***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: A hypotonic ( osmolality 224 mmol/l , sodium 60 mmol/l ) oral rehydration solution ( ORS ) was compared with an isotonic high glucose ORS ( osmolality 304 mmol/l , sodium 60 mmol/l ) in children with acute diarrhoea in a r and omised double blind study . The stool output and hence the mean consumption of ORS  for maintenance hydration was less ( p = 0.036 ) in patients receiving hypotonic ( 69 ml/kg ) than isotonic ( 97 ml/kg ) ORS . Hypotonic ORS  was more effective in patients with rotavirus positive than with rotavirus negative diarrhoea In a controlled trial in Petrozavodsk , Karelia , the effects of oral rehydration and Lactobacillus strain GG ( LGG ) on  recovery  from  acute diarrhoea ( 27 % rotavirus , 21 % bacterial aetiology ) were studied in 123 children aged between 1 and 36 months of age . On admission to hospital , the patients were first r and omized to receive either isotonic oral rehydration solution ( ORS ) with osmolality 311mosmol/l and sodium 90mmol/l ( WHO‐ORS ) , or a hypotonic ORS with osmolality 224mosmol/l and sodium 60mmol/l ( Light‐ORS ) , and thereafter r and omized to receive either 5 × 109 colony forming units of LGG or a matching placebo . The two ORS performed equally for acute rehydration , and oral rehydration with either ORS was associated with a shorter duration of diarrhoea than intravenous rehydration ( p= 0.036 ) . Patients receiving LGG had a significantly shorter duration of watery diarrhoea [ mean ( SD ) 2.7 ( 2.2 ) days ] than those receiving the placebo [ 3.7 ( 2.8 ) days , p= 0.03 ] . LGG significantly shortened the duration of rotavirus diarrhoea but not diarrhoea with confirmed bacterial aetiology ABSTRACT . Two groups of infants aged 2 to 20 months with moderate to severe dehydration were r and omly assigned to either sucrose high sodium ( 90 mEq/l ) or sucrose low sodium ( 58 mEq/l ) solution in a double blind manner . Rehydration was assessed on clinical grounds and confirmed by serial determination of body weight , hematocrit , total serum protein and blood urea nitrogen . Twenty ( 80 % ) of 25 patients on sucrose high sodium solution and 20 ( 77 % ) of 26 patients on sucrose low sodium solution were successfully hydrated . Only the assigned sucrose‐electrolyte solution was given during the average rehydration period of about 7 hours when the serum electrolytes were remeasured . Three patients on high sodium solution  developed mild hypernatremia . Slight hyponatremia was encountered in 2 patients on low sodium  solution . Purging rate was significantly higher in patients who failed as compared to those who succeeded . The results of this study suggest that oral sugar electrolyte solution with sodium concentration of 90 mEq/l is safe and effective in the majority of infants with diarrhoeal dehydration of diverse causes . However , intravenous fluids must be available particularly for those with a high purging rate as a significant number of them may fail A r and omized , multicenter clinical trial comparing two oral rehydration solutions ( ORS ) with different sugar content and total osmolality was carried out in France . Solution A had 168 mmol/L of sugar and a total osmolarity of 326 mosm/kg ; solution D had 90 mmol/L of sugar and a total osmolarity of 240 mosm/kg . Weight gain , stool output , and biologic variables were analyzed . This interim analysis included 49 infants ( 27 in group A and 22 in group D ) . Patients in both groups gained weight without any significant difference between the two ORS . Between admission and day 4 , the overall number of stools and the number of liquid stools decreased . Laboratory values were within the normal range on admission and remained unchanged . The weight increase during the first 24 hours and the reduced frequency of stools was similar in both groups Oral rehydration among infants aged 0–3 months has not been adequately investigated . A controlled , r and omized study was thus conducted in 65 young infants hospitalized with acute noncholera dehydrating diarrhea . The study was design ed to compare the efficacy and safety of the st and ard WHO oral glucose-electrolyte