Glucose vs Sucrose in Oral Rehydration

Glucose
vs Sucrose
Solutions
for Infants
Rotavirus-Associated
in Oral Rehydration
and Young Children
Diarrhea
Robert
E. Black,
MD, MPH, Michael H. Merson,
MD,
Philip
R. Taylor,
MD, Robert H. Yolken, MD, Md. Yunus,
A.R.M.A
AIim, BS, and David A. Sack,
MD
From the International
Centre for Diarrhoeal
Disease
Cholera Research
Laboratory),
Dacca, Bangladesh,
for Disease
Control,
Atlanta,
Laboratory
of Infectious
Allergy and Infectious
Diseases,
Bethesda,
Maryland,
Medicine,
Johns Hopkins
University,
Baltimore
ABSTRACT.
The use of oral rehydration
solutions
containing
essential
electrolytes
and either
glucose
or sucrose
of equal
osmolality
was compared
in a double-blind
se-
quential
trial
of 784
children
with
rotavirus-associated
diarrhea
treated
at a center
in rural Bangladesh.
The
fluid
failure
rate
was
11.5%
for the sucrose-containing
solution
(P
group
NS).
=
cause
and
of failure
taming
oral
an increased
taming
7.3%
Vomiting
for
the
for the
glucose-containing
a significantly
was
group
treated
with
oral
The
purging
rate
was
not
this
that
sucrose-con-
different
out
and
the two groups.
The oral fluid failure
rates
for children
in
the most underweight
category
(<60%
of expected
weight
for age) were
not different
from
those
for other
groups,
although,
as assessed
by purging
rate and initial
dehydration, the stool losses
of members
of this group
constituted
a greater
proportion
of their
body
weight.
Glucose
is the
preferred
carbohydrate
for oral electrolyte
solutions,
a!though
sucrose
can be substituted
with
only
minimum
loss of efficacy.
Pediatrics
67:79-83,
1981;
glucose-electrolyte
solution,
rotavirus,
malnutrition
and
diarrhea,
sucrose-electrolyte
solution,
oral rehydration.
as
sucrose-containing
used
acute
few
for
therapy
electrolytes
treatment
diarrhea
questions
of
with a solution
containhas been
successfully
dehydration
resulting
MATERIALS
from
all causes
in all age groups.’
are still
unanswered
about
using
A
it
American
for publication
Academy
April
of Pediatrics,
large
nesses
AND
be
solution;
in some
countries,
readily
available
more
of small,
this
well-controlled
question
be
substituted,
here
on the
oral
rehydration
number
indicate
glucose
use
is
of glucosesolutions
of
children
with
METHODS
Population
Disease
(formerly
the
center
provides
May 12, 1980.
Reprint requests
to (R.E.B.)
Center
for Vaccine
Development,
University
of Maryland
School
of Medicine,
29 S Greene
St,
Baltimore,
MD 21201.
PEDIATRICS
(ISSN
0031 4005). Copyright
© 1981 by the
Received
4, 1980; accepted
rhoeal
from
a
can
the
rotavirus-associated
diarrhea
treated
primarily
by
paramedical
workers
at a health
center
in rural
Bangladesh.
We also determined
the failure
rates
for children
of differing
nutritional
state
and the
effect
of nutritional
status
on the course
of rotavims-associated
diarrhea.
The
study
ment
Center
Oral rehydration
glucose
and
since,
report
for
sucrose
preparing
and
can
We
therapy
Patient
ing
whether
in
to address
sucrose
preferable.25
for
is
A number
carried
while
these
glucose
expensive
glucose.
MBBS,
Research,
Bangladesh
(formerly
Bureau of Epidemiology,
Center
Diseases,
National
Institutes
of
and Division
of Geographic
is important
is less
studies
common
of
for
question
than
rehydration
solution
and was associated
with
rate
of intake
of the sweeter
sucrose-con-
solution.
