Ors

ors

1. Oral Rehydration Salts Dr. simran jain IInd yr DNB Pediatrics CHRC

2. Cont… More than 5 million children under the age of 5 years die every year due to diarrhoea . In India, more than 1 million children get killed by this miserable disease known as diarrhoea . Before the advent of ORT, death from diarrhea was the leading cause of infant Between 1980 and 2006, With the introduction of ORT, infant deaths, worldwide have decreased the number of, from 5 to 3 million per year.

3. Introduction Worldwide, diarrhea claims several million lives annually, mostly those of infants. Poverty, crowding, and contaminated water supplies all contribute. Almost all of these deaths could have been prevented with adequate fluid replacement. Incidence is much lower in developed nations but remains one of the two most common reasons for visits to pediatric emergency departments

4. What is diarrhoea ? Increases in volume or fluidity of stools, changes in consistency, and increased frequency of defecation. Blood in stool indicate an acute diarrhoeal illnesses or dysentery, irrespective of frequency. “Passage of stools at least three times or a single loose stool in a 24 h period” WHO

5. Cont…. Diarrhoeal disorders are divided into: Acute Diarrhoea The most usual form of diarrhoeal illness, have an abrupt onset, resolve within 14 days and are mostly caused by infections Persistent Diarrhoea Diarrhoea which persists for longer than 14 days Chronic Diarrhoea Duration of symptoms is longer than a month

6. Pathophysiology of diarrhea Fluid from the body enters the intestinal lumen ( isosmotic i.e approx.142 mEq /L Na + ) during digestion. A healthy individual secretes 2000–3000mg of sodium per day into the intestinal lumen. Nearly all of this is reabsorbed so that sodium levels in the body remain constant. In a diarrheal illness, sodium rich intestinal secretions are lost before they can be reabsorbed. This can lead to a life-threatening hyponatraemia within hours. This is the motivation for sodium and water replenishment in ORT.

7. Ion exchange in intestine

8. Physiological basis of using ORT in Diarrhoea Sodium passes into epithelial cells by co-transport via the SGLT1 protein. From the intestinal, sodium is pumped by active transport by the Na + K + pump through to extracellular space. The Na + K + ATPase pump moves 3 Na + in exchange for 2 K + This creates a “downhill” sodium gradient within the cell. SGLT proteins use energy from sodium gradient to transport glucose into the cell against the glucose gradient..

9. Cont…. The GLUT uniporters then transport glucose across membrane. SGLT1 protein requires 2 Na + to co-transport one molecule of glucose (as galactose ). Without sodium, intestinal glucose is not absorbed. This is why oral rehydration salts (ORS) include both sodium and glucose. For each cycle, hundreds of water molecules move into the epithelial cell, slowly rehydrating the patient.

10. Oral rehydration therapy Most diarrhea-related deaths in children are due to dehydration…… ….loss of large quantities of water and electrolytes from the body in the liquid stool. Many of these deaths can be prevented with the use of oral rehydration therapy (ORT). Oral rehydration therapy (ORT) is a type of fluid replacement used as a treatment for dehydration. It involves drinking water mixed with sugar and salt and other home available fluids, while continuing to eat.

11. Oral rehydration solution So as soon as diarrhoea starts,  it is essential to give the child extra drinks to replace the liquid being lost. Oral Rehydration solution (ORS) is the cheap, simple and effective way to treat dehydration caused by diarrhoea .  ORS drink contains the main elements that are lost from the body during diarrhoea . effective in treating dehydration resulting from all types of acute diarrhoeal diseases.  ORS drinks should be given to the child every time a watery stool is passed.