solution containing 90 mmol of sodium per liter ( Group A : 22 infants ) with that of an oral glucose-electrolyte solution containing 60 mmol of sodium per liter ( Group B : 22 infants ) and with st and ard intravenous therapy ( Group C : 21 infants ) . Among the 44 infants in Groups A and B , none required intravenous therapy . Dehydration , acidosis , and initial hyponatremia or hypokalemia were corrected with equal efficacy in all the three groups . In the critical first 8 h , the mean sodium absorption was significantly higher ( p < 0.01 ) in Group A. This result ed in hypernatremia ( 50 % ) , periorbital edema ( 50 % ) , mild pedal edema ( 27 % ) , excessive irritability , and convulsions ( 4.5 % ) . The mean serum sodium levels at 8 , 24 , and even 48 h were significantly higher ( p < 0.05 ) than those in Groups B and C. It is concluded that glucose-electrolyte oral solution containing 60 mmol of sodium per liter is as safe and effective as intravenous rehydration for the treatment of noncholera neonatal and early infantile diarrhea , while the st and ard WHO solution carries a significant risk of hypernatremia under similar conditions Although oral glucose-electrolyte solutions containing 90 mmol of sodium per liter have been widely used in the treatment of acute diarrhea among under-nourished children in the developing world , they have rarely been studied in well-nourished children . We therefore conducted a controlled r and omized study among well-nourished children three months to two years who were hospitalized with acute diarrhea ( 52 in the United States , and 94 in Panama ) , to compare the efficacy of this solution with that of one containing 50 mmol of sodium per liter and with st and ard intravenous therapy .  Oral rehydration with both solutions according to protocol was successful in 97 of 98 children ( one required unscheduled intravenous therapy ) , and in 87 ( 89 per cent ) no intravenous therapy was required . All of six children admitted with hypernatremia were successfully treated with oral therapy alone . We conclude that glucose-electrolyte oral solutions containing either 50 or 90 mmol of sodium per liter are effective and safe in the treatment of well-nourished children hospitalized with acute diarrhea , and that they may completely replace the intravenous fluids in the majority of such children The paper describes the first controlled trial of an oral glucose electrolyte solution design ed on the basis of the optimum pathophysiological needs for rehydration in infantile diarrahoea . The solution , having a sodium concentration of 50 mmol/l , was tried in a group of 20 infants with moderate to severe dehydration due to acute diarrhoea and was compared with a matched group of 19 infants predominantly under 2 years of age taking a ' st and ard ' oral solution with a sodium concentration of 90 mmol/l . They could be hydrated as well with a low sodium oral solution alone as with the st and ard solution . Intravenous fluid was not required in either group . The group treated with the high soldium ' st and ard ' solution appeared to develop hypernatraemia and /or periorbital oedema more frequently than the other group . Also , the low sodium solution eliminated the need for additional free water orally Two hypotonic oral rehydration solutions with osmolarities of 224 mosmol/l ( Na+ 60 mmol/l , glucose 84 mmol/l ) and 204 mosmol/l ( Na+ 60 mmol/l , glucose 64 mmol/l ) , respectively , and oral treatment withLactobacillus GG were evaluated in a double blind trial in children aged 6–36 months hospitalised for acute diarrhoea . Early administration ofLactobacillus GG at the start of oral rehydration result ed in the shortest duration of diarrhoea , best weight gain , and fastest correction of acidosis . A reduced osmolarity oral rehydration solution  ( 224 mosmol/l ) combined with early administration of Lactobacillus GG is an effective treatment for acute diarrhoea  in young children ; further reduction of osmolarity may not be beneficial Previously we reported that st and ard oral rehydration salts ( ORS ) solution is not as effective as a reduced-osmolarity glucose-based ORS for the treatment of children with acute noncholera diarrhoea : with st and ard ORS the diarrhoea lasts longer , stool output is greater , serum sodium is higher , and there is more need for supplemental intravenous infusion . We studied a reduced-osmolarity maltodextrin (MD)-based ORS to determine whether it had similar benefits , and also the effect of sugar malabsorption on the efficacy of st and ard and MD-based ORS .  