July 29 is National ORS day. As we all know oral rehydration therapy has brought a tremendous
breakthrough in the treatment of diarrhoea. Before oral rehydration therapy, ADD was the leading
cause of infant mortality. But with oral rehydration therapy, there is a significant decrease in death
from diarrhoea. Most diarrhoea related death in children are due to dehydration. Worldwide
diarrhoea still kills millions of infants annually. Just in India, according to WHO estimations,
diarrhoea killed 321 children every day in 2015.
ORS is an oral rehydration salt mixture recommended by WHO. History of ORS can be dated as far as
2500 years ago when ancient physician Sushrutha described treating ADD with rice water and
coconut juice. ORT (Oral Rehydration Therapy) using ORS was first started in 1986-87. ORS packets
are distributed by the Central Government and are available free of cost. Nowadays prepared ORS
with different fruit flavours are available in the market in small ready to use packaging.
Preparation requires first washing hands with soap and water. Take a clean container and dissolve
one packet of ORS in one litre of clean drinking water and stir with a spoon. Wash the baby’s hands
before feeding. Give in small sips.
The principle of Oral Rehydration Therapy is that glucose enhances salt and water absorption from
the intestine. Then it can correct electrolyte and water deficit. ORS can be given to all age groups.
However, in very young babies, plain water or breastfeeds should be given in between. In children,
less than two years 50-100mls can be given for each loose stool. .In children of2-10 years about
100-200ml is given for each loose stool. If the child vomits wait for 10minutes before giving the
solution, this time more slowly. .Give ORS in small spoons at 1-2minute intervals and give only 1-2
spoons at a time. Then there is more chance of fluid being retained in the body. Large gulps of fluid
may result in vomiting. There may be a minimal risk of hypernatremia developing when ORS is given
in neonates and very young babies with immature kidney functions. However, this risk is avoided by
giving one part of water with two parts of ORS. After correction of dehydration, ORS with a lower
concentration will be needed for the maintenance of fluid and electrolyte balance.
There are four types of ORS:
- Standard ORS
- Low osmolarity ORS - advantages include a) decrease vomiting b) decrease hypernatremia and c)decrease volume of stool output.
- Super ORS - here glucose is replaced by cereals (rice powder), amino acids (like glycine). There are also ORS with zinc supplement.
- Trisodium Citrate based ORS - this makes ORS more stable. It is useful in high output diarrhoea to decrease the volume of stool
Dr Suja.P (1983 Batch)
MBBS.MD (paediatrics), MPhil (Behavioural sciences)
Paediatrician ESI hospital Vadavathoor. Kottayam