Dr Ravinder K Gupta, Dr Sharvil Dhar
Diarrhoea is the passage of loose stools in excessive frequency and quantity thus causing dehydration due to fluid and electrolyte loss. Diarrhoea is caused by poor sanitation and hygiene, resulting in dehydration and depriving the body of water and electrolytes that are essential for survival. It is one of the leading causes of death among young children. In this regard, ORS is an inexpensive solution of glucose and electrolytes given to treat cases of dehydration and is able to save 5 million young lives every year in India.
Oral Rehydration Therapy ( ORT ) is a type of fluid replacement used to prevent and treat dehydration due to diarrhoea. Dehydration from diarrhoea can be treated simply, effectively and cheaply in all age groups by giving orally an adequate glucose-electrolyte solution called Oral Rehydration Solution ( ORS ). It is very popularly called as “JEEVAN RAKHSHAK GHOL” Most patients can be rehydrated entirely with ORS only. The use of Oral Rehydration Therapy has been estimated to decrease the risk of death from diarrhoea to a great extent ( 90 % ).
Dehydration was a major cause of death during the 1829 Cholera pandemic in Russia and Europe. In 1831, intravenous fluid therapy was prescribed to treat dehydration cases. However, in 1953 it was an Indian Physician named Hemendra Nath Chatterjee who treated mild cholera cases with ORT and published his results in Lancet journal.
ORT came into common use for rehydration after the discovery that glucose promoted sodium and water absorption during the Cholera outbreak in the 1960s.
In 1971, during the Bangladesh Liberation War, an epidemic of Cholera ensued among the refugees. A physician named Dilip Mahalanabis prepared and distributed an improved ORS to 3000 patients. The mortality rate was only 3.6 % among those given ORS as compared to higher mortality seen in those given IV fluid therapy, thus highlighting the importance of giving ORS.
In the year 1980, World Health Organization recognized ORT and began a global program for its dissemination. It is on the World Health Organization’s list of Essential Medicines. Since the WHO began using ORT as its primary means of fighting diarrhoea, the annual death rate among children under 5 years suffering from acute diarrhoea has fallen from 5 million to less than 1 million.
Unlike other fluids, the ratio of the ingredients in an ORS matches what the body needs to recover from a diarrheal illness. The recommended formulation for Oral Rehydration Therapy includes Glucose, Sodium Chloride, Trisodium Citrate and Potassium Chloride. Glucose in the solution increases the uptake of sodium and water by the intestines, and the potassium chloride and trisodium citrate help prevent hypokalemia and acidosis respectively, which are both common side effects of diarrhoea. Thus, this solution corrected both fluid and electrolyte deprivation due to diarrhoea.
In 2003, WHO and UNICEF recommended that a low osmolarity solution ( 245 mOsm /L ) be used instead of the earlier standard preparation of higher osmolarity ( 311 mOsm / L ). This low osmolarity solution reduces stool volume in children with diarrhoea by about 25 %.
Mild to moderate dehydration in children, both at home or in the hospital is best treated with ORS. However, patients with severe dehydration will need IV replacement therapy.
ADMINISTRATION :
ORS is cheap, effective and easy to administer. The salts can be prepackaged and typically include a combination of Sodium, Glucose, Potassium and Citrate to be mixed with clean drinking water. The solution is prepared by mixing one packet of Oral Rehydration Salts with one litre of clean drinking water. The mixture is then stirred till all the contents are dissolved. This solution is then administered to the child in small quantities frequently. At home, after each loose stool give 50-100 ml of ORS for children less than 2 years of age and 100- 200 ml of ORS for children between 2 – 10 years of age.
ORT has been shown to correct dehydration in more than 90 % of patients with acute diarrhoea.
The homemade solution can also be prepared easily at home by mixing 6 teaspoons of sugar and half a teaspoon of salt mixed in one litre of clean water. A bit of lemon juice can also be added to the solution. Other home-available fluids that can also be used are breast milk, salted rice water, salted yoghurt water and coconut water.
WHEN NOT TO USE ORS?
ORS should be used with caution in children with heart or kidney disease. Intravenous replacement therapy is given instead of ORS in cases of reduced consciousness and children in shock and decreased urine output. If vomiting is continuing despite proper administration of ORS , Intravenous fluids should be considered. The claim that ORS is not suitable for diabetics is just a myth. The truth is ORS can be a healthy drink for people suffering from such conditions. However, moderate amounts of the respective solution can be consumed as long as they don’t disturb the optimal insulin levels. Pregnant women can also opt for this solution as it is safe, provides immediate results, and is affordable.
Water content in the body is essential for the proper functioning of vital organs. The loss of water from the body ( dehydration ) is serious in cases of infants and children. ORS is a simple and easy-to-make solution that restores the body’s electrolyte and fluid balance. Thus it is an affordable method to treat dehydration due to diarrhoea. Awareness is the first step towards any solution and mitigation of a problem. ORS DAY aims to build awareness about the importance of ORS in the general public so that widespread use of ORS is encouraged among people.
A combination of oral rehydration salts (ORS) and zinc treatment is a low-cost and effective solution to treat childhood diarrhoea, as it both reduces diarrhoeal episode symptom severity, duration and prevents subsequent episodes from occurring. UNICEF advocates and encourages countries to only use co-packaged ORS and zinc in order to ensure greater adherence to WHO’s treatment guidelines.
ORS day was first observed by the Indian Academy of Pediatrics (IAP) in 2001 with the intention of lowering the cases of childhood diarrhoeal deaths. This day day is celebrated every year on 29 th July .
“ORS DAY” THEME FOR 2023: ” O- Only, R- Rational, S – Solution for diarrhoea”
“ORS WEEK” SLOGAN FOR 2023: “Oral Rehydration, No More Dehydration”
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