Effect of Rice Solution on Dehydration among Children with Acute Diarrhea in the Pediatric Ward in Selected Hospital

Acute gastroenteritis is among the most common causes of morbidity and mortality in children of any age, and dehydration and electrolyte imbalance are the most common clinical problems [1,2,3]. The most common type of treatment is oral rehydration therapy (ORT) with oral rehydration solutions (ORS), which is used to replace intravascular volume, correct metabolic acidosis, and prevent malnutrition [3,4].

Oral rehydration solutions based on rice have also been suggested as an alternative to glucose-based ORS because they may have a greater absorption of sodium and water by mechanisms including colonic fermentation and greater short-chain fatty acid production [5,6]. Other studies have shown that rice-based ORS can decrease stool and intravenous fluid needs; but results are inconclusive, especially with non-cholera pediatric diarrhea [7].

Guidelines from World Health Organization recommends oral rehydration solution (ORS) as the cornerstone of dehydration management, while acknowledging that the effectiveness of rice-based solutions may vary across different clinical settings and population groups. [8]. The majority of the literature has been done in an outpatient or cholera-endemic environment, and there is little high-quality evidence done on hospitalized pediatric populations.

Although this has been studied before, there is a deficiency of clear evidence on the effectiveness of rice-based ORS in particular in children who are admitted to paediatric wards with acute diarrhea and dehydration. Rice-based solutions are not well incorporated into the conventional WHO-ORS inpatient guidelines, and there is a lack of comparative information with glucose-based ORS with regard to stool output, electrolyte replacement, intravenous fluids, weight gain, and the length of stay in hospitals [9,10,11].

The originality of the given work is that the population studied is a hospital-based population of pediatrics, where the issue of dehydration management is more significant and demands rigorous clinical guidelines. This research will examine the effectiveness and safety of rice-based ORS in decreasing the stool burden, enhancing hydration and electrolyte imbalances, reducing the use of intravenous fluids, and reducing the length of stay, thus adding context-specific evidence to the current body of knowledge of improving the practice of pediatric inpatient care [12].

Aim of the Study

The study aimed to evaluate the effect of Rice solution on dehydration and electrolytes among children admitted with acute diarrhea in the paediatric ward.

A quantitative research approach using a true experimental pre-test–posttest control group design was adopted. The study was conducted in the pediatric ward of Government Rajaji Hospital among children admitted with acute diarrhea. Children aged 3–6 years who met the inclusion criteria were selected using probability sampling through a simple random lottery method.

Criteria of the Study

The inclusion criteria were the presence of acute diarrhea, hospitalization on the pediatric ward, and parental or guardian consent. Children who had chronic diarrhea, had severe systemic illness, or had special treatment of diarrhea were excluded.

Data Collection Procedure

Baseline data for both the control and experimental groups were collected after obtaining institutional permission and informed consent. Pre-test assessment included evaluation of dehydration status using the IMNCI Assessment of Dehydration Scale developed by the World Health Organization, which considers general condition, eyes, tears, mouth and tongue, thirst, and skin pinch. Baseline electrolyte levels (sodium, potassium, and chloride) were measured using blood samples.

The rice solution was prepared by taking 100 g of parboiled rice, washing it thoroughly, and soaking it in clean water for 30 minutes. The soaked rice was then boiled in 1000 ml of water with 5 g of salt for 40–50 minutes until a well-cooked, semi-liquid consistency was obtained. The mixture was cooled and filtered using a clean cloth or sieve to obtain a clear rice-based solution, ensuring hygienic preparation throughout. Children in the experimental group received 150 ml of the prepared rice solution three times daily for three consecutive days, along with standard diarrhea management. The control group received standard hospital care only. No blinding was implemented in this study, as both caregivers and investigators were aware of group allocation due to the nature of the intervention.

Post-test assessment was conducted after the intervention period using the same IMNCI scale and laboratory investigations to measure electrolyte levels. The effectiveness of the intervention was determined by comparing pre-test and post-test findings between and within the groups.