One
substituted
sucrose
group
more
globally.
with
to the
field
research
provided
by
and Admission
Assessment
was conducted
at the Matlab
Treatof the International
Centre
for DiarResearch,
Bangladesh
Cholera
Research
treatment
for
approximately
269,000
area.
Medical
a paramedical
physician.
When
the
center,
a brief
history
(ICDDRB)
Laboratory).
gastrointestinal
care
staff
This
ill-
residents
of the
at the Center
is
supervised
by a
patients
visited
was obtained
examination,
weight,
was
including
performed.
determination
Serum
specific
determined
dom sample
with
a refractometer
for
of patients
on admission.
PEDIATRICS Sponsored
Vol. 67
No. 23,1 2021
January
Downloaded from www.aappublications.org/news at Indonesia:AAP
on July
the
and
treatment
a physical
of
gravity
body
was
a small,
ranOn Nov 17,
1981
79
we began
with
1977,
patients
routinely
diarrhea
zyme-linked
immunosorbent
addition
to
nella,
erichia
testing
the
for rotavirus
routinely
stools
with
assay
examining
from
the
all
en-
(ELISA),6’7
stools
for
in
mens
and enterotoxigenic
Eschearlier.8’9
For confirmation
a random
sample
of 109 speci-
results
positive
by
ELISA
in
a different
ELISA
assay
immune
and nonimmmune
confirmed
Matlab
with
sera;
were
tested
wells
coated
all specimens
in
tinuing
losses.
134,
place
K
moderate
(loss
(loss
of >10%
were
initially
(composition
fluid
13,
Cl
rehydration
of initial
99,
HCO3
stool
cholera
were
until
discharge.
Since
1974
the
20,
Cl
by
the
World
and
of 5% to
of body
according
All
cots,
and
determined
to
had
used
80,
HCO
could
sucrose
be
was
glucose
111)
Organization
Because
published
substituted
considerably
at
oral
solution
were
not
the study
routinely
sucrose
in the oral
(GORS)
maintain
to
(40 gm/liter
rehydration
the
consistency
two
hours
of
therapy,
breast-feeding
was
to
) for
soluoral
glucose-
health
of
informed
of this change
(two months).
No other
given.
Plain
water
was
peared
thirsty
but showed
or to those
whose
mothers
as
that
for glucose,
and beless expensive
than
Feb
1, 1978.
The
sucrose-containing
(SORS)
looked
exactly
like the
to
rehydra-
ICDDRB2’4
indicating
tion
on
solution
who,
90,
recommended
for
of studies
reports3’5
Na
we substituted
(20 gm/liter)
center
observation,
until
the end of
medicines
were
given,
generally
children
no signs
requested
who
ap-
of dehydration
it. Continued
5 to
no
diarrhea,
period).
To
assess
ceased
in
minimal
of body
the
their
fluid.
Patients
fully
rehydrated
or was
10 mi/kg
tients
were
weighed
by using
that
weight,
nutritional
(gen-
weight
and,
eight
hour
previous
status
before
being
the percentage
and
Stevenson)
age was calculated.
We
all
pa-
discharged
of the
and,
Boston
weight
for
median
the
tients
who
sume
losses
enough
because
rates
the
oral
staff
believed
oral fluid
to
of persistent
were
GLUCOSE
classified
were
therapy,
unable
match
continuing
vomiting
and/or
as oral
therapy
pato
confluid
high
failures
outcome
less
of
than
therapy
5 years
for
of age
385
with
GORS
and SORS
groups
were
equally
matched
by
age, sex, frequency
of vomiting,
duration
of diarrhea
and vomiting
before
hospitalization,
admission
specific gravity,
frequency
of other
pathogens
in their
stool,
and nutritional
status
(Table
1).
