

對於兒童因腹瀉而住院,較少滲透壓的ORS與當前世界衛生組織標準ORS比較有較少量非預期的靜脈內注射,在隨機化後較低的大便排出,和較少的嘔吐。在與世界衛生組織標準ORS比較未發現增加變成低血鈉的風險。

翻譯人

本摘要由三軍總醫院詹舜名翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

腹瀉孩童失去身體水份有時變成脫水。溶解糖和鹽在水中的配方廣泛被應用來治療腹瀉造成的脫水。這項回顧顯示較低滲透壓溶液與當前的國際標準ORS比較,較少孩童後續需要靜脈內點滴。