Published online June 1, 2005
PEDIATRICS Vol. 115 No. 6 June 2005, pp. 1788 (doi:10.1542/peds.2005-0503)
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Oral Versus Intravenous Rehydration of Moderately Dehydrated Children

William B. Greenough, III, MD
Division of Geriatric Medicine and Gerontology
Johns Hopkins University
Baltimore, MD 21224

To the Editor.—

The February 2005 Pediatrics article "Oral Versus Intravenous Rehydration of Moderately Dehydrated Children: A Randomized, Controlled Trial" by Spandorfer et al1 is a superb demonstration of how a simple, low-cost oral rehydration therapy (ORT), which is currently estimated to save 2 to 3 million lives annually of children <4 years old in resource-poor settings, performs better than the more expensive and painful higher-risk intravenous fluid therapy usually used for children in the United States. Additionally, the experience by parents of using ORT empowers them to do it at home, which reduces future emergency-department costs and trauma to parents and their children.

Since the discovery of glucose-based oral rehydration solution (ORS) in the 1960s, there have been additional improvements in ORT. These improvements were foreshadowed in an editorial in The New England Journal of Medicine by Michael Field, who introduced the concept of lower-osmolar rice- and/or protein-based solutions with a quote from Michael Sendak: "Sipping once, Sipping twice, Sipping chicken soup with rice."2

Recently a review of all published controlled studies comparing rice-based ORS with glucose-based ORS concluded that rice-based ORS has advantages that are especially important in more severe cases.3 The duration of diarrhea is shortened and fluid loss is less when using these low-osmolar, high-substrate-containing ORS preparations.

I hope the excellent article by Spandorfer et al will change practice in the United States and that, as in developing countries, there will be additional studies with low-osmolar rice-based ORS. There is currently 1 such solution available (CeraLyte; Cera Products, Inc, Columbia, MD) with a composition appropriate for replacing diarrhea salt and water losses.

REFERENCES

  1. Spandorfer PR, Alessandrini EA, Joffe MD, Localio R, Shaw KN. Oral versus intravenous rehydration of moderately dehydrated children: a randomized, controlled trial. Pediatrics. 2005;115 :295 –301[Abstract/Free Full Text]
  2. Field M. New strategies for treating watery diarrhea. N Engl J Med. 1977;297 :1121 –1122[Medline]
  3. Fontaine O, Gore SM, Pierce NF. Rice-based oral rehydration solution for treating diarrhoea. Cochrane Database Syst Rev. 2000;(2):CD001264
PEDIATRICS (ISSN 1098-4275). ©2005 by the American Academy of Pediatrics

Related articles in Pediatrics:

Oral Versus Intravenous Rehydration of Moderately Dehydrated Children: In Reply
Philip R. Spandorfer, Evaline A. Alessandrini, Mark D. Joffe, Russell Localio, and Kathy N. Shaw
Pediatrics 2005 115: 1788. [Extract] [Full Text]  

Oral Versus Intravenous Rehydration of Moderately Dehydrated Children: In Reply
Philip R. Spandorfer, Evaline A. Alessandrini, Mark D. Joffe, Russell Localio, and Kathy N. Shaw
Pediatrics 2005 115: 1788-1789. [Extract] [Full Text]  




This Article
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