ORAL REHYDRATION SALTS (ORS)

What are Oral Rehydration Salts?

Oral Rehydration Salts (ORS) are a mixture of electrolytes (salts), and carbohydrates (in the form of sugar), which are dissolved in water. They are used to replace salts and water that the body loses when you have dehydration caused by gastroenteritis, diarrhoea, or vomiting.
Unlike other fluids, the proportion of salts and sugar in an ORS matches what the body needs to recover.
Fizzy drinks, juices, tea, coffee and sports drinks are not suitable because of their high sugar content. High sugar content is likely to worsen diarrhoea.
Home-made salt / sugar mixtures are used in developing countries if rehydration drinks are not available but they have to be made carefully, as too much salt / sugar can be dangerous for children.

DOSAGE

Infants

1 Month to 1 Year

1–1½ times usual feed Volume

Children

1 year to 12 years

200 ml (~1 cup) after every loose motion.

Children

12 years and above

200 to 400 ml (~1 to 2 cups) after every loose motion

Adults

Drink freely as required

Use during pregnancy and lactation

There are no special problems with this group. The dose is the same as adult dose.

WHO-ORS

WHO recommends an osmolarity as stated in the table below

WHO-ORS	mOsmol / L
Sodium	75
Chloride	65
Glucose, anhydrous	75
Potassium	20
Citrate	10
Total Osmolarity	245

The therapeutic values of the substances are as follows:

Glucose facilitates the absorption of sodium (and hence water) on a 1:1 molar basis in the small intestine.
Sodium and potassium are needed to replace the body losses of these essential ions during diarrhoea and vomiting.
Citrate corrects the acidosis that occurs as a result of diarrhoea.

SIGNIFICANCE OF RIGHT OSMOLARITY

Osmolarity is a measure of the number of particles in a litre of the liquid they are dissolved in. The
measurement is given in milliosmoles per litre, or mOsmol / L for short.

The conditions of diarrhoea, vomiting, excessive sweating, burns and some medicines may change the
osmolarity of body fluids.

Therefore, it should be corrected by giving right osmolarity solutions to such patients.

Studies have shown that the effectiveness of ORS for treatment of children with acute diarrhoea is improved by giving ORS
having total osmolarity to 245 mOsmol / L.

ORS having total osmolarity of 245 mOsmol / L has the following advantages:

It reduces stool output or stool volume by about 25% when compared to higher osmolarity ORS.
It reduces vomiting by almost 30%.
It reduces the need for unscheduled intravenous (IV) injection therapy by more than 30%.

This last advantage is particularly important because this means reduced chances of hospitalization, and therefore reduced risk of hospital acquired infections, less disruption of breastfeeding, decreased use of needles (which remains a strong advantage especially in high HIV prevalence contexts), less cost, and in areas where IV therapy is not readily available less risk of diarrhoea related deaths.

ORS + ZINC

...Continue ORS till diarrhoea stops...

*The number of ORS sachets to be consumed per day is variable and depends on the patient's condition.

WHO and UNICEF recommend the use of ORS and Zinc for the treatment of acute diarrhoea. When ORS and Zinc team up together, diarrhoea doesn’t stand a chance.

In 2004, the World Health Organization (WHO) set a global recommendation to formalize ORS + Zinc as the gold standard treatment for diarrhoeal disease. WHO recommends the ORS along with routine use of Zinc supplementation, at a dosage of 20 mg / day for children older than 6 months or 10 mg / day in those younger than 6 months, for 10–14 days. ORS with Zinc is also recommended by the Indian Academy of Paediatrics (IAP) and Government of India for the treatment of acute diarrhoea.

Supplementary Zinc benefits children with diarrhoea because it is an important nutrient for protein formation, cell growth, immune function, and intestinal transport of water and electrolytes. Zinc is also important for normal growth and development of children both with and without diarrhoea.

Studies have shown that zinc treatment results in a 25% reduction in duration of acute diarrhoea and a 40% reduction in treatment failure or death in persistent diarrhoea.