Of these
784 patients,
291 (35%)
did not have
diarrhea
after
visiting
the health
data
were
excluded
from
subsequent
remaining
data
tient’s
had
analyzed
status
no-to-mild
The
groups
were
mean
duration
ization
was
longer
for
center
and
analysis.
according
or
moderate-to-
in these
also well
of diarrhea
matched,
before
SORS
pa-
ie, whether
patients
the
their
The
to the
on admission,
dehydration
dehydration.
hydration
that the
ately
were
dehydration
severe
two
de-
except
hospital-
group
of moder-
severely
dehydrated
patients
(21.2 hours
for the SORS
vs 12.7 hours
for the GORS;
t = 2.2,
P = < .05).
Both
sets
of patients
had slightly
lower
failure
rates
for the
GORS
than
for the
SORS
groups;
to
however,
the rates
were
not significantly
different
(Table
2). The
failure
rates
for the no-to-mild
and
moderate-to-severe
dehydration
groups
were
also
not significantly
groups,
although
different
for the GORS
and SORS
there
was a trend
toward
a higher
failure
rate
for the moderately
to severely
dehydrated
patients.
Overall,
oral therapy
was effective
for 93% of all patients
receiving
GORS
and for 88%
of those
receiving
SORS.
Patients
with
no-to-mild
body
with
rehydration
the
children
rotavirus-associated
diarrhea
who received
GORS
before
Feb
1, 1978, with
that
for 399 consecutive
rotavirus-positive
patients
after
Feb
1, 1978. The
SORS
advocated.
receiving
compared
consecutive
(GORS
While
80
intravenous
they
were
had
than
dehydration
Evaluation
purging
diarrhea
less
usually
they
glucose-elec-
glucose,
glucose
containing
output
hours
in mEq/liter:
30,
Health
were
and
eight
the
a
deficit
to re-
patients
intake
every
(composition
therapy.
as other
after
solucon-
given
intravein mEq/liter:
48)
losses.
Center
solution
K
staff
or apto 5% of
regimen
to replace
their
estimated
simultaneously
given
oral solution
treated
on
measurements
sucrose
cause
with
or severe
continuing
trolyte
oral
weight)
weight)
dehydration
nous
rehydration
standard
and were
appear
dehydrated
ie, had lost up
received
replacement
Those
of body
tion
well
with
when
RESULTS
body
weight,
ad libitum
for
Na
their
treated
home
as positive.’0
Patients
who did not
peared
mildly
dehydrated,
10%
and
(Stuart
child’s
with
were
Treatment
their
tion
were
sent
erally
Salmo-
Shigella,
vibrios,
coli as described
of rotavirus
and
were
on
gained
admission
an
weight,
respectively,
moderate-to-severe
group)
treated
average
and
of
with
1% and
GORS
1.2%
and
of their
after
treatment.
Patients
dehydration
gained
a 4.2%
5.6%
body
weight
after
rehydration
in each
group
gaining
8%
(SORS
group)
with
or more
26% of patients
of their
body
of
their
weight.
The
solutions
causes
of the oral fluid
included:
(1) intake
failures
with the two
insufficient
for purg-
VS SUCROSE
IN ORAL
REHYDRATION
SOLUTIONS
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from www.aappublications.org/news
at Indonesia:AAP
Sponsored on July 23, 2021
TABLE
1
.
Admission
wit h Glucose
Treated
ristics
Oral
Characte
or Sucrose
of Patients
Rehydration
with
Rotavirus-Associated
Solution
Characteristics
Oral Rehydration
Glucose
of age
Months
Sex
*
(M/F)
Mean
(n
Solution
385)
=
Sucrose
12.0 (0.25)
248/136
97.1
1.6 (0.1)
1.2 (0.05)
Vomiting
before
admission
(%)
Days
of diarrhea
before
admission
Days
of vomiting
before
admission
Admission
specific
gravity
Other pathogens
Percent
weight
Diarrhea
1.027
(%)
for age
(n
399)
=
12.1 (0.26)
262/137
98.4
1.6 (0.08)
1.3 (0.07)
(.<0.001)t
1.028
(<0.001)
9.7
9.0
71.0 (0.5)
71.4 (0.5)
(1 SEM).
t
n = 70.
