Oral Rehydration Therapy

1. Oral rehydration Oral rehydration
therapytherapy
Jervin manoJervin mano

2. What is oral What is oral
rehydration therapy?rehydration therapy?
Rehydrating a Rehydrating a
dehydrated dehydrated
person through person through
oral route is oral route is
called as ORTcalled as ORT. .

3. AIMAIM
To correct the To correct the
water water
&electrolyte &electrolyte
deficietdeficiet
To prevent To prevent
dehydrationdehydration
Reduce mortalityReduce mortality

4. PROOF?PROOF?
A study in A study in
kolkatta kolkatta
showed showed
90-95% of all 90-95% of all
cases of cases of
cholera cholera
&acute &acute
diarrhoea can diarrhoea can
be treated be treated
with ors alonewith ors alone
..
 Mortality rate in cholera has been reducedMortality rate in cholera has been reduced
to 0.11% from 49.3%to 0.11% from 49.3%

6. PRINCIPLEPRINCIPLE
Glucose when Glucose when
given orally given orally
enhances the enhances the
intestinal intestinal
absorption of absorption of
salt & water.salt & water.
Thus it can Thus it can
correct correct
electrolyte & electrolyte &
water deficit.water deficit.

7. WHOM CAN IT BE WHOM CAN IT BE
GIVEN?GIVEN?
IN WHAT IN WHAT
CONDITIONS CAN CONDITIONS CAN
IT BE GIVEN?IT BE GIVEN?
All age groupsAll age groups
All aetiologiesAll aetiologies
All countriesAll countries

8. TYPES OF ORS??TYPES OF ORS??
Sodium bicarbonate basedSodium bicarbonate based
Trisodium citrate basedTrisodium citrate based
Reduced osmolarity ORSReduced osmolarity ORS
Super ORSSuper ORS

9. Sodium bicarbonate Sodium bicarbonate
based ORSbased ORS
CompositionComposition
2.5Sodium
bicarbonate
2.5KCl
20.0Glucose
3.5NaCl
(gm)Contents

10. DisadvantagesDisadvantages
Less stableLess stable
Stool output not Stool output not
reducedreduced

11. Trisodium Trisodium
citrate based citrate based
ORSORS

12. CompositionComposition
2.0Trisodiu
m citrate
1.5KCl
20.0Glucose
3.5NaCl
(gm)Contents

13. OsmolarityOsmolarity
310mMTOTAL
10mMCitrate
20mMK
+
110mMGlucose
80mMCl
+
90mMNa
+

14. Advantages
More stableMore stable
Less stool Less stool
output in high output in high
output output
diarrhoeadiarrhoea
Tri Na Tri Na
citrate-citrate-
increases increases
intestinal intestinal
absorption of absorption of
Na & waterNa & water

15. Possible adverse Possible adverse
effectseffects
Hyper Hyper
tonicity in tonicity in
net fluid net fluid
absorptionabsorption

16. To overcome thisTo overcome this

17. We should reduce the We should reduce the
osmolarity of the ORSosmolarity of the ORS

18. Reduced Reduced
osmolarity osmolarity
ORSORS

19. CompositionComposition
Trisodium
citrate
KCl
Glucose
NaCl
Contents
2.9
1.5
13.5
2.6
(gm)

20. OsmolarityOsmolarity
TOTAL
Citrate
K
+
Glucose
Cl
+
Na
+
245mM
10mM
20mM
75mM
65mM
75mM

21. AdvantagesAdvantages
Increased efficacy of ORS in non Increased efficacy of ORS in non
cholera diarrhoeacholera diarrhoea
Need for unscheduled supplement Need for unscheduled supplement
IV therapy in children fell by IV therapy in children fell by
33%.33%.
Stool output decreased by 20%.Stool output decreased by 20%.
Vomiting decreased by 30%.Vomiting decreased by 30%.
Safe & effectiveSafe & effective..