A total of 90 boys aged 3 - 24 months with acute noncholera diarrhoea and moderate dehydration were r and omly assigned to either st and ard ORS ( glucose 20 g/l , osmolarity 311 mmol/l ) or MD-ORS ( MD 50 g/l , osmolarity 227 mmol/l ) . There were no differences in treatment results . Some 46 % of subjects had a high total stool output ( > 300 g/kg ) , which was unrelated to the type of ORS given . High stool output was significantly associated with a longer duration of diarrhoea ( 33 vs. 15 hours ; P < 0.001 ) , a persistently elevated serum sodium ( 149 vs. 144 mmol/l at 24 h ; P < 0.02 ) , the need for intravenous infusion ( 11/41 vs. 0/48 ; P < 0.002 ) , and an increase in faecal reducing substances ( 10.8 vs. 3.4 g/l at 24 h ; P < 0.001 ) . We conclude that some children given st and ard ORS develop osmotic diarrhoea owing to the combined effect of transient sugar malabsorption and slight hypertonicity of the ORS . Earlier studies show that this adverse outcome can largely be avoided when extra water is given in reduced-osmolarity glucose-based ORS . Reduced osmolarity has no benefit , however , when glucose is replaced by maltodextrin , probably because the sugars released by hydrolysis of MD , when malabsorbed , raise the intraluminal osmolarity to equal or exceed that of st and ard ORS . Thus , reduced-osmolarity glucose-based ORS is superior to both st and ard ORS and reduced-osmolarity solutions based on maltodextrin and probably other complex carbohydrates . Studies are in progress to define the optimal formulation of reduced-osmolarity glucose-based ORS Male children ( N = 101 ) 6–35 months of age presenting with acute watery diarrhea for 48 h at home before hospitalization were admitted into a r and omized , double-blind clinical trial . Fifty-one children were treated with st and ard oral rehydration solution ( ORS ) ( World Health Organization [ WHO ] formulation containing citrate ) and 50 were treated with an improved ORS formulation ( containing , in addition to the st and ard formula , 20 g maltodextrin instead of glucose , and 4 g glycine and 4 g glycyl-glycine ) . None were given antibiotics . No i.v . infusions were given . Rotavirus was detected by enzyme-linked immunosorbent assay in stools of 43 children . Clinical characteristics of children in the two treatment groups were comparable . Improved ORS did not produce significant reduction in the volume of diarrhea stools . Children given improved ORS  had greater weight gain than that observed in children treated with st and ard ORS , but the differences were not statistically significant except at the end of the first 24 h. Among children with rotavirus diarrhea , no significant differences were observed between the 23 children who received improved ORS and the 20 who received st and ard ORS Summary The clinical efficacy of a diluted oral rehydration salts ( ORS ) solution was compared in a pilot study with that of intravenous ( i.v . ) therapy and of st and ard World Health Organization (WHO)/United Nations Childrens Fund ( UNICEF ) ORS solution in children with acute diarrhea . Sixty-one boys aged 3 to 24 months , admitted to hospital with acute diarrhea and signs of dehydration , were r and omly assigned to groups receiving st and ard ORS solution , diluted ORS solution , or i.v . therapy . In children treated with st and ard ORS solution and small amounts of plain water , the total fluid 
    Output:
    
REVIEW ER 'S CONCLUSIONS In children admitted to hospital with diarrhoea , reduced osmolarity ORS when compared to WHO st and ard ORS is associated with fewer unscheduled intravenous fluid infusions , lower stool volume post r and omization , and less vomiting .
No additional risk of developing hyponatraemia when compared with WHO st and ard ORS was detected