:j: n = 27.
§ Salmonella,
Shigella,
II Discharge
TABLE
2.
Status
Oral Rehydration
of Patients*
with Oral
Treated
weight
with
Solution
Dehydration
Status
enterotoxigemc
as a percentage
Failures
by Dehydration
Rotavirus-Associated
Oral
Rehydr
Diarrhea
ation
Solution
Glucose
No. of
Cases
None
to mild
Moderate
severe
Total
*
Includes
iting,
and
these
more
group
common
than
for
drated
there
SORS
14
5
6.5
11.9
201
33
259
patients
19
with
7.3
diarrhea
234
Failures
while
No.
%
22
5
10.9
15.2
27
11.5
hospitalized.
group;
(2) inadequate
two in each
group;
one in glucose
(4) abdominal
causes,
ten
group.
This
42
six in each
dehydration,
sucrose
No. of
Cases
%
217
only
ing rate,
of initial
Failures
correction
(3) vom-
group
and 12 in sucrose
group;
distention
or combinations
of
in glucose
group
and
seven
in
Vomiting,
by
itself,
was
reason
for failure
the GORS
group
(x
significantly
for
=
was
particularly
the case
for
to mildly
dehydrated
patients,
were
one of 14 GORS
failures
failures
because
of vomiting
the
SORS
6.6, P <.025).
the
nondehyamong
whom
and ten of 22
(P
=
.016,
Fisher’s
exact
test, one tailed).
In fact, significantly
more
of the SORS-treated
patients
(47.4%)
than
of
the GORS-treated
cases
(36.6%)
vomited
while hospitalized
(x2 = 8.8, P < .001).
However,
88% of the
patients
fully
who
treated
vomited
with
one
in the
hospital
of the
oral
were
rehydration
coli,
median
success-
Vibrio
weight
groups
categories
of the
a percentage
weight
for
failure
the
.06 vs 4.9
Furthermore,
treatment
±
0.4)
were
the
mean
were similar
(Table
4).
groups
with
were
not
in-
GORS
and
for
the
all
for GORS,
population
category
had
SORS.
SORS,
ward
a higher
purging
of therapy
in underweight
grouped
by
rate
or the
body
in the
children
weight.
diaras
median
similar
Furthermore,
nutritional
categories
two
Children
in each of the four nutritional
had similar
mean
durations
of diarrhea
during
their
hospitalization.
There
was
were
similar
with rotavirus-associated
by their
weight
at discharge
the reference
age,
each
rates
combined
categories
before
and
a trend
to-
first eight
hours
when
patients
This
trend
may
correlate
with
the observation
that
the lower
the
category
of nutritional
status
the higher
the proportion
of moderately
to severely
dehydrated
patients
as assessed
on admission
and by percentage
gain in body
weight
after
rehydration
(Table
4).
DISCUSSION
cared
and
at
stituted
0.3
two
of
their
rates
failure
tients
results
±
±
eight
hours
of therapy
for ten
no or mild
dehydration
who
was 16.1 nil/kg/hr.
This
was
(Table
3).
When
the children
rhea
were
grouped
obtained
(6.9
age.
almost
twice
that of that group
as a whole
(t = 1.94,
P < .10). The
purging
rates
for both
dehydration
suits
rate
(6.2
different.
take rate in the first
of the patients
with
were
SORS
failures
A comparison
of oral fluid intake
rates
during
the
total
course
of therapy
showed
one possible
mechanism
for the increased
rate
of vomiting
for the
SORS
groups.
