{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T18:29:40Z","timestamp":1780424980198,"version":"3.54.1"},"update-to":[{"DOI":"10.12688\/wellcomeopenres.12357.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2017,10,27]],"date-time":"2017-10-27T00:00:00Z","timestamp":1509062400000}},{"DOI":"10.12688\/wellcomeopenres.12357.2","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2017,10,27]],"date-time":"2017-10-27T00:00:00Z","timestamp":1509062400000}}],"reference-count":24,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2017,10,27]],"date-time":"2017-10-27T00:00:00Z","timestamp":1509062400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Wellcome Trust","award":["105603"],"award-info":[{"award-number":["105603"]}]},{"name":"Wellcome Trust","award":["203077"],"award-info":[{"award-number":["203077"]}]}],"content-domain":{"domain":["wellcomeopenresearch.org"],"crossmark-restriction":false},"short-container-title":["Wellcome Open Res"],"abstract":"<ns4:p><ns4:bold>Background<\/ns4:bold>: Diarrhoea complicates over half of admissions to hospital with severe acute malnutrition (SAM). World Health Organization (WHO) guidelines for the management of dehydration recommend the use of oral rehydration with ReSoMal (an oral rehydration solution (ORS) for SAM), which has lower sodium (45mmols\/l) and higher potassium (40mmols\/l) content than old WHO ORS. The composition of ReSoMal was designed specifically to address theoretical risks of sodium overload and potential under-treatment of severe hypokalaemia with rehydration using standard ORS. In African children, severe hyponatraemia at admission is a major risk factor for poor outcome in children with SAM complicated by diarrhoea. We therefore reviewed the evidence for oral rehydration therapy in children with SAM.<\/ns4:p><ns4:p> <ns4:bold>Methods<\/ns4:bold>: We conducted a systematic review of randomised controlled trials (RCTs) on 18<ns4:sup>th<\/ns4:sup> July 2017 comparing different oral rehydration solutions in severely malnourished children with diarrhoea and dehydration, using standard search terms. The author assessed papers for inclusion. The primary endpoint was frequency of hyponatraemia during rehydration.<\/ns4:p><ns4:p> <ns4:bold>Results<\/ns4:bold>: Six RCTs were identified, all published in English and conducted in low resource settings in Asia. A range of ORS were evaluated in these studies, including old WHO ORS, standard hypo-osmolar WHO ORS and ReSoMal. Hyponatraemia was observed in two trials evaluating ReSoMal, three children developed severe hyponatraemia with one experiencing convulsions. Hypo-osmolar ORS was found to have benefits in time to rehydration, reduction of stool output and duration of diarrhoea. No trials reported over-hydration or fatalities.<\/ns4:p><ns4:p> <ns4:bold>Conclusions<\/ns4:bold>: Current WHO guidelines strongly recommend the use of ReSoMal based on low quality of evidence. Studies indicate a significant risk of hyponatraemia on ReSoMal in Asian children, none have been conducted in Africa, where SAM mortality remains high. Further research should be conducted in Africa to evaluate optimal ORS for children with SAM and to generate evidence based, practical guidelines<\/ns4:p>","DOI":"10.12688\/wellcomeopenres.12357.3","type":"journal-article","created":{"date-parts":[[2017,10,27]],"date-time":"2017-10-27T14:05:05Z","timestamp":1509113105000},"page":"66","update-policy":"https:\/\/doi.org\/10.12688\/wellcomeopenres.crossmark-policy","source":"Crossref","is-referenced-by-count":18,"title":["Oral rehydration of malnourished children with diarrhoea and dehydration: A systematic review"],"prefix":"10.12688","volume":"2","author":[{"given":"Kirsty A.","family":"Houston","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jack G.","family":"Gibb","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0007-0645","authenticated-orcid":false,"given":"Kathryn","family":"Maitland","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2560","published-online":{"date-parts":[[2017,10,27]]},"reference":[{"key":"ref-1","doi-asserted-by":"publisher","first-page":"e38321","DOI":"10.1371\/journal.pone.0038321","article-title":"Diarrhoea complicating severe acute malnutrition in Kenyan children: a prospective descriptive study of risk factors and outcome.","volume":"7","author":"A Talbert","year":"2012","journal-title":"PLoS One."},{"key":"ref-2","doi-asserted-by":"publisher","first-page":"1919-1922","DOI":"10.1016\/S0140-6736(98)07499-6","article-title":"Mortality in severely malnourished children with diarrhoea and use of a standardised management protocol.","volume":"353","author":"T Ahmed","year":"1999","journal-title":"Lancet."},{"key":"ref-3","doi-asserted-by":"publisher","first-page":"229-235","DOI":"10.3329\/jhpn.v29i3.7870","article-title":"Risk factors of mortality in severely-malnourished children hospitalized with diarrhoea.","volume":"29","author":"S Roy","year":"2011","journal-title":"J Health Popul Nutr."