The effect of flavoring oral rehydration solution on its composition and palatability.

Objective: As a number of mild to moderately dehydrated children refuse to drink oral rehydration solution (ORS) because of its strong salty taste, many parents and health workers flavor ORS with the childs favorite juice. The effects of flavoring ORS on electrolyte content and osmolality were assessed and the palatability of various solutions were compared with commercially flavored ORS.
Methods: Osmolality, sodium, potassium, chloride and glucose content after flavoring with varying concentrations of apple juice, orange juice or orangeade was determined. Two of the solutions were offered to 30 children and adults to assess palatability.
Results: All additions to ORS (apple juice, orange juice or orangeade) caused a decrease of sodium (-30 to -53 mmol/L) and chloride (-27 to -47 mmol/L) content, whereas osmolality increased to greater than 311 mOsm/kg. These homemade oral rehydration solutions did not fulfill ESPGAN criteria for ORS, and rehydration will therefore be less effective. The majority of subjects also preferred the commercially flavored ORS.
Conclusion: Only very small amounts of apple juice or orange juice can be added to the ORS without significantly altering electrolyte composition and osmolality. Palatability, however, does not improve compared with commercially flavored ORS. We therefore recommend using commercially flavored ORS, the composition of which fulfills ESPGAN criteria.