BMJ 2001;323:81-85 ( 14 July )

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Reduced osmolarity oral rehydration solution for treating dehydration due to diarrhoea in children: systematic review

Editorial by Fuchs

Seokyung Hahn, research fellow, ^a YaeJean Kim, paediatrician, ^b Paul Garner, professor. ^c

^a Medical and Pharmaceutical Statistics Research Unit, University of Reading, Reading RG6 6FN, ^b Department of Paediatrics, Seoul National University Children's Hospital, Seoul 110-774, South Korea, ^c Effective Health Care Alliance Programme, International Health Division, Liverpool School of Tropical Medicine, Liverpool L3 5QA

Correspondence to: S Hahn, Department of Health Sciences and Clinical Evaluation, University of York, York YO10 5DD s.hahn{at}rdg.ac.uk

Objectives: To compare reduced osmolarity oral rehydration solution with standard World Health Organization oral rehydration solution in children with acute diarrhoea.
Design: Systematic review of randomised controlled trials.
Studies: 15 randomised controlled trials including 2397 randomised patients.
Outcomes: The primary outcome was unscheduled intravenous infusion; secondary outcomes were stool output, vomiting, and hyponatraemia.
Results: In a meta-analysis of nine trials for the primary outcome, reduced osmolarity rehydration solution was associated with fewer unscheduled intravenous infusions compared with standard WHO rehydration solution (odds ratio 0.61, 95% confidence interval 0.47 to 0.81). Three trials reported that no patients required unscheduled intravenous infusion. Trials reporting secondary outcomes suggested that in the reduced osmolarity rehydration solution group, stool output was lower (standardised mean difference in the log scale 0.214 (95% confidence interval 0.305 to 0.123; 13 trials) and vomiting was less frequent (odds ratio 0.71, 0.55 to 0.92; six trials). Six trials sought presence of hyponatraemia, with events in three studies, but no significant difference between the two arms.
Conclusion: In children admitted to hospital with dehydration associated with diarrhoea, reduced osmolarity rehydration solution is associated with reduced need for unscheduled intravenous infusions, lower stool volume, and less vomiting compared with standard WHO rehydration solution.

What is already known on this topic Oral rehydration solution prevents death from diarrhoea in many developing countries What this study adds Children receiving a reduced osmolarity rehydration solution were less likely to need intravenous infusion than those receiving WHO rehydration solution Reduced osmolarity rehydration solution also reduced stool output and vomiting No difference was found in rates of hyponatraemia

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