COMPARATIVE EFFICACY OF RICE-BASED AND GLUCOSE-BASED ORAL REHYDRATIONSALTS PLUS EARLY REINTRODUCTION OF FOOD

The use of oral rehydration salts (ORS) to restore fluid balance in ch ildren with diarrhoea is universally accepted. However, there is uncer tainty about whether glucose-based ORS or ORS based on precooked rice powder is more effective. In a randomised trial we compared the two ty pes of ORS in children who were given food immediately after completio n of rehydration. 460 boys aged 3-18 months, admitted to hospital with acute diarrhoea and signs of dehydration, were randomly assigned to g roups receiving rice-based and glucose-based ORS solution (230 to each group). After full rehydration (4-12 h), a weaning food consisting of rice and mixed vegetables was given until the diarrhoea stopped. Cont inuing losses of liquid stool and vomitus were replaced with the assig ned ORS solution. There were no differences between the groups during the rehydration phase in stool volume, volume of ORS solution taken, d uration of rehydration phase, or weight gain. However, after initiatio n of feeding, the glucose-based ORS group had significantly lower stoo l volumes than the rice-based ORS group (142 [95% CI 117-173] vs 96 [7 7-120] g/kg); they also took a smaller amount of ORS solution (153 [12 7-185] vs 111 [90-136] mL/kg) and had a shorter duration of diarrhoea (55 [SD 35] vs 44 [35] h). Glucose-based ORS solution was more effecti ve than rice-based ORS solution for the treatment of diarrhoea in chil dren when feeding with a rice-based diet was started soon after correc tion of dehydration. These results support the continued recommendatio n of glucose-based ORS solution as standard therapy for treatment of c hildren with acute diarrhoea and emphasise the importance of resuming feeding as soon as dehydration has been corrected.