Data Analysis

Data were analyzed using IBM SPSS Statistics. Demographic and clinical variables were described using descriptive statistics. Normality of the data was assessed with the Shapiro–Wilk test. Changes in electrolyte levels between groups and across time, including main and interaction effects, were evaluated using repeated measures ANOVA.

Ethical Considerations

Ethical approval was given by the Institutional Ethics Committee (Reference No: 12129/1EC/2024-26). Informed consent was given to parents or guardians in writing and they were only allowed to participate. The privacy, safety and confidentiality of the participants were maintained in the study.

Most of the children in both groups were 3 years old, 40 and 38 percent respectively in the control and experimental group respectively. The majority of the control group (64 percent) was comprised of male children and the experimental group was slightly higher in females (52 percent). The majority of children were of the Hindu religion, with 78% in the control and 70% in the experimental group. Most of the respondents in the two groups drank corporation water (88%). In the control group, fathers were mostly workers (62%), whereas in the experimental group they were mostly of the type of everybody being either a private or a government worker (42%). Likewise, the control group had mothers who were mostly workers (56%), whereas in the experimental group, the majority of mothers were either private or government employees (44%). Majority of the participants visited sanitary latrines with more of the experimental group (94%) using sanitary latrines as compared to the control group (68%) (Table 1).

Table 1: Socio-Demographic Analysis of Control (Con) and Experimental (Exp) Groups

The results indicate that dehydration status had a significant effect on sodium levels (p < 0.001), while gender and nutritional status did not show a significant independent effect. Significant differences were observed between control and experimental groups and between pre-test and post-test values across all variables. Interaction effects were significant mainly for dehydration status, indicating its strong influence on sodium levels. Overall, dehydration status was the key factor affecting sodium levels (Table 2).

Table 2: Influence of Gender, Nutritional Status, and Dehydration Status on Sodium Level

The mean values reveal that both groups have an increase in the level of sodium, potassium and chloride between the pre-test and post-test, but the improvement is more in the experimental group. There were significant group differences, test differences and interaction differences among all electrolytes (p<0.001). The result of within-group analysis indicated significant improvement in both groups with greater effects in the experimental group. There was no large difference in groups at pre-test in sodium and potassium and a slight difference in chloride. Post-test concentration demonstrated significant differences of all three electrolytes which resulted in improved outcomes in the case of experimental group (Table 3).

Table 3: Comparison of Sodium, Potassium, Chloride among the Groups

The study findings demonstrated that electrolyte levels, including sodium, potassium, and chloride, improved significantly following the intervention, with greater post-test improvement observed in the experimental group compared to the control group [13,14]. This finding is consistent with previous studies indicating that balanced or low-sodium interventions can effectively regulate serum electrolytes and reduce complications such as hyperchloremia, thereby enhancing overall electrolyte status [15,16]. Furthermore, significant differences between groups at both pre-test and post-test, along with significant interaction effects (p<0.001), indicate a strong and distinct impact of the intervention on electrolyte balance [17,18].

Although minor variations in effect size were observed across studies due to differences in intervention composition, dosage, and participant characteristics, the overall findings consistently support the effectiveness of the intervention in improving electrolyte homeostasis [19,20].

Limitations A small sample was used to carry out the study and this could influence the generalizability of the findings. The duration of follow-up was short, restricting the assessment of long-term effects of the intervention on electrolyte balance. Variations in individual characteristics such as dietary intake, hydration status, and severity of illness were not fully controlled. Additionally, the study was carried out in a single clinical setting, which may limit external validity.

The study concludes that the intervention was effective in improving electrolyte levels, including sodium, potassium, and chloride, among children. Significant improvements were observed from pre-test to post-test, with greater changes in the experimental group compared to the control group. The findings support the effectiveness of the intervention in enhancing electrolyte balance and reducing dehydration-related complications, indicating its potential value in clinical practice.

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