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Efficacy and safety of a modified oral rehydration solution (ReSoMaL) in the treatment of severely malnourished children with watery diarrhea

2003; Elsevier BV; Volume: 143; Issue: 5 Linguagem: Inglês

10.1067/s0022-3476(03)00500-6

1097-6833

Nazmul Alam, Jena Hamadani, Nahrina Dewan, George J. Fuchs,

Child Nutrition and Water Access

Objectives Efficacy, development of overhydration, and correction of electrolyte disturbances of severely malnourished children with acute diarrhea using a modified oral rehydration solution for malnourished children (termed ReSoMaL and recommended by the World Health Organization [WHO]) were evaluated and compared with standard WHO-oral rehydration solution (ORS). Study design Children age 6 to 36 months with severe malnutrition and acute watery diarrhea were randomized to ReSoMaL (n = 65) or standard WHO-ORS (n = 65). Major outcome measures included the number of children who developed overhydration and the number who corrected hypokalemia. Results The numbers of children who developed overhydration were not significantly different (ReSoMaL vs WHO-ORS, 5% vs 12%, P = .2). ReSoMaL corrected basal hypokalemia in a greater proportion of children by 24 hours (36% vs 5%, P = .0006) and 48 hours (46% vs 16%, P = .004) compared with WHO-ORS. More children on ReSoMaL than WHO-ORS remained hyponatremic at 48 hours (29% vs 10%, P = .017). Three children in the ReSoMaL group developed severe hyponatremia by 24 hours, with one experiencing hyponatremic convulsions (serum sodium, 108 mmol/L). Conclusions ReSoMaL has a large beneficial effect on potassium status compared with standard ORS. However, ReSoMaL therapy may result in symptomatic hyponatremia and seizures in patients with severe diarrhea.