},{"key":"ref-4","doi-asserted-by":"publisher","first-page":"110","DOI":"10.1186\/1475-2891-10-110","article-title":"Diarrhea is a major killer of children with severe acute malnutrition admitted to inpatient set-up in Lusaka, Zambia.","volume":"10","author":"A Irena","year":"2011","journal-title":"Nutr J."},{"key":"ref-5","first-page":"51","article-title":"Guidelines for the inpatient treatment of severely malnourished children.","author":"A Ashworth","year":"2003"},{"key":"ref-6","article-title":"Guideline: Updates on the management of severe acute malnutrition in infants and children.","year":"2013"},{"key":"ref-7","doi-asserted-by":"publisher","first-page":"e500","DOI":"10.1371\/journal.pmed.0030500","article-title":"Children with severe malnutrition: can those at highest risk of death be identified with the WHO protocol?","volume":"3","author":"K Maitland","year":"2006","journal-title":"PLoS Med."},{"key":"ref-8","first-page":"in press","article-title":"Intravenous rehydration of malnourished children with acute gastroenteritis and severe dehydration: a systematic review.","author":"K Houston","year":"2017","journal-title":"F1000."},{"key":"ref-9","doi-asserted-by":"publisher","first-page":"166-171","DOI":"10.1136\/archdischild-2015-309188","article-title":"The effects of malnutrition on cardiac function in African children.","volume":"101","author":"J Silverman","year":"2016","journal-title":"Arch Dis Child."},{"key":"ref-10","article-title":"Cardiovascular physiology in children with acute severe malnutrition in Kenya.","author":"B Brent","year":"2015"},{"key":"ref-11","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1186\/s13054-017-1679-0","article-title":"Myocardial and haemodynamic responses to two fluid regimens in African children with severe malnutrition and hypovolaemic shock (AFRIM study).","volume":"21","author":"N Obonyo","year":"2017","journal-title":"Crit Care."},{"key":"ref-12","article-title":"Pocket book of hospital care for children 2nd edition. 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A repeated measures study.","volume":"10","author":"M Mwangome","year":"2011","journal-title":"Nutr J."}],"container-title":["Wellcome Open Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/wellcomeopenresearch.org\/articles\/2-66\/v3\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/wellcomeopenresearch.org\/articles\/2-66\/v3\/pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/wellcomeopenresearch.org\/articles\/2-66\/v3\/iparadigms","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,5,18]],"date-time":"2020-05-18T11:52:42Z","timestamp":1589802762000},"score":1,"resource":{"primary":{"URL":"https:\/\/wellcomeopenresearch.org\/articles\/2-66\/v3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,10,27]]},"references-count":24,"URL":"https:\/\/doi.org\/10.12688\/wellcomeopenres.12357.3","relation":{},"ISSN":["2398-502X"],"issn-type":[{"value":"2398-502X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,10,27]]},"assertion":[{"value":"Indexed","URL":"https:\/\/wellcomeopenresearch.org\/articles\/2-66\/v3#article-reports","order":0,"name":"referee-status","label":"Referee status","group":{"name":"current-referee-status","label":"Current Referee Status"}},{"value":"10.21956\/wellcomeopenres.13842.r26515, Andr\u00e9 Briend, Department of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg, Denmark, 20 Oct 2017, version 2, indexed","URL":"https:\/\/wellcomeopenresearch.org\/articles\/2-66\/v2#referee-response-26515","order":0,"name":"referee-response-26515","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Kathryn Maitland<\/b>; \n<i>Posted: 23 Oct 2017<\/i>; Thank you Professor Briend. We have made the suggested changes and have submitted the revised version (3).","URL":"https:\/\/wellcomeopenresearch.org\/articles\/2-66\/v3#referee-comment-3134","order":1,"name":"referee-comment-3134","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.21956\/wellcomeopenres.13380.r25181, Maren Johanne Heilskov Rytter, Department of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg, Denmark, 04 Sep 2017, version 1, 1 approved, 1 approved with reservations","URL":"https:\/\/wellcomeopenresearch.org\/articles\/2-66\/v1#referee-response-25181","order":2,"name":"referee-response-25181","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Kathryn Maitland<\/b>; \n<i>Posted: 26 Sep 2017<\/i>; Please see our joint response","URL":"https:\/\/wellcomeopenresearch.org\/articles\/2-66\/v3#referee-comment-3057","order":3,"name":"referee-comment-3057","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"This work was supported by the Wellcome Trust [105603], an ISSF fellowship (Year 4 & 5 on 1st Oct 14 - 30 Sept 16, (2014 \u20132018)) awarded by Imperial College, London, to Dr K Houston; [203077], the KEMRI Wellcome Trust Programme East African Overseas Programme Award. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.","order":4,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}