23. DOSAGE & DOSAGE &
REQUIREMENT?REQUIREMENT?
If the child’s weight is known, If the child’s weight is known,
the amount of ORS soln.for the amount of ORS soln.for
rehydration during the first 4hrs rehydration during the first 4hrs
may be calculated as 75ml/kgmay be calculated as 75ml/kg

24. DOSAGE & REQUIREMENT?DOSAGE & REQUIREMENT?
2200-4
000
1200-2
200
800-12
00
600-80
0
400-60
0
200-40
0
Soln.
(ml)
30<16-29.
9
11-15.
9
8-10.95-7.9<5Wt.
(kg)
15yrs<5-14yr
s
2-4yrs1-2yrs4-11m
ths
<4mth
s
Age

25. HOW TO HOW TO
ADMINISTER???ADMINISTER???
Teach the Teach the
mothermother
ORSORS

26. RULESRULES
<2yrs :- give 1-2 teaspoon every <2yrs :- give 1-2 teaspoon every
2-3 minutes2-3 minutes
Older children :- offer frequent Older children :- offer frequent
sips out of a cupsips out of a cup
Adults:- drink as much as they Adults:- drink as much as they
cancan
Give the estimated amount Give the estimated amount
within 4hrswithin 4hrs

27. If the child vomits??If the child vomits??
Wait for 10 minutesWait for 10 minutes
Give a teaspoonful every 2-3 Give a teaspoonful every 2-3
minutesminutes

28. If the child wants to drink more If the child wants to drink more
than the estimated amount ?than the estimated amount ?
No harm , give moreNo harm , give more

29. If the child refuses to drink ?If the child refuses to drink ?
See whether the signs of See whether the signs of
dehydration has disappeareddehydration has disappeared
If yesIf yes
Treat similar to a non dehydrated Treat similar to a non dehydrated
diarrheal child.diarrheal child.

30. If the child is breast fed ?If the child is breast fed ?
Nursing + Nursing +
treatment treatment
with ORS with ORS
solutionsolution

31. Non breast fed infants less Non breast fed infants less
than 6 monthsthan 6 months
Along with ORS solution give Along with ORS solution give
100-200 ml of clean water for 100-200 ml of clean water for
first 4 hoursfirst 4 hours

32. Where is it Where is it
available ?available ?
PHCPHC
Sub centersSub centers
HospitalsHospitals
Chemist shopsChemist shops

33. Cost?Cost?
FreeFree

34. How to prepare How to prepare
it ?it ?
Dissolve the entire contents of Dissolve the entire contents of
the packet in 1l of drinking the packet in 1l of drinking
waterwater
It should be used within 24 It should be used within 24
hourshours

35. If ORS packets are If ORS packets are
not available ?not available ?
Table salt (5gm) + sugar (20gm) Table salt (5gm) + sugar (20gm)
in 1l of drinking waterin 1l of drinking water

36. Administer till Administer till
the diarrhea the diarrhea
stopsstops
Earlier the Earlier the
treatment is treatment is
instituted the instituted the
better is for better is for
the patientthe patient

37. ORT programmeORT programme
First started in 1986-1987First started in 1986-1987
Implemented through RCH Implemented through RCH
programmeprogramme
ORS packets are supplied by the ORS packets are supplied by the
central govt.central govt.
Twice a year 150 packets of ORS Twice a year 150 packets of ORS
are provided as apart of drug kit are provided as apart of drug kit
supplied to all sub centers in the supplied to all sub centers in the
countrycountry

38. ThemeTheme
Adequate nutritional care of Adequate nutritional care of
child with diarrhoeachild with diarrhoea
Proper advice to mother in Proper advice to mother in
feedingfeeding

39. Achievements & Achievements &
benefitsbenefits
Low cost treatmentLow cost treatment
Treatment of the patient in their Treatment of the patient in their
own homesown homes
Ingredients are inexpensive and Ingredients are inexpensive and
readily availablereadily available

40. Achievements & Achievements &
benefitsbenefits
Drinking water is sufficient (no Drinking water is sufficient (no
need for boiling or other means need for boiling or other means
of sterilization)of sterilization)
Breakthrough in the fight Breakthrough in the fight
against cholera and other against cholera and other
diarrheal diseasesdiarrheal diseases
Mortality rate in cholera has Mortality rate in cholera has
been reduced to 0.11% from been reduced to 0.11% from
49.3%49.3%