Menu ENN Search

NGOnut discussion summaries - ORS v Resomal, Lactose intolerance, and split peas

O.R.S OR RESOMAL

Question

Does anyone have any data documenting the superiority of a reduced sodium, higher potassium ORS over the standard WHO ORS? The few studies which we have found seemed to indicate no great excess risk with standard ORS.

Edited from responses to this question.

The reason for advocating a low sodium high potassium ORS in severe malnutrition is to prevent heart failure. The risk of sodium overload is particularly marked with kwashiorkor cases where research shows that heart failure can be induced with relatively low sodium intakes. Such levels may be easily reached by rehydrating a severely malnourished child with standard WHO ORS. The issue may not be so critical in marasmic children. This is the reason why a new ORS formulation (RESOMAL) was developed. Although the idea for this formulation began circulating amongst NGOs in 1993, it has still not been officially endorsed by WHO and will not be until the long-awaited WHO manual on Treatment of Malnutrition' is published.

Although RESOMAL formula is new, it is based on principles which have been known for years. Previous versions of the WHO manual on diarrhoea management in severe malnutrition, recommend giving water between ORS feeds (this is like diluting ORS). In a way, RESOMAL just reproduces in a glass the mixing which used to happen previously in the stomach of the child and adds a potassium supplement. The attraction of RESOMAL is that it is much easier to handle, hence its great success in emergency situations. Other advantages of RESOMAL are that it has additional sugar and Magnesium, Zinc and Copper. RESOMAL should only be used in hospital and its introduction should not imply that it is any better than standard ORS for well nourished children. There is absolutely no risk of inducing heart failure in moderately malnourished children with standard ORS at whatever dose, and community programmes should continue to use standard ORS A respondent from Latin America pointed out that higher potassium ORS is not available in that part of the world. He agreed that in theory, modified ORS (RESOMAL) should be better for severely malnourished dehydrated patients. However concern was expressed, about advocating that the standard WHO ORS not be used with malnourished patients. This, he pointed out, may have dangerous outcomes as in many countries acceptance of the standard WHO ORS by health workers and the population at large has taken many years and much efforts. Care should be taken he says, not to undermine these efforts. Modified ORS must become readily available before recommending that it substitute standard WHO ORS. He suggests that a useful approach is recommending low sodium , high potassium ORS when it is available otherwise continue using standard WHO ORS. This respondent's personal experience and that of several of his colleagues is that excellent clinical results rehydrating malnourished children with the standard WHO ORS have Been achieved.


LACTOSE INTOLERANCE

Question

My understanding is that a low-lactose feed is recommended for young babies and children hospitalised with severe diarrhoea who may or may not be malnourished. But is this best achieved by giving them, i) lactose-free milk, ii) yoghurt made from ordinary milk, iii) F75/FlOO or iv) something else?

Edited from responses to this question

  1. Babies and children with diarrhoea should be breastfed.
  2. There is some risk of secondary lactose intolerance in babies with severe diarrhoea, especially if they are not breastfed and also malnourished. However, there is no need to put any infant with diarrhoea on low-lactose feeds unless they exhibit distinct signs of lactose intolerance. These signs are explosive and watery diarrhoea, acid 'bums' bottom and distended abdomen but absence of fever.
  3. In the specific case of young non-breasted infants with severe diarrhoea and signs of lactose intolerance, there are 3 options;
    1. diluted lactose containing milk (or infant formula) feeds;
    2. yoghurt and/or other foods fermented with Lactobacilli;
    3. lactose-free milk.
  4. When questions of cost, logistics and safety are taken into account, expert opinion is divided as to which of these three options is most appropriate in emergency situations.

A further respondent emphasised that diluted lactose containing milks should be given only under close observation as the symptoms of full-blown secondary lactase deficiency tend to persist unless lactose intake is drastically reduced in which case intake of any lactose containing food will is unsuitable. For this condition soya formula is a good alternative. The respondent points out that full blown pictures are uncommon and many infants with apparent lactase deficiency after a few days of diluted feeds are back to full lactose containing feeds.


SPLIT PEAS

Dear NGO Nut

A Danish company recently visited us in UNHCR to brief us about pre-cooked yellow spur peas. I wanted to share this potentially positive development in the food production sector with interested purchasers/distributors of food.

The idea of a pre-cooked yellow split pea was developed by the company in response to their learning about the frequent scarcity of fuel for cooking that often occurs in relief operations. This is a particular problems when pulses (such as those from temperate zones) take over an hour to cook.

Pre-cooked yellow split peas were therefore developed. These peas have been dehulled and split after which they were treated with steam. This has reduced the cooking time to 20-30 minutes. Moreover they do not have the typical green pea flavour but taste rather neutral, resembling lentils, which are acceptable in a wide range of countries. WFP has carried out field tests in 26 countries with positive results. UNHCR has also carried out some field tests in Tanzania and Ethiopia where the peas were evaluated as tasteful, with an average cooking time of 30 minutes. Soaking is not required which therefore allows greater retention of micro-nutrients. The price is 340 USD/MT and is about 1% more expensive than the untreated variant. Introduction of the product needs to be accompanied with an information campaign to inform users about the shorter cooking time and the fact that soaking is not required.

