ORAL REHYDRATON SOLUTION

ORS -special combination of dry salts that, when

properly mixed with safe water, can help
rehydrate the body when a lot of fluid has been
lost due to diarrhoea.
Use of ORT prevents deaths of 1 million to 2
million children each yr
Basis of ORS -During Diarrhoea,even thou Na &
H2O are lost Glucose,AA, Dipeptides are
absorbed without difficulty.So…….
 WHO Recommended ORS types
ORS Bicarbonate ORS Citrate
NaCl -3.5g NaCl -3.5g
NaHCo3 -2.5g Trisod.citrate
KCl -1.5g dehydrate -2.9g
Glucose -20g KCl -1.5g
Water -1L Glucose -20g
Water -1L
TYPES OF DEHYDRATION
50%cases - IsoNatremic type
45% - Hyponatremic type
5% - Hypernatremic type
Why K+ in ORS?
Why HCO3 in ORS?
 INDICATIONS
MILD to MODERTE dehydration

As MAINTENANCE therapy in severe

dehydration
TYPES OF ORS FORMULATIONS
Glucose based ORS

Rice based ORS

Low osmolarity ORS

Home available ORS

ORS with other nutrients

 Oral Rehydration Therapy
Home made - sugar(40g) +salt (4g) solution

Food based -rice water(50g)+salt(40g)

-lassi + salt

Others -plain H2O, lemon water, coconut

water, rice kanji, dhal water
without salt
 WHAT IS NOT ORT?
Glucose water without salt

Fluids without starch / sugar & salt in children

who are starved

Fluids consumed in small amounts.eg- tea.

 IMPROVED ORS
APPROACH 1:
Glucose - replaced by starch based cereal
powder(50g/L)
eg:cooked rice powder
APPROACH 2:
Glucose polymers(Maltodextrin)OR AA are
combined with or used instead of glucose
( AA & Dipeptides cause increase in
absorption of H2O &Na by diff
mechanism. So double benefit)
 LOW OSMOLARITY ORS

Why low osmolarity?

In stool output
Dehydration
need for IV fluids
In both Na & Glucose results in in
osmolarity

Overall – 224mOsm/L(Glu-84 & Na-60)

 LOW OSMOLARITY ORS
Reduced osmolarity ORS grams Reduced osmolarity ORS Mmol/
/litre litre
Sodium chloride 2.6 Sodium 75

Glucose, anhydrous 13.5 Chloride 65

Potassium chloride 1.5 Glucose 75

Trisodium citrate, dihydrate 2.9 Potassium 20

Citrate 10

Total Weight 20.5 Total Osmolarity 245

 Standard ORS Reduced Osmolarity ORS solutions
solution

(mEq or mmol/l) (mEq or (mEq or (mEq or

mmol/l) mmol/l) mmol/l)

Glucose 111 111 75-90 75

Sodium 90 50 60-70 75

Chloride 80 40 60-70 65

Potassium 20 20 20 20

Citrate 10 30 10 10

Osmolarity 311 251 210-260 245

 RICE BASED ORS
Tastes better and provides more calories than the glucose-based
culturally acceptable,
reduces stool volume (by about 40 percent)
shortens the duration of diarrhea in both cholera and other severe
diarrheal diseases.

Starches other than rice, including wheat flour and maize, have
also been shown to reduce stool volume in patients with cholera.

reduce diarrhea by adding more substrate to the gut lumen

without increasing osmolality, thus providing additional glucose
molecules for glucose-mediated absorption.
 HOME AVAILABLE ORS
SUGAR - 3 Finger scoop &
Salt - 3 Finger pinch &
1L - boiled & cooled water

Rice kanji , tea dicoction , lemon water, etc.,

 Home based ORS
Home-prepared solutions - recommended for use
by parents to give to their child immediately after
an attack of diarrhoea starts and BEFORE any
signs of dehydration occur

Basically, the idea is to PREVENT dehydration

and PRESERVE good nutritional status by
maintaining fluid and food intake.
 HOME MADE ORS
Home made ORS recipe
Preparing a 1 (one) litre oral rehydration solution [ORS] using Salt,
Sugar and Water at Home
Mix an oral rehydration solution using one of the following recipes;
depending on ingredients and container availability:

Ingredients:
one level teaspoon of salt
eight level teaspoons of sugar
one litre of clean drinking or boiled water and then cooled
5 cupfuls (each cup about 200 ml.)
 ORS WITH NUTRIENTS
Why nutrients?

Nutrients help in absorption of Na & H2O

Hastens recovery of intestinal epithelium

 ADVANTAGES OF ORS
More physiological
Easy to administer
Cost effective
Home equivalents available
Free of cost at PHC ,Subcenters
Readily available & needs no sterilisation
 DISADVANTAGES OF ORS
INEFFECTIVE when,
Stool purge is high (>5ml/kg/hr)
Persistent vomitting
Incorrect preparation /administration
Abd. Distension & Ileus
Glusose malabsorption cases

Most importantly , ORS doesn’t reduce severity /

duration of diarrhoea
 OTHERS
Another possible way to produce a better oral
rehydration solution would be to combine the
standard solution with nutrients and vitamins
that have been shown to modify the courses of
diarrheal illnesses, probably by their
antioxidative actions. These include vitamin
A, zinc, magnesium, selenium, and
other micronutrients
 ZINC TREATMENT
zinc deficiency caused by limitations in the diet is a
common problem and a contributing factor to the
high prevalence of some infectious diseases in
children, including pneumonia and diarrhea.
Recent studies suggest that a 10- to 14-day therapy
of zinc treatment can considerably reduce the
duration and severity of diarrheal episodes, decrease
stool output, and lessen the need for hospitalization.
Zinc may also prevent future diarrhea episodes for
up to three months.
 ADVICE
REST THE GUT Theory
Give as much as ORS –NO Harm in feeding excess
DO NOT stop breast feeding during ORT
Non breast fed infants(<6m)- additional 100-200ml of
clean water during first 4 hrs
<2yrs -1 teaspoon q1-2M
Older children – freq. sips in a cup
If child vomits – wait for 10 mins & start again slowly
Avoid high fibre diet during ORT
Staple foods – to be enriched with fats& oils/sugars
eg:rice +milk/curd &sugar
 REFERENCES
The New England Journal Of Medicine
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&d
b
http://www.pjonline.com/Editorial/20040508/articles/p580oralreh
ydration.html
http://www.rehydrate.org/ors/rice_based_ors.htm
http://www.rehydrate.org/ors/solution_for_survival.htm
http://www.unu.edu/unupress/food/8F172e/8F172E04.htm
http://www.supply.unicef.dk/Catalogue/bulletin9.htm
http://www.eddcontrol.org/index.htm#ORS
PARK Textbook of medicine
Text book on PAEDIATRICS by O.P.Ghai
Control of diarrhoeal diseases by WHO
ORS