The nondehydrated
to mildly
dehydrated
patients
receiving
the SORS
solution
drank
faster
child’s
solu-
tions.
a significantly
cholerae.
for
than
those
receiving
the GORS
solution
(5.9 ± 0.3
ml/kg/hr)
(t = 2.1, P < .05). Among
moderately
to
severely
dehydrated
patients,
the SORS
group
alsO
tended
to consume
the fluid faster,
but the rates
for
the two
significantly
Sucrose
No.
to
Escherichia
of Harvard
ml/kg/hr)
With
a large
for
study
population,
in earlier
studies
for primarily
ours
indicate
glucose
in
we
by physicians.
that
sucrose
the
oral
confirmed
of much
fewer
repa-
Both
these
can be sub-
rehydration
Downloaded from www.aappublications.org/news at Indonesia:AAP Sponsored on July 23, 2021 ARTICLES
treat-
81
TABLE
3.
Purging
Rates
Status
and
by Dehydration
Time
(ml/kg/hr)
for
Oral Rehydration
Patients
with
Rotavirus-Associated
Solution
Used
Period
Dehydration
None
to Mild
217)
(n
3.7
3.5
(0.3)*
(0.2)
4.2
3.6
(0.3)
(0.2)
3.2
(0.2)
3.4
(0.2)
Glucose
(n
First
First
8-hr
day
Total
*
treatment
Mean
4.
Patients
with
period
(1 SEM);
in any
TABLE
period
time
Status,
Severity
Rotavirus-Associated
Weight/Age
Total
Patients
(%)
70.0-79.9
Percentage
P
.01)
=
of Diarrhea,
Moderate-Severe
(0.7)
(0.5)
5.7 (0.7)
5.6 (0.6)
4.6
(0.4)
4.7
Oral
Rehydration
Dehydration
Gain
Body
(%)
Purging
of 5%
Weight
Rate
First
ml/hr
8 hr
29
4.1
(0.3)
with
9
moderate-severe
vs 80
group
even
failure
for <60
63
10.1
4.1 (0.5)
59
10.0
group
(Fisher’s
vs allother
dehydration
greater
for
<60
groups
vs all other
loss
of efficacy.25
fact
a slightly
larger
treated
group
was
other
investigators
with
were
in
our
much
not
significantly
that
faster.
We
cose-
patients
also
receiving
confirmed
earlier
greater
taste.
Rapid
personnel
with less
were
faced
supervision.
Despite
sociated
the fact
diarrhea
diarrhea
regardless
of
sucrose
could
and
a few
thus
cases
more
may
led
in
double
the
number
can
be
stances
to
of
osmoles
in the upper
intestine
than
would
occur
from
the glucose
solution.
Resultant
intraluminal
fluid
accumulation
and intestinal
distention
could
have
caused
vomiting.
Although
vomiting
was an
important
cause
of
oral
rehydration
failures,
88% of the children
who
vomited
in the hospital
were
served
successfully
by others
toxin-associated
in purging
82
treated
studying
with
oral
rotavirus2
arr4’
rates
for
the
we found
two
solutions
therapy.
and
As obentero-
no difference
despite
young
children
a little
higher
than
ies of rotavirus-associated
appealing
have
and
test
[FET]
.04) or < 60
that
with
can
and secretory
is reasurring
of diarrhea
treatment
requiring
the oral
more
where
difficult
circumour paramedical
treating
more
patients
rotavirus-asdurations
nutritional
stool may represent
in children
with
a
age or malnutrition.
rhea
in developing
support
undernourished
countries.
GLUCOSE Downloaded
VS SUCROSE
IN ORAL
REHYDRATION
SOLUTIONS
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at Indonesia:AAP
Sponsored on July 23, 2021
use
of this
children
the
a greater
low
body
The con-
the
further
of
status,
status
should
are
from other
studwhich
probably
puts
the underweight
and in more
need
The equal
success
of varied
nutritional
chronically
in
center.9
intravenous
solutions
children
with
comparable
of their
a glu-
solution
This
cause
reported
diarrhea,
to the
center
that
have
to drink
sequent
greater
dehydration
child
at higher
risk of death
effective
rehydration
therapy.
oral rehydration
for children
for
the
those
attributed
in the rural
fluid lost in diarrheal
proportionate
loss
weight
due to young
tended
at our
Our overall
rates
of patients
therapy
after
treatment
with
and vomiting.
