Resomal vs cholera saline
Reading File
Finding Sources
Finding Sources
Finding Sources
Finding Sources
Searching the Web
ReSoMal vs cholera saline composition comparison WHO
Reading File
Here is a detailed comparison of ReSoMal vs "Cholera Saline" (i.e., the original high-sodium ORS / standard ORS designed for cholera-type diarrhoea):
ReSoMal vs Cholera ORS (Original WHO ORS)
Background
The original WHO ORS was designed in the 1970s primarily to treat secretory diarrhoea from cholera, which causes massive sodium-rich fluid losses. It had high sodium (90 mmol/L) to replace these losses.
ReSoMal (Rehydration Solution for Malnutrition) was developed later specifically for children with Severe Acute Malnutrition (SAM), who have very different pathophysiology and cannot safely receive the high sodium loads of cholera ORS.
Composition Comparison
| Component | Old WHO ORS ("Cholera ORS") | Current WHO ORS (Low-osmolarity) | ReSoMal |
|---|---|---|---|
| Sodium | 90 mmol/L | 75 mmol/L | 45 mmol/L |
| Potassium | 20 mmol/L | 20 mmol/L | 40 mmol/L |
| Glucose | 111 mmol/L | 75 mmol/L | 125 mmol/L |
| Chloride | 80 mmol/L | 65 mmol/L | 70 mmol/L |
| Citrate/HCO3 | 30 mmol/L | 10 mmol/L | 7 mmol/L |
| Osmolarity | ~311 mOsm/L | ~245 mOsm/L | ~300 mOsm/L |
| Magnesium | None | None | Yes (3 mmol/L) |
| Zinc | None | None | Yes |
| Copper | None | None | Yes |
Why the Differences Matter
ReSoMal has LESS sodium (45 vs 90 mmol/L)
Children with SAM have abnormally high intracellular sodium (due to failure of Na-K ATPase). They are paradoxically hypernatraemic intracellularly despite often appearing hyponatraemic in serum. Giving high-sodium cholera ORS causes:
- Fatal fluid overload
- Pulmonary oedema
- Cardiac failure (already compromised in kwashiorkor/marasmus)
ReSoMal has MORE potassium (40 vs 20 mmol/L)
SAM causes profound total body potassium depletion (even when serum K+ looks normal). Correcting this is essential for cardiac function and preventing refeeding-related arrhythmias.
ReSoMal contains micronutrients
SAM depletes magnesium, zinc, and copper. ReSoMal addresses these deficiencies simultaneously during rehydration.
Cholera ORS needs HIGH sodium
Cholera toxin activates adenylyl cyclase → massive Cl⁻ and Na⁺ secretion into the gut lumen → "rice-water stools." You must replace this sodium loss aggressively. In a well-nourished person with cholera, the Na-K ATPase is intact and excess sodium is handled safely.
Clinical Rules
| Situation | Use |
|---|---|
| Child with SAM + dehydration (no suspected cholera) | ReSoMal 5-10 mL/kg/hour, slowly over up to 12 hours |
| Child with SAM + suspected cholera or profuse watery diarrhoea | Standard low-osmolarity WHO ORS (NOT ReSoMal) - per WHO/ReliefWeb guidance |
| Child with SAM + shock / severe dehydration unable to tolerate oral fluids | IV half-strength Darrow's + 5% dextrose OR Ringer's lactate + 5% dextrose (NOT normal saline) |
| Well-nourished person or adult with cholera | Standard WHO ORS (75 mmol/L Na) or original ORS (90 mmol/L Na) |
Key point: When a SAM child has cholera, the sodium losses from cholera outweigh the risk of sodium overload from standard ORS - so ReSoMal is contraindicated in that specific combination.
Rate of Rehydration
- Cholera / standard ORS: Can be given more rapidly (replacing large ongoing losses)
- ReSoMal in SAM: Given slowly - 5 mL/kg every 30 min for first 2 hours, then 5-10 mL/kg/hour alternating with therapeutic milk (F-75), monitored closely for signs of fluid overload
Summary
ReSoMal is essentially a "de-sodiumed, potassium-enriched, micronutrient-supplemented" ORS. The cholera ORS works on the principle of sodium-glucose cotransport (SGLT1) replacing massive secretory losses. ReSoMal works on the same cotransport mechanism but adjusts electrolyte ratios to match the specific metabolic derangements of malnutrition - where the danger is sodium overload, not sodium depletion.
