ORS- Oral Rehydration Solution

A brief overview of composition of ORS and the rationale behind it.

1. O.R.S. The rationale behind the composition Oct. 2006

2. Historical Perspective Discovery of ORS A Combination of Scientific Vigour & Serendipity David R. Nalin

3. Two Approaches Analyzing the composition of stool. Analyzing the alteration in the composition of Extracellular Fluid in the body. Daniel Darrow, et al., J. Pediatr., 1949

4. 1962, Captain Phillips Combined Glucose & Sodium Ignorant of Co- transport physiology Dr David Nalin interview, 1992

5. The discovery that sodium transport and glucose transport are coupled in the small intestine so that glucose accelerates absorption of solute and water (is) potentially the most important medical advance this century August, 1978

6. Glucose Na + H 2 O K + ORS

7. Why Potassium? Long standing diarrhea leads to Hypokalemia. Malaise Muscle Weakness Paralytic ileus

8. Why Citrate? Tri Sodium citrate is a basic salt which corrects Acidosis.

9. MAGIC BULLET: The History Of Oral Rehydration Therapy Joshua Ruxin, Medical History, 1994.

10. Content Standard ORS Low Osmolar ORS Glucose 111 75 Sodium 90 75 Chloride 80 65 Potassium 20 20 Citrate 10 10 Osmolarity 311 245 WHO ORS

11. . ReSoMal (Rehydration Solution for Malnourished) UNICEF Technical Bulletin, Mar 2012

12. Rice based ORS Glucose replaced by starch & oligosaccharides Zinc ORS Zinc reduces the duration of diarrhea in pediatric patients. M.K.Bhan et al., N Engl J Med., 1995

13. Home – made ORS www.rehydrate.org

14. Substitutes for ORS Breast milk Rice porridge – Conjee Carrot juice If possible, Orange juice, Banana & coconut water may be added for Potassium

15. Severe Dehydration i.v., fluids Normal Saline 0.9%NaCl Ringer’s lactate Sodium Lactate Sodium Chloride Potassium Chloride Calcium Chloride

16. Further Reading: Essential Paediatrics, O.P.Ghai. www.rehydrate.org Magic Bullet: The History Of Oral Rehydration Therapy, Joshua Ruxin, Medical History, 1994.

17. Thank you!