An alternative
exbe that
rapid
enzymatic
hydrolysis
result
=
reports2’3”2
be used
to treat
rotavirus-associated
diarrhea
with
similar
success.
since
rotavirus
is the leading
larger
of its
in
P
(FET
electrolyte
infants
sweetness
exact
SORS
or sucrose-containing
In our study,
treatment
with
SORS
was associated for the first time with significantly
higher
rates
of vomiting.
This
largely
accounted
for the higher
number
of SORS
failures,
especially
for the nondehydrated
to mildly
dehydrated
patients.
The
vomiting
may have
resulted
from an increased
rate
of intake
of the sucrose-containing
solution
because
intake
5.3
9.5
.007).
toward
SORS-
rates
greater
Oral Therapy
Failure
(%)
.0004).
=
moderate-severe
=
(2)
30 (3)
dehydration
P
(FET
a minimal
but
for
nd/hr/kg
21
studies,
Failed
Total
Diarrhea
Duration
(hr)
6
these
distention
could
Therapy
18
by
gastric
planation
patients
90
only
(0.4)
and sucrose-treated
status.
Which
33)
=
5.7
5.7
64
62
with
the
at
(n
(0.6)
(0.6)
The
trend
we observed
number
of failures
for the
similar
to that
observed
population
different.
Rates
Sucrose
42)
4.9
4.3
Percentage
of patients
with
group
vs 80
group
(FET
P
:j: Mean
(1 SEM).
smaller
and
=
27 (3)
27 (2)
group
solution
(n
25t
14
t
ment
Glucose
201)
=
26*
15
of patients
or <60
Sucrose
to Severe
57
158
168
80.0
*
Moderate
Diarrhea
Assessed
on
Admission
<60.0
60.0-69.9
Status
no significant
differences
between
glucosein either
category
of cases
by dehydration
period
Nutritional
=
Diarrhea
of
of
therapy
with
diar-
2. Sack
IMPLICATIONS
The
world
health
community
is currently
trying
to promote
widespread
use of oral rehydration
therapy
as an integral
part
of primary
health
care.’3
The decision
of whether
to use glucose-or
sucrosecontaining
solutions
in country
programs
must
be
based
on a number
of factors
including
cost and
availability
of ingredients
and
comparative
4.
5.
efficacy.
Our study
confirms
the finding
of others
that,
though
glucose
is preferred,
sucrose
can be used
an oral
solution
which
is safe
and
effective
treatment
3.
alin
for
6.
7.
of diarrhea.
DA,
8. Merson
ACKNOWLEDGMENTS
We
would
like
to
acknowledge
the
support
of the
International
Centre
for Diarrhoea!
Diseases
Research,
Bangladesh
(formerly
the Cholera
Research
Laboratory)
and the International
Center
for Medical
Research
(Na.
tional
Institutes
of Health
Grant
5R07A110048-17).
We also wish to express
our gratitude
for the technical
assistance
of Mr S. Huda
and Mr S. Rahman
and the
nursing
care provided
by the staff of the Matlab
Treatment
Center.
REFERENCES
1. Pierce
against
NF,
Hirschhorn
N: Oral
fluid-A
simple
dehydration
in diarrhea.
WHO Chron 31:87,
ON
You
can
reassured
Editorial
teach
that
EVALUATING
what
you
note:
weapon
1977
is testable
have
This
THE
and
accomplished
comment
applies
Chowdhury
AMAK,
Teacher
speaking,
Options
in Education,
A, et al:
Rehydration
MH,
Sack
RB,
Kibria
AKMB,
et
al:
Efficacy
of
pooling
strains
for laboratory
diagnosis
of enterotoxigenic
Escherichia
coli (ETEC)
diarrhoea.