F75 vs f100
Finding Sources
Searching the Web
F75 vs F100 therapeutic milk SAM severe acute malnutrition WHO composition comparison
Here is a full breakdown of F-75 vs F-100:
F-75 vs F-100: WHO Therapeutic Milks for SAM
The Core Concept
Both are specially formulated liquid diets for inpatient management of Severe Acute Malnutrition (SAM). The number in the name is the caloric density per 100 mL. They are used sequentially - F-75 first, F-100 second - mirroring the two clinical phases of SAM treatment.
Composition Comparison
| Constituent | F-75 | F-100 |
|---|---|---|
| Energy | 75 kcal/100 mL | 100 kcal/100 mL |
| Protein | 0.9 g/100 mL (5% of energy) | 2.9 g/100 mL (12% of energy) |
| Fat | 32% of energy | 53% of energy |
| Lactose | 1.3 g/100 mL | 4.2 g/100 mL |
| Sodium | 0.6 mmol/100 mL (very low) | 1.9 mmol/100 mL |
| Potassium | 3.6 mmol/100 mL | 5.9 mmol/100 mL |
| Magnesium | 0.43 mmol/100 mL | 0.73 mmol/100 mL |
| Zinc | 2.0 mg/100 mL | 2.3 mg/100 mL |
| Osmolarity | 333 mOsm/L | 419 mOsm/L |
(Source: NCBI/WHO guidelines)
Why the Difference? - The Pathophysiology
Phase 1 - Stabilization: Use F-75
In acute SAM, the child has:
- Impaired Na-K ATPase → cells cannot pump sodium out → high intracellular Na
- Depleted glycogen stores → risk of hypoglycaemia
- Compromised heart and kidneys → cannot handle fluid/protein loads
- Gut mucosal atrophy → impaired absorption
F-75 is deliberately low in protein and energy to avoid:
- Refeeding syndrome - sudden high carbohydrate/protein load causes massive intracellular shift of phosphate, potassium, magnesium → hypophosphataemia → cardiac arrest
- Fluid overload / cardiac failure - low sodium, modest energy keeps the heart safe
- Metabolic stress - the damaged liver cannot handle high amino acid loads
Goal: Survival and metabolic stabilization, NOT weight gain. Give 100 mL/kg/day in 8 feeds.
Phase 2 - Rehabilitation: Use F-100
Once the child is:
- Eating well (good appetite returned)
- Oedema reducing
- No infections/complications
- Alert and active
Switch to F-100. Now the goal is catch-up growth - rapid weight gain of 10-15 g/kg/day. The higher protein (2.9 g/100 mL) drives new tissue synthesis. The higher fat content (53% energy) provides dense calories without osmotic diarrhoea.
Clinical Protocol Summary
| Parameter | F-75 (Stabilization) | F-100 (Rehabilitation) |
|---|---|---|
| Phase | Phase 1 (days 1-7 approx.) | Phase 2 (weeks 2-6) |
| Goal | Prevent death, correct metabolic chaos | Catch-up growth, restore body composition |
| Volume | 100 mL/kg/day | 150 mL/kg/day (escalating) |
| Feeds/day | 8 feeds (every 3 hrs) | 5-6 feeds |
| Expected weight change | Little to none (or oedema loss) | +10-15 g/kg/day |
| Duration | Until appetite returns + oedema resolves | Until WHZ > -2 SD (recovery) |
| Transition | - | Give F-100 same volume as last F-75 for 48 hrs, then escalate |
The Transition Rule (Important for Exams)
When switching from F-75 to F-100:
- Do NOT suddenly increase volume. Start F-100 at the same volume as the last F-75 dose (130 mL/kg/day) for the first 48 hours - this prevents refeeding syndrome even with the richer formula.
- Then gradually increase to 150-220 mL/kg/day over the next few days.
What About F-100 Diluted?
For infants under 6 months or breastfed infants, F-100 diluted (F-100D) is used instead of standard F-100. It reduces osmolarity and protein load to be safer for young infants whose kidneys cannot concentrate urine efficiently.
RUTF vs F-100
Ready-to-Use Therapeutic Food (RUTF) - e.g., Plumpy'Nut - has the same nutrient profile as F-100 but is a peanut-based paste used for outpatient (community-based) management of uncomplicated SAM. F-100 requires inpatient supervision; RUTF can be safely given at home. Both are used in the rehabilitation phase but in different settings.
Memory Hook
F-75 = "First and Fragile" - low energy, low sodium, stabilize the sick child
F-100 = "Feed and Flourish" - high energy, high protein, rebuild the recovering child
This is a shared conversation. Sign in to Orris to start your own chat.