Imporatant information on Oral Rehydration Therapy (ORT) and how to make Oral Rehydration Salts Drink (ORS)
Vomiting seldom prevents successful management of dehydration since much of the fluid is still absorbed. If the person vomits, the World Health Organization (WHO) recommends taking a pause of five to ten minutes and then restarting the solution more slowly. For example, a child under two can be given a teaspoonful of fluid every two to three minutes. Older people can take frequent sips from a cup.
Since its introduction and development for widespread use in the latter part of the 20th century, oral rehydration therapy has decreased human deaths from dehydration in diarrheal illnesses, especially in cholera epidemics and in children. It represents a major advance in global public health. It is on WHO’s List of Essential Medicines, a list of the most important medication needed in a basic health system.
Before the introduction of ORT, diarrhea was the leading cause of death in children under the age of one in developing countries. Between 1980 and 2006, the introduction of ORT is estimated to have decreased the number of infant deaths, worldwide, from 5 to 3 million per year. In 2008, diarrhea was the second most common cause of death in children under five years (17 percent), (after pneumonia (19 percent)). Moreover, by the same year, the use of ORT in children under five had declined.
In situations where an oral rehydration solution is not available, homemade solutions are sometimes used. However, there is currently insufficient evidence to recommend usage of these homemade solutions.
ORT is less invasive than the other strategies for fluid replacement, specifically intravenous (IV) fluid replacement. Mild to moderate dehydration in children seen in an emergency department is best treated with ORT. Persons taking ORT should eat within 6 hours and return to their full diet within 24–48 hours.
The degree of dehydration should be assessed before initiating ORT. ORT is suitable for people who are not dehydrated and those who show signs and symptoms of mild to moderate dehydration. People who have severe dehydration should seek professional medical help immediately and receive intravenous rehydration as soon as possible to rapidly replenish fluid volume in the body.
ORT should be discontinued and fluids replaced intravenously when vomiting is protracted despite proper administration of ORS, signs of dehydration worsen despite giving ORT, the person is unable to drink due to a decreased level of consciousness, or there is evidence of intestinal blockage or ileus. ORT might also be contraindicated in people who are in hemodynamic shock due to impaired airway protective reflexes. Short-term vomiting is not a contraindication to receiving oral rehydration therapy. In persons who are vomiting, drinking oral rehydration solution at a slow and continuous pace will help the vomiting to resolve.
WHO and UNICEF jointly have developed official guidelines for the manufacture of ORS and describe acceptable alternative preparations, depending on material availability. Commercial preparations are available as either pre-prepared fluids or packets of oral rehydration salts (ORS) ready for mixing with water.
The formula for the current WHO-ORS (also known as low-osmolar ORS or reduced-osmolarity ORS) is 2.6 grams (0.092 oz) salt (NaCl), 2.9 grams (0.10 oz) trisodium citrate dihydrate (C
2O), 1.5 grams (0.053 oz) potassium chloride (KCl), 13.5 grams (0.48 oz) anhydrous glucose (C
6) per litre of fluid.
A basic oral rehydration therapy solution can also be prepared when packets of oral rehydration salts are not available. It can be made using 6 level teaspoons (25.2 grams) of sugar and 0.5 teaspoon (2.1 grams) of salt in 1 litre of water. The molar ratio of sugar to salt should be 1:1 and the solution should not be hyperosmolar. The Rehydration Project states, “Making the mixture a little diluted (with more than 1 litre of clean water) is not harmful.”
The optimal fluid for preparing ORS solution is clean water. However, if this is not available the usually available water should be used. ORS should not be withheld simply because the available water is potentially unsafe. Rehydration takes precedence.
When ORS packets and suitable teaspoons for measuring sugar and salt are not available, WHO has recommended that home made gruels, soups, etc. may be considered to help maintain hydration. A Lancet review in 2013 emphasized the need for more research on appropriate home made fluids to prevent dehydration.
Reduced-osmolarity oral rehydration salts
In 2003, WHO and UNICEF recommended that the osmolarity of ORS be reduced from 311 to 245 mOsm/l . These guidelines were also updated in 2006. This recommendation was based on multiple clinical trials showing that the reduced osmolarity solution reduces stool volume in children with diarrhea by about twenty-five percent and the need for IV therapy by about thirty percent when compared to standard ORS. The incidence of vomiting is also reduced. The reduced osmolarity ORS has lower concentrations of glucose and sodium chloride than the original ORS, but the concentrations of potassium and citrate are unchanged.
The reduced osmolarity ORS has been criticized by some for not providing enough sodium for adults with cholera. Clinical trials have, however, shown reduced osmolarity ORS to be both safe and effective for adults and children with cholera.
ORT is based on evidence that water continues to be absorbed from the gastrointestinal tract even while fluid is lost through diarrhea or vomiting.
WHO/UNICEF guidelines suggest ORT should begin at the first sign of diarrhea in order to prevent dehydration. Babies may be given ORS with a dropper or a syringe. Infants under two may be given a teaspoon of ORS fluid every one to two minutes. Older children and adults should take frequent sips from a cup. WHO recommends giving children under two a quarter- to a half-cup of fluid following each loose bowel movement and older children a half- to a full cup. If the person vomits, the carer should wait 5–10 minutes and then resume giving ORS.(Section 4.2) ORS may be given by aid workers or health care workers in refugee camps, health clinics and hospital settings. Mothers should remain with their children and be taught how to give ORS. This will help to prepare them to give ORT at home in the future. Breastfeeding should be continued throughout ORT.
