Can rice water be used as an oral rehydration solution (ORS) for managing dehydration?

Rice Water as Oral Rehydration Solution

Rice-based oral rehydration solutions can be used for managing dehydration from diarrhea, with evidence showing they may reduce stool output in the first 6 hours compared to standard glucose-based ORS, though they do not clearly reduce overall duration of illness or total stool volume. 1

Mechanism and Composition

Rice-based ORS works through a different mechanism than standard glucose-based solutions:

• Rice-based ORS contains cooked rice powder instead of glucose, providing complex carbohydrate polymers that are slowly digested by intestinal enzymes and absorbed as glucose, along with larger proteins digested as smaller peptides and amino acids 1
• The polymer structure avoids excessive osmotic load that can occur with high concentrations of simple sugars, which would otherwise draw water into the gut lumen and worsen diarrhea 1
• The sodium-glucose cotransport mechanism remains intact, allowing continued absorption of sodium and water even during acute diarrhea 1

Clinical Evidence and Efficacy

The evidence for rice-based solutions shows mixed results:

• Clinical trials in developing countries reported that cereal-based ORS reduces stool output and duration of diarrhea 1
• However, critical analysis reveals these studies often failed to standardize or adequately measure the maintenance diet, making it unclear whether dietary variations rather than the ORS itself accounted for differences 1
• One study of Ricelyte (a commercial rice-syrup preparation) showed reduced stool output during the first 6 hours compared to standard glucose-based ORS, but found no differences in duration of diarrhea or total stool output 1
• Firm conclusions about relative efficacy remain difficult to draw due to incomplete reporting of stool output after 48 hours 1

Commercial vs. Homemade Preparations

There is an important distinction between commercial and homemade rice-based solutions:

• Ricelyte (commercial preparation) contains 30 g/L of rice-syrup solids with only small glucose polymers, differing from true cereal-based solutions that contain whole rice 1
• Ricelyte contains 50 mEq/L sodium, making it a lower-sodium solution intended primarily for maintenance rather than active rehydration 1
• Homemade cereal-based solutions can be easily prepared but require time and effort, can become contaminated if unrefrigerated, and are difficult to standardize 1
• Studies from India showed homemade food-based solutions had wide variation in sodium content and generally inadequate amounts of cereal base and glucose 1

Practical Recommendations

When considering rice-based solutions for rehydration:

• For mild to moderate dehydration, rice-based ORS can be used as an alternative to standard glucose-based ORS 1
• Standard WHO low-osmolarity ORS with 65-70 mEq/L sodium remains the gold standard for rehydration 2, 3
• When purging rates are very high (>10 mL/kg/hour), solutions with 75-90 mEq/L sodium are recommended, which most rice-based commercial preparations do not provide 1
• Commercial rice-based products like Ricelyte with lower sodium (50 mEq/L) are more appropriate for maintenance hydration after initial rehydration is complete 1

Critical Pitfalls

Several important caveats apply to rice-based solutions:

• Standardization remains problematic with homemade preparations, risking inadequate electrolyte content 1
• Contamination risk increases if solutions are left unrefrigerated 1
• The perceived advantage of reducing stool output may be confounded by early feeding practices, which independently reduce severity and duration of diarrhea 1
• Do not use rice water as a substitute for proper ORS in severe dehydration, which requires IV fluids initially 2, 4
• Avoid using rice-based solutions with inadequate sodium content when active rehydration is needed rather than maintenance 1