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Efficacy of standard glucose-based and reduced-osmolarity maltodextrin-based oral rehydration solutions: effect of sugar malabsorption.
Bull World Health Organ. 1996; 74(5):471-7.BW

Abstract

Previously we reported that standard oral rehydration salts (ORS) solution is not as effective as a reduced-osmolarity glucose-based ORS for the treatment of children with acute noncholera diarrhoea: with standard ORS the diarrhoea lasts longer, stool output is greater, serum sodium is higher, and there is more need for supplemental intravenous infusion. We studied a reduced-osmolarity maltodextrin (MD)-based ORS to determine whether it had similar benefits, and also the effect of sugar malabsorption on the efficacy of standard and MD-based ORS. A total of 90 boys aged 3-24 months with acute noncholera diarrhoea and moderate dehydration were randomly assigned to either standard ORS (glucose 20 g/l, osmolarity 311 mmol/l) or MD-ORS (MD 50 g/l, osmolarity 227 mmol/l). There were no differences in treatment results. Some 46% of subjects had a high total stool output (> 300 g/kg), which was unrelated to the type of ORS given. High stool output was significantly associated with a longer duration of diarrhoea (33 vs. 15 hours; P < 0.001), a persistently elevated serum sodium (149 vs. 144 mmol/l at 24 h; P < 0.02), the need for intravenous infusion (11/41 vs. 0/48; P < 0.002), and an increase in faecal reducing substances (10.8 vs. 3.4 g/l at 24 h; P < 0.001). We conclude that some children given standard ORS develop osmotic diarrhoea owing to the combined effect of transient sugar malabsorption and slight hypertonicity of the ORS. Earlier studies show that this adverse outcome can largely be avoided when extra water is given in reduced-osmolarity glucose-based ORS. Reduced osmolarity has no benefit, however, when glucose is replaced by maltodextrin, probably because the sugars released by hydrolysis of MD, when malabsorbed, raise the intraluminal osmolarity to equal or exceed that of standard ORS. Thus, reduced-osmolarity glucose-based ORS is superior to both standard ORS and reduced-osmolarity solutions based on maltodextrin and probably other complex carbohydrates. Studies are in progress to define the optimal formulation of reduced-osmolarity glucose-based ORS.

Authors+Show Affiliations

Department of Paediatrics, Bab El-Sha'reya Hospital, Alazhar Faculty of Medicine, Cairo, Egypt.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

9002327

Citation

el-Mougi, M, et al. "Efficacy of Standard Glucose-based and Reduced-osmolarity Maltodextrin-based Oral Rehydration Solutions: Effect of Sugar Malabsorption." Bulletin of the World Health Organization, vol. 74, no. 5, 1996, pp. 471-7.
el-Mougi M, Hendawi A, Koura H, et al. Efficacy of standard glucose-based and reduced-osmolarity maltodextrin-based oral rehydration solutions: effect of sugar malabsorption. Bull World Health Organ. 1996;74(5):471-7.
el-Mougi, M., Hendawi, A., Koura, H., Hegazi, E., Fontaine, O., & Pierce, N. F. (1996). Efficacy of standard glucose-based and reduced-osmolarity maltodextrin-based oral rehydration solutions: effect of sugar malabsorption. Bulletin of the World Health Organization, 74(5), 471-7.
el-Mougi M, et al. Efficacy of Standard Glucose-based and Reduced-osmolarity Maltodextrin-based Oral Rehydration Solutions: Effect of Sugar Malabsorption. Bull World Health Organ. 1996;74(5):471-7. PubMed PMID: 9002327.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Efficacy of standard glucose-based and reduced-osmolarity maltodextrin-based oral rehydration solutions: effect of sugar malabsorption. AU - el-Mougi,M, AU - Hendawi,A, AU - Koura,H, AU - Hegazi,E, AU - Fontaine,O, AU - Pierce,N F, PY - 1996/1/1/pubmed PY - 1996/1/1/medline PY - 1996/1/1/entrez KW - Africa KW - Age Factors KW - Arab Countries KW - Biology KW - Carbohydrate Metabolic Effects KW - Carbohydrates KW - Child KW - Comparative Studies KW - Demographic Factors KW - Developing Countries KW - Diarrhea KW - Diarrhea, Infantile--prevention and control KW - Diseases KW - Egypt KW - Electrolyte Balance KW - Glucose Metabolism Effects KW - Homeostasis KW - Ingredients And Chemicals KW - Mediterranean Countries KW - Metabolic Effects KW - Northern Africa KW - Oral Rehydration KW - Physiology KW - Population KW - Population Characteristics KW - Research Methodology KW - Research Report KW - Studies KW - Treatment KW - Youth SP - 471 EP - 7 JF - Bulletin of the World Health Organization JO - Bull. World Health Organ. VL - 74 IS - 5 N2 - Previously we reported that standard oral rehydration salts (ORS) solution is not as effective as a reduced-osmolarity glucose-based ORS for the treatment of children with acute noncholera diarrhoea: with standard ORS the diarrhoea lasts longer, stool output is greater, serum sodium is higher, and there is more need for supplemental intravenous infusion. We studied a reduced-osmolarity maltodextrin (MD)-based ORS to determine whether it had similar benefits, and also the effect of sugar malabsorption on the efficacy of standard and MD-based ORS. A total of 90 boys aged 3-24 months with acute noncholera diarrhoea and moderate dehydration were randomly assigned to either standard ORS (glucose 20 g/l, osmolarity 311 mmol/l) or MD-ORS (MD 50 g/l, osmolarity 227 mmol/l). There were no differences in treatment results. Some 46% of subjects had a high total stool output (> 300 g/kg), which was unrelated to the type of ORS given. High stool output was significantly associated with a longer duration of diarrhoea (33 vs. 15 hours; P < 0.001), a persistently elevated serum sodium (149 vs. 144 mmol/l at 24 h; P < 0.02), the need for intravenous infusion (11/41 vs. 0/48; P < 0.002), and an increase in faecal reducing substances (10.8 vs. 3.4 g/l at 24 h; P < 0.001). We conclude that some children given standard ORS develop osmotic diarrhoea owing to the combined effect of transient sugar malabsorption and slight hypertonicity of the ORS. Earlier studies show that this adverse outcome can largely be avoided when extra water is given in reduced-osmolarity glucose-based ORS. Reduced osmolarity has no benefit, however, when glucose is replaced by maltodextrin, probably because the sugars released by hydrolysis of MD, when malabsorbed, raise the intraluminal osmolarity to equal or exceed that of standard ORS. Thus, reduced-osmolarity glucose-based ORS is superior to both standard ORS and reduced-osmolarity solutions based on maltodextrin and probably other complex carbohydrates. Studies are in progress to define the optimal formulation of reduced-osmolarity glucose-based ORS. SN - 0042-9686 UR - https://www.unboundmedicine.com/medline/citation/9002327/Efficacy_of_standard_glucose_based_and_reduced_osmolarity_maltodextrin_based_oral_rehydration_solutions:_effect_of_sugar_malabsorption_ L2 - https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/9002327/ DB - PRIME DP - Unbound Medicine ER -