Alanine-based oral rehydration solution: Assessment of efficacy in acute noncholera diarrhea among children

S. Sazawal, S. Bhatnagar, M. K. Bhan, S. K. Saxena, N. K. Arora, S. K. Aggarwal, D. K. Kashyap

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


This randomized, double-blind trial determined whether adding 90 mmol/L of alanine with a reduction in glucose to 90 mmol/L (alanine ORS) improves the efficacy of the standard oral rehydration solution (WHO-ORS). One hundred twenty-nine males aged 3, 48 months with weight for length 3=70% of NCHS, diarrheal duration =£96 h, and clinical signs of mild to moderate dehydration were randomly allocated to either treatment group. During 0-6 h of treatment, ORS was offered at 120 ml/kg for rehydration without food or water. Beyond 6 h, ORS was offered as a volume-to-volume replacement for stool losses and a mixed diet of uniform composition was offered in amounts standardized for body weight. The most frequently isolated pathogens in alanine ORS and WHO-ORS groups were rotavirus (42 and 48%, respectively) and enterotoxigenic Escherichia coli (15 and 12%, respectively). In the 0-6 h period when food was withheld, me-dian urine output in ml/kg (8;5, p < 0.05) and percentage decrease in total serum solids (9:7%, p = 0.06) was sig-nificantly greater in alanine ORS than in WHO-ORS; median ORS intake and stool output were marginally lower in the alanine group but the differences were statistically not significant. Between 0 h and recovery, although the median values for duration of diarrhea (56.5 and 65.0 h), ORS consumption (260 and 323 ml/kg), and stool output (188.4 and 216.3 g/kg) were lower in the alanine ORS group, these differences with the WHO-ORS group were not statistically significant. Our findings are consistent with improved efficacy of WHO-ORS following alanine fortification but the clinical benefits achieved in these mildly dehydrated cases fall short of what may be clinically meaningful and of relevance to public health.

Original languageEnglish (US)
Pages (from-to)461-468
Number of pages8
JournalJournal of pediatric gastroenterology and nutrition
Issue number4
StatePublished - May 1991
Externally publishedYes


  • Alanine
  • Children
  • Diarrhea
  • Oral rehydration solution

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Gastroenterology


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