12. Oral rehydration salts

13. PRINCIPLE of ORS Glucose when given orally enhances the intestinal absorption of salt & water . Thus it can correct electrolyte & water deficit . WHOM CAN IT BE GIVEN? All age groups IN WHAT CONDITIONS CAN IT BE GIVEN? All aetiologies All countries

14. Types of ORS?? Sodium bicarbonate based Trisodium citrate based Reduced osmolarity ORS Super ORS

15. Sodium bicarbonate based ORS Composition Contents (gm) NaCl 3.5 Glucose 20.0 KCl 2.5 Sodium bicarbonate 2.5

16. Trisodium citrate based ORS Composition Contents (gm) NaCl 3.5 Glucose 20.0 KCl 1.5 Trisodium citrate 2.0

17. Bicarbonate vs. Tricitrate ORS Bicarbonate-based ORS Less stable Stool output not reduced Tricitrate -based ORS More stable Less stool output in high output diarrhoea Tri Na citrate-increases intestinal absorption of Na & water

18. WHO ORS Osmolarity Na + 90mM Cl + 80mM Glucose 110mM K + 20mM Citrate 10mM TOTAL 310mM

19. Any adverse effect of this WHO ORS ???? How to overcome this???? Possible adverse effects is hyper tonicity in net fluid absorption We should reduce the osmolarity of the ORS

20. Reduced osmolarity ORS Contents (gm) NaCl 2.6 Glucose 13.5 KCl 1.5 Trisodium citrate 2.9 Composition

21. Osmolarity of this new ORS Na + 75mM Cl + 65mM Glucose 75mM K + 20mM Citrate 10mM TOTAL 245mM

22. Advantages of low osmolarity ORS Increased efficacy of ORS in non cholera diarrhoea Need for unscheduled supplement IV therapy in children fell by 33 %. Stool output decreased by 20 %. Vomiting decreased by 30 %. Safe & effective.

23. DOSAGE & REQUIREMENT? Age <4mths 4-11mths 1-2yrs 2-4yrs 5-14yrs ≥15yrs Wt.(kg) <5 5-7.9 8-10.9 11-15.9 16-29.9 ≥30 Soln.(ml) 200-400 400-600 600-800 800-1200 1200-2200 2200-4000 If the child’s weight is known….. ….. the amount of ORS soln.for rehydration during the first 4hrs may be calculated as 75ml/kg

24. How to administer??? Wash your hands with soap and water before preparing solution. Prepare a solution, in a clean pot, by mixing 1 packet of Oral Rehydration Salts (ORS)  with one litre of clean drinking water. Stir the mixture till all the contents dissolve. Wash your hands and the baby's hands with soap and water before feeding solution. Give the sick child as much of the solution as it needs, in small amounts frequently.

25. Cont….. Give child alternately other fluids - such as breast milk and juices. Continue to give solids if child is four months or older.  If the child still needs ORS after 24 hours, make a fresh solution. ORS  does not  stop diarrhoea . It prevents the body from drying up. The diarrhoea will stop by itself. If child vomits, wait ten minutes and give it ORS again. Usually vomiting will stop. If diarrhoea increases and /or vomiting persists, take child over to a health clinic.

26. How to prepare oral rehydration solution

27. How to prepare….

28. Rules <2yrs :- give 1-2 teaspoon every 2-3 minutes Older children :- offer frequent sips out of a cup Adults:- drink as much as they can Give the estimated amount within 4hrs Wait for 10 minutes Give a teaspoonful every 2-3 minutes If the child vomits??

29. Cont….. If the child wants to drink more than the estimated amount ? If the child refuses to drink ? If the child is breast fed ? Non breast fed infants less than 6 months No harm , give more See whether the signs of dehydration has disappeared If yes Treat similar to a non dehydrated diarrheal child. Nursing + treatment with ORS solution Along with ORS solution give 100-200 ml of clean water for first 4 hrs

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

31. Achievements & benefits Low cost treatment Treatment of the patient in their own homes Ingredients are inexpensive and readily available Drinking water is sufficient (no need for boiling or other means of sterilization) Breakthrough in the fight against cholera and other diarrheal diseases Mortality rate in cholera has been reduced to 0.11% from 49.3%

32. Thank you