Arnold Timmer
UNHCR, Geneva

More like this

en-net: Use of half strength infant formula instead of F75 Formula

Hi All I am currently working as a Dietitian Advisor to the Samoan NHS. A current practice in the Paediatric ward for infants ranging from about 6 months to 2 years,...

en-net: Treatment of diarrhea in SAM and MAM

What is the most up-to-date recommendations on treating diarrhea with ORS/zinc in children with moderate acute malnutrition who are entering a supplementary feeding program...

en-net: Lactose Intolerance

What are the messages on IYCF regarding the feeding guidance for Lactose intolerance baby? How should they select and prepare food from natural sources?

Dear...

en-net: What to do when ReSoMal and CMV not available?

We are having shortages and cannot find in-country sources for some our needed products. The shortage is expected to last until next year. In particular, I need to know how I...

FEX: Carbohydrate malabsorption in acutely malnourished children and infants: A systematic review

Summary of research* Location: Global What we know: Diarrhoea is commonly associated with SAM; carbohydrate malabsorption may be a contributing factor. What this article...

FEX: Postscript to: 'A pragmatic approach to managing severe malnutrition: Is F75 always beneficial?'

Michael Golden,Yvonne Grellety It is quite wrong to consider the advantage of F75 as "theoretical". However, a decreased mortality will not be seen if other aspects of faulty...

en-net: Abdominal enlargement for SAM patients treated in ITC

Hi! we recently gathered In patient Therapeutic Care Centers in our Region who had been established for a year or more. They had case presentations and sharing of...

en-net: inpatient SAM management

hi..
in Jordan, the CMAM program is integrated into primary healthcare...thus, only children with urgent complications are referred for secondary healthcare...

FEX: Postscript on local capacity building for treatment of severe malnutrition

Ann Ashworth Hill, Professor of Community Nutrition Public Health Nutrition Unit, London School Hygiene and Tropical Medicine International NGOs usually provide better...

en-net: Treatment of dirrhea with OSR in internal center (Hospital)

I would like to know if there is any contraindications regarding the use of OSR in children and adolescents suffering from SAM. If its use can adversely affect drug absorption...

en-net: Zinc supplementation for diarrhea treatment

Hi all, as extensive Research shows that Rehydratation and Diarrhea Treatment through ORS plus Zinc is very efficient and WHO does recommend the same, compared to using just...

en-net: Diarrhoea in children taking F-100 and F-100

Whats the best other feeding option for severely malnourished children with diarrhoea, especially if the fomular (F-100 and F-75) seems to aggravate the diarrhoea We have been...

en-net: Lactose Intolerance

What the treatment for SAM child suffering lactose intolerance? And SAM child suffering both lactose intolerance and celiac disease ? Hello, Just a small precision: it is...

FEX: Therapeutic challenges and treatment of hypovolaemic shock in severe malnutrition

Summary of proceedings1 A severely malnourished child attending the Kilifi programme A recent article by Maitland on therapeutic challenges in the treatment of severe...

en-net: Traitement de cas grave de Kwashiorkor

Dear all,

Colleagues of mine had the following case this morning:

Three years old neglected girl. Kwashiorkor case: Bilateral oedema hands and feet, gut oedema,...

en-net: ReSoMaL (Rehydration Solution for Malnutrition) for children under 6 months with severe acute malnutrition

Dear all, is ReSoMal forbidden for children under 6 months suffering from severe acute malnutrition with severe dehydration? If yes , what is your experience about...

FEX: Debate on the Management of Severe Malnutrition : A Response

By Professor Ann Ashworth, London School of Hygiene and Tropical Medicine Background Many individuals and organisations, including NGOs, have contributed to the improved...

en-net: Prepartion of ReSoMal when there is no CMV

This is a question regarding infants and children management of dehydration in SAM. I am trying to figure out how to treat a child with SAM and diarrhea who is admitted to...

en-net: severely malnourished case unable to tolerate plumpu nut

A 1.5 years old severely manourished girl with Cerebral Palsy is unable to tolerate plumpy nut because of chewing and swallowing difficulties. Before she was admitted to the...

FEX: Letter on local v imported therapeutic milk, by Rebecca Norton and Jean-Pierre Papart (with responses by Mike Golden, Ann Ashworth, Mary Lung'aho and David Sanders)

Recently, ENN was party to an exchange of questions and discussion between field staff and 'experts' relating to decisions on the use of readymade therapeutic products versus...

Close

Reference this page

Arnold Timmer (1998). NGOnut discussion summaries - ORS v Resomal, Lactose intolerance, and split peas. Field Exchange 3, January 1998. p25. www.ennonline.net/fex/3/ngonut

(ENN_3312)

Close

Download to a citation manager

The below files can be imported into your preferred reference management tool, most tools will allow you to manually import the RIS file. Endnote may required a specific filter file to be used.