Oral rehydration salt solution for treating cholera: ≤ 270 mOsm/L solutions vs ≥ 310 mOsm/L solutions


Oral rehydration solution (ORS) is used to treat the dehydration caused by diarrhoeal diseases, including cholera. ORS formulations with an osmolarity (a measure of solute concentration) of ≤ 270 mOsm/L (ORS ≤ 270) are safe and more effective than ORS formulations with an osmolarity of ≥ 310 mOsm/L (ORS ≥ 310) for treating non-cholera diarrhoea. As cholera causes rapid electrolyte loss, it is important to know if these benefits are similar for people suffering from cholera.

To compare the safety and efficacy of ORS ≤ 270 with ORS≥ 310 for treating dehydration due to cholera.

Search methods
We searched the Cochrane Infectious Disease Group Specialized Register (April 2011), CENTRAL (The Cochrane Library Issue 4, 2011), MEDLINE (1966 to April 2011), EMBASE (1974 to April 2011), and LILACS (1982 to April 2011). We also contacted organizations and searched reference lists.

Selection criteria
Randomized controlled trials comparing ORS ≤ 270 with ORS ≥ 310 for treating adults and children with acute diarrhoea due to cholera.

Data collection and analysis
Two reviewers independently applied eligibility criteria, assessed trial quality, and extracted data. We pooled dichotomous data using risk ratio (RR), pooled continuous data using mean difference (MD) or the standardized mean difference (SMD), and presented the results with 95% confidence intervals (CI).

Main results
For glucose-based ORS, seven trials (718 participants) met the inclusion criteria. Biochemical hyponatraemia (blood sodium levels

Two trials also examined rice-based ORS. In the ORS ≤ 270 group, duration of diarrhoea was shorter (MD -11.42 hours, CI -13.80 to -9.04; 102 participants, two trials).

Authors’ conclusions
In people with cholera, ORS ≤ 270 is associated with biochemical hyponatraemia when compared with ORS ≥ 310, but there are no differences in terms of other outcomes. Although this risk does not appear to be associated with any serious consequences, the total patient experience in existing trials is small. Under wider practice conditions, especially where patient monitoring is difficult, caution is warranted.

Plain language summary
Oral rehydration salt solutions for treating cholera: lower salt content versus higher salt content solutions

Cholera is caused by pathogenic bacteria ingested with contaminated food or water and is commonly found where sanitation measures are poor. It causes severe diarrhoea and vomiting, which can lead to profound dehydration and potentially death. Oral rehydration solution (ORS) is an effective treatment for diarrhoea, and ORS with a salt concentration of ≤ 270 mOsm/L, which has a lower electrolyte content than the earlier ORS ≥ 310 mOsm/L, is safe and more effective in people with non-cholera diarrhoea. This review found that ORS ≤ 270 mOsm/L appears to be as effective as ORS ≥ 310 mOsm/L at rehydrating people with cholera, but may lead to low blood salt levels. More research is needed to better understand these potential safety issues.


Musekiwa, A.; Volmink, J. Oral rehydration salt solution for treating cholera: ≤ 270 mOsm/L solutions vs ≥ 310 mOsm/L solutions. Cochrane Database of Systematic Reviews (2011) : Art. No.: CD003754. [DOI: 10.1002/14651858.CD003754.pub3]

Oral rehydration salt solution for treating cholera: ≤ 270 mOsm/L solutions vs ≥ 310 mOsm/L solutions

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