ORAL REHYDRATION SALT (ORS)

What are the constituents?

The composition of the new, reduced osmolality ORS, as recommended by WHO, is as follows:
• Sodium chloride—2.6 g
• Glucose (anhydrous)—13.5 g
• Potassium chloride—1.5 g
• Trisodium citrate dehydrate—2.9 g
(Total weight of a packet = 20.5 g)
The new ORS was launched by WHO in January 2004.

What benefit does trisodium citrate offer over the use of sodium bicarbonate in ORS?
Trisodium citrate has the following advantages over sodium bicarbonate:
• It improves the shelf life of ORS.
• It helps in reducing the stool output probably through a direct action on the intestinal mucosa, enhancing
the absorption of sodium and water.

How is the ORS reconstituted?

The contents of the packet are dissolved in 1 L of drinking water.

What is the role of each of the constituents?

• Glucose facilitates absorption of sodium and hence water.
• Sodium and potassium replace the loss of these essential elements in diarrhea and vomiting.
• Citrate corrects the acidosis that occurs due to diarrhea and dehydration.

How is the new ORS different from the older formulation?

The new ORS contains lesser amount of sodium and glucose thereby resulting in a lower osmolarity
solution after reconstitution.
The reduced osmolarity of the solution has been shown to have the following benefits in addition to
correction of dehydration:
• It reduces the stool output by 25% in comparison to the original formula.
• It reduces vomiting by 30%.
• It has been demonstrated to reduce the need for IV therapy by more than 30%.

What is the indication?

Mild and moderate dehydration

What are the instructions given regarding reconstitution?

• Dissolve the entire content of the packet in 1 L of clean drinking water.
• The prepared solution should be used within 24 hours. Discard the solution left after 24 hours.
• The solution should be made fresh daily.
• It should not be boiled or sterilized otherwise.

What are the alternatives if ORS is not available?

The alternatives to ORS solution are home available fluids. Some examples are as follows:
• Green coconut water
• Rice water
• Dal water
• Buttermilk

Compiled by: Ramesh Kunwar, Public Health Officer

• Vegetable soup
• Unsweetened fresh fruit juice

Write some examples of drinks NOT suitable for treating dehydration.

• Soft drinks
• Sweetened fruit drinks
• Sweetened tea
The sugar in these drinks may lead to more dehydration due to high osmolarity.

What are the 4 rules of home treatment in diarrhoea?

The four rules of home treatment are:
1. Give extra fluid – as much as the child will take
2. Give zinc
3. Continue feeding
4. When to return (for a follow-up visit, or immediately if danger signs develop) WHO dia module

Mention some food items which contain zinc?

Zinc is present in good amount in meat, egg, grains, nuts and oilseeds. As the plant foods do not contain
good amount of zinc, therefore vegetarians are more prone to zinc deficiency.

Compiled by: Ramesh Kunwar, Public Health Officer