Comparison of glucose/electrolyte and glucose/glycine/electrolyte oral rehydration solutions in hospitalized children with diarrhea in Costa Rica

Abstract

The experience of Nalin et al. and Patra et al. with a "super oral rehydration solution (ORS)" containing glucose plus glycine to enhance the intestinal absorption of sodium and water prompted us to investigate a similar ORS containing the standard World Health Organization (WHO/ORS) plus either 55 or 110 mmol/L glycine in infants and small children with noncholera diarrhea. We did not find a statistically significant difference between the glycine-fortified ORS and the standard WHO/ORS with respect to the clinical outcome and composition of serum electrolytes.

PIP: Oral rehydration solutions containing the WHO recommended mixture alone, or with 111 mmol/L glycine or 55 mmol/L glycine were compared for treatment of 30 male children aged 1-24 months with clinical diarrheal dehydration in the emergency room of the National Children's Hospital, San Jose, Costa Rica. ORS volume was estimated by doubling the degree of dehydration judged clinically, offered by teaspoons over 4 hours. Children that could not tolerate oral solution were given ORS by nasogastric tube. Those with hypokalemia 3 mmol/L were given a solution containing 20 mmol/L K+ or iv fluid. The time to rehydration averaged 9.45 hours with the WHO solution, 10.2 hours with the low glycine ORS and 8.95 with the high glycine ORS (n.s.). Percent body weight gain did not differ significantly. The average stool weight and urine excretion were lower in the high glycine group, not significantly. 3 children developed mild hypernatremia, but normalized without additional treatment. Thus, glycine-fortified ORS made no significant difference in clinical outcome or serum electrolytes in this series.