Oral Rehydration salt

ORS history, its composition, various type of ORS and home-based fluid for dehydration

1. Oral Rehydration Salt (ORS) Dr Nishant Kumar Assistant Professor Department of Community Medicine Madhubani Medical College , Madhubani , Bihar

2. Introduction - A Brief History Captain Robert Allan Phillips -NAMRU-2( Naval Medical Research Unit)-1961 Dr Richard Cash , Dr David Nalin - 1967 , National Institute of Health - Dacca , East Pakistan. Chittagong Protocol Second Protocol Matlab-UNICEF , WHO Hemendra Nath Chatterjee - 1953.

3. ORS It is a firmly established strategy to successfully treat acute diarrhoea's due to all aetiologies. The aim is to prevent dehydration and reduce mortality. It is based on the observation that glucose given orally enhance the intestinal absorption of salt and water and is capable of correcting the electrolyte and water deficit.

4. ORS - Composition Sodium chloride 2.6gm/lts Glucose anhydrous 13.5gm/lts Potassium chloride 1.5gm/lts Trisodium Citrate, dehydrate 2.9gm/lts Total weight 20.5gm/lts

5. ORS- Reduced Osmolarity Sodium 75 mmol/liters Chloride 65 mmol/liters Glucose ,anhydrous 75 mmol/liters Pottassium 20mmol/liters Citrate 10 mmol/liters Total Osmolarity 245 mOsm/l Original ORS had 90meq/l of Sodium and total Osmolarity was 311 mOsm /l

6. Benefits Reduced osmolarity Reduced osmolarity of ORS avoids adverse affects of hypertonicity on net fluid absorption by reducing concentration of glucose and sodium chloride Lower sodium osmolarity improve the efficacy of ORS in children due to acute non cholera diarrhoea It causes decline in reduction in unscheduled IV fluid intervention by 33% , Stool output decrease by 20% and vomiting decrease by 30%.

7. Different Types of ORS- Rice Based ORS Taste better, provide more calories than glucose based ORS Culturally accepted , reduced stool volume( by 40%, ), shortens duration of diarrhoea in both cholera and other diarrhoea diseases. Starch other than rice , including wheat flour and maize can be used Decrease diarrhoea by adding more substrate to the gut lumen without increasing osmolality.

8. Super ORS These are special type of ORS which instead of mono sugar contains complex sugars. They may be rice based, or otherwise starch free.( glycine,/alanine based or glucose polymer based) They provide rehydration Reduce stool output Provide increase amount of calories (180Kcal/liters) With gradual release of glucose , prevent secondary disaccharide intolerance Contribute to weight gain , in malnourished children Have Short half life ( less than 10 hours) and to be prepared 2- 3 times a day.

9. Super Super ORS Addition of Zinc to Super ORS Improve absorption of water and electrolyte in intestine Faster regeneration of gut epithelium Increase level of enterocyte brush border enzyme Enhanced immune response leading to increased clearance of the pathogen.

10. Home Based ORS Home based solutions to be used by children to give to their child immediately after attack of diarrhoea starts. Breast milk , Gruel , Carrot Soup, Rice water, Green coconut water , Orange juice and mashed banana.

11. Thank You