What is the efficacy of oral rehydration solutions, such as electrolyte packets versus Pedialyte (electrolyte-rich beverage), for electrolyte replenishment and hydration?

From the Guidelines

For mild to moderate dehydration, oral rehydration solutions such as electrolyte packets or Pedialyte are effective for electrolyte replenishment and hydration, with the choice between them depending on individual needs and preferences 1. When considering the efficacy of oral rehydration solutions, it's essential to prioritize the most recent and highest quality studies. The 2017 Infectious Diseases Society of America clinical practice guidelines for the diagnosis and management of infectious diarrhea recommend reduced oral rehydration solution (ORS) as the first-line therapy for mild to moderate dehydration in infants, children, and adults with acute diarrhea from any cause 1.

Key Considerations

• The guidelines suggest that ORS can be given to all age groups, with any cause of diarrhea, and is safe in the presence of hypernatremia as well as hyponatremia (except when edema is present) 1.
• Pedialyte is a commercially available formulation that can be used as an ORS, containing a scientifically balanced ratio of sodium, potassium, chloride, and zinc with appropriate sugar content to promote optimal fluid absorption through the sodium-glucose cotransport system.
• Electrolyte packets, such as LMNT, Liquid I.V., or DripDrop, are also effective choices for mild to moderate dehydration, offering convenience and effective hydration with sodium, potassium, magnesium, and limited sugar content.

Recommendations

• For severe dehydration, particularly in children or after significant fluid loss from illness, Pedialyte remains the gold standard 1.
• For everyday use, athletic recovery, or mild dehydration, quality electrolyte packets offer comparable benefits with greater portability and often more palatable flavors 1.
• The ideal choice between electrolyte packets and Pedialyte depends on individual needs, with Pedialyte being better for medical situations and electrolyte packets being more practical for daily use and athletic activities.

Recent Guidelines

• The 2024 American Heart Association and American Red Cross guidelines for first aid recommend orally rehydrating with any available rehydration drink or potable water in the absence of shock, confusion, or inability to swallow 1.
• These guidelines also suggest choosing a 4% to 9% carbohydrate-electrolyte drink over potable water, 0% to 3.9% carbohydrate-electrolyte drinks, coconut water, or low-fat cow’s milk, if each is readily available 1.

From the Research

Efficacy of Oral Rehydration Solutions

• The efficacy of oral rehydration solutions, such as electrolyte packets versus Pedialyte, for electrolyte replenishment and hydration has been studied in various contexts, including diarrheal illness and exercise-induced dehydration 2, 3, 4, 5, 6.
• In the context of diarrheal illness, oral rehydration solutions are widely used and recommended, with the World Health Organization (WHO) recommending a glucose-containing reduced osmolarity solution 2, 3.
• A study comparing the efficacy of two oral rehydration solutions, one containing 90 mmol/L of sodium (World Health Organization-recommended solution) and the other containing 75 mmol/L of sodium (Pedialyte RS), found similar clinical outcomes and normalization of altered serum electrolyte values in both groups 4.
• Another study found that a single solution, such as Pedialyte, can be used for both oral rehydration and maintenance therapy in infants with mild to moderate dehydration caused by acute diarrhea 5.
• In the context of exercise-induced dehydration, a study compared the efficacy of three commercial oral rehydration solutions and found that an amino acid-based sugar-free solution achieved positive sodium and chloride balance post-exercise, which was greater than a glucose-based and sugar-free solution 6.

Comparison of Oral Rehydration Solutions

• The composition of oral rehydration solutions can vary, with some containing glucose, sodium, and potassium, while others may contain additional ingredients such as amino acids or rice syrup solids 4, 5, 6.
• The choice of oral rehydration solution may depend on the specific context and individual needs, with some solutions being more effective for certain types of dehydration or populations 2, 3, 4, 5, 6.
• Overall, oral rehydration solutions are a effective and recommended treatment for dehydration, and the choice of solution should be based on the individual's specific needs and the severity of dehydration 2, 3, 4, 5, 6.