Document resource
Assessing dehydration in severely malnourished children is a clinical challenge. The choice for oral fluid management is also a challenge as there are concerns that using a standard oral rehydration solution (ORS) may cause sodium and fluid overload when there is acute malnutrition, complicating a diarrhoeal and fluid loss illness. Many international guidelines, including those from the WHO, recommend use of low-sodium rehydration solution for acute malnutrition (such as ReSoMal). These solutions have a lower sodium concentration of 45 mmol/L and higher potassium of 40 mmol/L compared with standard WHO-ORS which contains a higher sodium concentration at 75 mmol/L and 20 mmol/L of potassium. Maitland K et al (T he Lancet Child & Adolescent Health 2026;10(5):319–329. https://doi.org/10.1016/S2352-4642(25)00371-2) have examined this advice and carried out a phase 2, open-label, superiority randomised controlled trial comparing the safety and superiority of standard WHO-ORS versus ReSoMal. In six hospitals, in four African countries (Kenya, Niger, Nigeria and Uganda), 415 eligible children were enrolled into the study (218 (53%) males; 197 (47%) females); 272 were enrolled into stratum A (137 to ReSoMal and 135 to WHO-ORS) and 143 were enrolled into stratum B (69 to ReSoMal and 74 to WHO-ORS). They were aged between 6 months and 12 years with a diagnosis of severe acute malnutrition who were admitted to hospital with severe (stratum A) or moderate (stratum B) dehydration and diarrhoea. Children with severe dehydration (stratum A) received their allocated ORS as soon as possible.