Article type
Abstract
Background:
Oral rehydration solution (ORS) is the primary treatment for diarrhea. The traditional glucose-based ORS, with an osmolarity of 311 mmol/L, was standard until the early 2000s. Due to concerns about sodium levels and hypernatremia cases, a low-osmolarity ORS solution (LORS) with an osmolarity of 245 or less was introduced. We conducted a systematic review of randomized controlled trials (RCTs) to evaluate LORS effectiveness versus standard ORS for acute and persistent diarrhea.
Methods:
We searched PubMed, CINAHL, Wiley Cochrane Library, ClinicalTrials.gov, WHO-ICTRP, and Scopus until July 20, 2023. Studies were included if published after 1990 and focused on LORS in acute and persistent diarrhea in children younger than age 10. Meta-analysis was done using Review Manager version 5.4.1. Log approximation, ROB 2 for bias assessment, and the GRADE approach for evidence quality was applied. The World Health Organization (WHO) commissioned this review for guideline revision.
Results:
For the comparison of LORS with standard ORS in acute diarrhea, the review suggested a comparable effect of LORS on the number of patients cured within 5 days (risk ratio [RR] = 0.95; 95% CI = 0.61-1.49; low-certainty evidence), treatment failure (RR = 0.13; 95% CI = 0.02-1.00; low-certainty evidence), and frequency of unscheduled intravenous therapy (RR = 0.77; 95% CI = 0.72-9.38; very low-certainty evidence). However, a significant reduction was observed in the duration of diarrhea (mean difference [MD] = -0.28 hours; 95% CI = -0.41 to -0.15; low-certainty evidence), stool output (MD = -0.25 g/kg; 95% CI = -0.35 to -0.16; low-certainty evidence), and ORS intake (MD = -0.18 mL/kg; 95% CI = -0.28 to -0.07; moderate-certainty evidence) in the LORS group. In persistent diarrhea, the effect was comparable for the number of patients cured (RR = 1.08; 95% CI = 0.91-1.28; low-certainty evidence) whereas the duration of diarrhea (MD = -30.60 hours; 95% CI = -48.95 to -12.25; low-certainty evidence), stool output (MD = -14.00 g/kg; 95% CI = -26.63 to -1.37; low-certainty evidence), and ORS intake (MD = -21.40 mL/kg; 95% CI = -41.01 to -1.79; low-certainty evidence) were all significantly reduced with LORS.
Conclusion:
LORS should remain recommended for children younger than age 10 with acute watery or persistent diarrhea, supporting current World Health Organization guidelines.
Oral rehydration solution (ORS) is the primary treatment for diarrhea. The traditional glucose-based ORS, with an osmolarity of 311 mmol/L, was standard until the early 2000s. Due to concerns about sodium levels and hypernatremia cases, a low-osmolarity ORS solution (LORS) with an osmolarity of 245 or less was introduced. We conducted a systematic review of randomized controlled trials (RCTs) to evaluate LORS effectiveness versus standard ORS for acute and persistent diarrhea.
Methods:
We searched PubMed, CINAHL, Wiley Cochrane Library, ClinicalTrials.gov, WHO-ICTRP, and Scopus until July 20, 2023. Studies were included if published after 1990 and focused on LORS in acute and persistent diarrhea in children younger than age 10. Meta-analysis was done using Review Manager version 5.4.1. Log approximation, ROB 2 for bias assessment, and the GRADE approach for evidence quality was applied. The World Health Organization (WHO) commissioned this review for guideline revision.
Results:
For the comparison of LORS with standard ORS in acute diarrhea, the review suggested a comparable effect of LORS on the number of patients cured within 5 days (risk ratio [RR] = 0.95; 95% CI = 0.61-1.49; low-certainty evidence), treatment failure (RR = 0.13; 95% CI = 0.02-1.00; low-certainty evidence), and frequency of unscheduled intravenous therapy (RR = 0.77; 95% CI = 0.72-9.38; very low-certainty evidence). However, a significant reduction was observed in the duration of diarrhea (mean difference [MD] = -0.28 hours; 95% CI = -0.41 to -0.15; low-certainty evidence), stool output (MD = -0.25 g/kg; 95% CI = -0.35 to -0.16; low-certainty evidence), and ORS intake (MD = -0.18 mL/kg; 95% CI = -0.28 to -0.07; moderate-certainty evidence) in the LORS group. In persistent diarrhea, the effect was comparable for the number of patients cured (RR = 1.08; 95% CI = 0.91-1.28; low-certainty evidence) whereas the duration of diarrhea (MD = -30.60 hours; 95% CI = -48.95 to -12.25; low-certainty evidence), stool output (MD = -14.00 g/kg; 95% CI = -26.63 to -1.37; low-certainty evidence), and ORS intake (MD = -21.40 mL/kg; 95% CI = -41.01 to -1.79; low-certainty evidence) were all significantly reduced with LORS.
Conclusion:
LORS should remain recommended for children younger than age 10 with acute watery or persistent diarrhea, supporting current World Health Organization guidelines.