Oral rehydration salts (ORS) is a special drink made up of sugars, salts, and clean water. It can help replace fluid loss from severe diarrhea or vomiting. Studies have shown ORS to be as effective as intravenous fluid administration when treating dehydration. ORS drinks can be made using purchased packets, like Pedialyte®, Infalyte®, and Naturalyte®. You can also make ORS drinks at home using clean water, salt, and sugar.
Making Your Own ORS Solution
1Wash your hands. Thoroughly wash your hands with soap and water before preparing the drink. Make sure you have a clean pitcher or bottle ready.
2Gather the ingredients. To make your own ORS solution, you’ll need:
- table salt (such as Kosher salt, iodized salt or sea salt)
- clean water
- granulated or powdered sugar
3Mix the dry ingredients. Add a half-teaspoon of table salt and 2 tablespoons of sugar into a clean container. You can use granulated or powdered sugar.
- If you don’t have a teaspoon to measure, you can use a fistful scoop of sugar and a three finger pinch of salt. But, this is not accurate and is not recommended.
4Add one liter of clean drinking water. If you cannot measure out a liter, add 5 cups of water (each cup is about 200 ml). Only use clean water. The water can be bottled water or recently boiled and cooled water.
- Be sure to only use water. Milk, soup, fruit juice or soft drinks cannot be used since they will make the ORS ineffective. Don’t add any extra sugar.
5Stir well and drink. Use a spoon or whisk to mix the ORS powder into the water. After a minute or so of vigorous stirring, the solution should be completely dissolved. Now, it is ready to drink.
- ORS solution can be refrigerated for 24 hours. Do not store it any longer.
Understanding ORS Drinks
1Ask your doctor if you need to take ORS drinks. If you have severe diarrhea or vomiting, your body will lose fluids, which can lead to dehydration. If so, you’ll notice: increased thirst, dry mouth, sleepiness, less frequent urination, dark yellow urine, headache, dry skin, and dizziness. If you experience any of these symptoms, call your doctor. You’ll probably be told to start taking ORS drinks if the symptoms aren’t severe.
- Left untreated, dehydration can become severe. Severe dehydration symptoms include: very dry mouth and skin, very dark yellow or brown urine, loss of skin elasticity, lowered pulse rate, sunken eyes, seizure, generalized body weakness, and even coma. If you or the person you’re caring for show severe dehydration symptoms, get emergency help.
2Understand how ORS drinks can prevent severe dehydration. ORS drinks are designed to replace lost salt content and improve absorption of water by the body. At the first signs of dehydration, you should take ORS. This mainly helps by re-hydrating the body. It is easier to prevent dehydration early on by drinking ORS drinks than to cure it.
- Severe dehydration will require hospitalization and intravenous fluid administration. But, if caught early, ORS drinks can be prepared at home to treat mild dehydration.
3Learn how to take ORS drinks. Sip ORS drinks throughout the day. You can drink it along with eating meals. If you vomit, take a break from drinking ORS. Wait 10 minutes, then drink the solution again. If you’re nursing and treating a baby, you must continue breast feeding while treating with ORS. You can keep using ORS until diarrhea has stopped. The following tells you how much ORS you must give to:
- Babies and toddlers: 0.5 liter of ORS drink every 24 hours
- Children (2 to 9 years old): 1 liter of ORS drink every 24 hours
- Children (more than 10 years old) and adults: 3 liters (0.79 US gal) of ORS drink every 24 hours
4Know when to see a doctor if you’re suffering from diarrhea. Symptoms should start to disappear a few hours after drinking the ORS solution. You should start urinating more and the urine will start to look light yellow or almost clear. If symptoms do not improve, or if any of the following symptoms begin, get immediate medical help:
- presence of blood in diarrhea or black, tarry stools
- persistent vomiting
- high fever
- very dehydrated (feeling dizzy, lethargic, sunken eyes, no urination in the past 12 hours)
- Diarrhea usually stops in three or four days. The real danger is the loss of liquid and nutrients from the child’s body, which can cause dehydration and malnutrition.
- Encourage the child to drink as much as possible.
- You can purchase ORS packets from drugstores or pharmacies. Each packet makes one serving and has 22 grams (0.78 oz) of powder. Follow the specific package instructions to mix it up.
- The BRAT diet (bananas, rice, applesauce and toast) helps individuals rebound from bouts of diarrhea and in some cases can prevent further dehydration from happening, as these foods are easy on the gastrointestinal system.
- If you’re suffering from diarrhea, consider taking zinc supplements. 10 mg to 20 mg of zinc can be taken every day for 10–14 days after an initial bout of diarrhea.This replenishes zinc content in the body and will prevent severity of further episodes. Zinc is rich in seafood such as oysters and crab, beef, fortified cereal, and baked beans. This foods can help, but supplementation will be needed to replenish the zinc lost during severe diarrhea.