J Clin Microbiol
9:493,
1979
9. Black
RE, Merson
MH, Rowe B, et al: Epidemiology
of
enterotoxigenic
Escherichia
coli in rural Bangladesh.
Proceedings
ofthe 14th Joint Conference
on Cholera,
US-Japan
Cooperative
Medical
Science
Program,
Karatsu,
1978
10.
11.
Yolken
RH,
Stopa
RI. Analysis
of nonspecific
reactions
in
enzyme-linked
immunosorbent
assay
testing
for human
rotavirus.
J Cliii Microbiol
10:703, 1979
Sack
DA, Islam
5, Brown
KH, et al: Oral therapy
in children
with cholera:
A double
blind comparison
of sucrose
with
glucose electrolyte
oral solution.
J Pediatr
96:20, 1980
12. Taylor
PR, Merson
MH, Black RE, et a!: Oral rehydration
therapy
for treatment
of rotavirus
diarrhea
in a rural treatment center
in Bangladesh.
Arch Dis Child 55:376, 1980
13. Control
of diarrheal
diseases:
WHO’s
programme
takes
shape.
WHO Chron 32:369, 1978
TEACHING
test
OF
what
is
READING
teachable
and
be
falsely
something!
equally
well
to pediatric
Submitted
From
Eusof
in rotavirus
diarrhoea:
A double-blind
comparison
of sucrose
with glucose electrolyte
solution.
Lancet
2:280,
1978
Nalin DR, Levine
MM, Mats L, et al: Comparison
of sucrose
with glucose in oral therapy
of infantile
diarrhoea.
Lancet
2:
277, 1978
Palmer
DL, Koster
VT, Islam
AFM, et al: Comparison
of
sucrose and glucose in the oral electrolyte
therapy
of cholera
and other severe diarrheas.
N Engl JMed
297:1107,
1977
Chatterjee
A, Mahalanabis
D, Jalan
KN, et al: Evaluation
of a sucrose/electrolyte
solution
for oral rehydration
in
acute
infantile
diarrhea.
Lancet
1:1333, 1977
Yolken
RH, Kim HW, Chen T, et al: Enzyme-linked
immunoassay
(ELISA)
for detection
of human
reovirus-like
agent
of infantile
gastroenteritis.
Lancet
1:263, 1977
Yolken
RH, Wyatt RG, Kapikian
AZ. Elisa for rotavirus.
Lancet
2:819, 1977
National
Public
recertification.
by E.K.M.
Radio.
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83
Glucose vs Sucrose in Oral Rehydration Solutions for Infants and Young Children
with Rotavirus-Associated Diarrhea
Robert E. Black, Michael H. Merson, Philip R. Taylor, Robert H. Yolken, Md. Yunus,
A.R.M.A Alim and David A. Sack
Pediatrics 1981;67;79
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Downloaded from www.aappublications.org/news at Indonesia:AAP Sponsored on July 23, 2021
Glucose vs Sucrose in Oral Rehydration Solutions for Infants and Young Children
with Rotavirus-Associated Diarrhea
Robert E. Black, Michael H. Merson, Philip R. Taylor, Robert H. Yolken, Md. Yunus,
A.R.M.A Alim and David A. Sack
Pediatrics 1981;67;79
The online version of this article, along with updated information and services, is located on
the World Wide Web at:
http://pediatrics.aappublications.org/content/67/1/79
Pediatrics is the official journal of the American Academy of Pediatrics. A monthly publication, it has
been published continuously since 1948. Pediatrics is owned, published, and trademarked by the
American Academy of Pediatrics, 345 Park Avenue, Itasca, Illinois, 60143. Copyright © 1981 by the
American Academy of Pediatrics. All rights reserved. Print ISSN: 1073-0397.
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