OIFFERENT TTPES OF

ORS
FORMULATIONS
AO7ANTACES ANO
OISAO7ANTACES
ORAL REHYDRATON SOLUTION
■ ORS -special combination of dry salts that, when
properly mixed with safe water, can help
rehydrate the body when a lot of fluid has been
lost due to diarrhoea.
■ Use of ORT prevents deaths of 1 million to 2
million children each yr
■ Basis of ORS -During Diarrhoea,even thou Na &
H2O are lost Glucose,AA, Dipeptides are
absorbed without difficulty.So…….
 WHO Recommended ORS types
ORS Bicarbonate ORS Citrate
■ NaCl -3.5g ■ NaCl
-3.5g ■ Trisod.citrate
■
■ NaHCo3
KCl -2.5g
-1.5g dehydrate -2.9g
■ Glucose -20g ■ KCl -1.5g
■ Water -1L ■ Glucose -20g
■ Water -1L
 TYPES OF DEHYDRATION
■ 50%cases - IsoNatremic type
■ 45% - Hyponatremic type
■ 5% - Hypernatremic type
■ Why K+ in ORS?
■ Why HCO3 in ORS?
 INDICATIONS
■ MILD to MODERTE dehydration

■ As MAINTENANCE therapy in severe

dehydration
 TYPES OF ORS FORMULATIONS
■ Glucose based ORS

■ Rice based ORS

■ Low osmolarity ORS

■ Home available ORS

■ ORS with other nutrients

 Oral Rehydration Therapy
■ Home made - sugar(40g) +salt (4g) solution

■ Food based -rice water(50g)+salt(40g)

-lassi + salt

■ Others -plain H2O, lemon water, coconut

water, rice kanji, dhal water
without salt
 WHAT IS NOT ORT?
■ Glucose water without salt

■ Fluids without starch / sugar & salt in children

who are starved

■ Fluids consumed in small amounts.eg- tea.

 IMPROVED ORS
■ APPROACH 1:
Glucose - replaced by starch based cereal
powder(50g/L)
eg:cooked rice powder
■ APPROACH 2:
Glucose polymers(Maltodextrin)OR AA are
combined with or used instead of glucose
( AA & Dipeptides cause increase in
absorption of H2O &Na by diff
mechanism. So double benefit)
 LOW OSMOLARITY ORS

■ Why low osmolarity?

In stool output
Dehydration
need for IV fluids
■ In both Na & Glucose results in in
osmolarity

■ Overall – 224mOsm/L(Glu-84 & Na-60)

 LOW OSMOLARITY ORS
Reduced osmolarity ORS grams Reduced osmolarity ORS Mmol/
/litre litre
Sodium chloride 2.6 Sodium 75

Glucose, anhydrous 13.5 Chloride 65

Potassium chloride 1.5 Glucose 75

Trisodium citrate, dihydrate 2.9 Potassium 20

Citrate 10

Total Weight 20.5 Total Osmolarity 245

 Standard ORS Reduced Osmolarity ORS solutions
solution

(mEq or mmol/l) (mEq or (mEq or (mEq or

mmol/l) mmol/l) mmol/l)

Glucose 111 111 75-90 75

Sodium 90 50 60-70 75

Chloride 80 40 60-70 65

Potassium 20 20 20 20

Citrate 10 30 10 10

Osmolarity 311 251 210-260 245

 RICE BASED ORS
■ Tastes better and provides more calories than the glucose-based
■ culturally acceptable,
■ reduces stool volume (by about 40 percent)
■ shortens the duration of diarrhea in both cholera and other severe
diarrheal diseases.

■ Starches other than rice, including wheat flour and maize, have
also been shown to reduce stool volume in patients with cholera.

■ reduce diarrhea by adding more substrate to the gut lumen

without increasing osmolality, thus providing additional glucose
molecules for glucose-mediated absorption.
 HOME AVAILABLE ORS
■ SUGAR - 3 Finger scoop &
Salt - 3 Finger pinch &
1L - boiled & cooled water

■ Rice kanji , tea dicoction , lemon water, etc.,

 Home based ORS
■ Home-prepared solutions - recommended for use
by parents to give to their child immediately after
an attack of diarrhoea starts and BEFORE any
signs of dehydration occur

■ Basically, the idea is to PREVENT dehydration

and PRESERVE good nutritional status by
maintaining fluid and food intake.
 HOME MADE ORS
■ Home made ORS recipe
Preparing a 1 (one) litre oral rehydration solution [ORS] using Salt,
Sugar and Water at Home
Mix an oral rehydration solution using one of the following recipes;
depending on ingredients and container availability:

Ingredients:
■ one level teaspoon of salt
■ eight level teaspoons of sugar
■ one litre of clean drinking or boiled water and then cooled
5 cupfuls (each cup about 200 ml.)
 ORS WITH NUTRIENTS
■ Why nutrients?

Nutrients help in absorption of Na & H2O

Hastens recovery of intestinal epithelium

 ADVANTAGES OF ORS
■ More physiological
■ Easy to administer
■ Cost effective
■ Home equivalents available
■ Free of cost at PHC ,Subcenters
■ Readily available & needs no sterilisation
 DISADVANTAGES OF ORS
■ INEFFECTIVE when,
Stool purge is high (>5ml/kg/hr)
Persistent vomitting
Incorrect preparation /administration
Abd. Distension & Ileus
Glusose malabsorption cases

■ Most importantly , ORS doesn’t reduce severity /

duration of diarrhoea
 OTHERS
■ Another possible way to produce a better oral
rehydration solution would be to combine the
standard solution with nutrients and vitamins
that have been shown to modify the courses of
diarrheal illnesses, probably by their
antioxidative actions. These include vitamin
A, zinc, magnesium, selenium, and
other micronutrients
 ZINC TREATMENT
■ zinc deficiency caused by limitations in the diet is a
common problem and a contributing factor to the
high prevalence of some infectious diseases in
children, including pneumonia and diarrhea.
■ Recent studies suggest that a 10- to 14-day therapy
of zinc treatment can considerably reduce the
duration and severity of diarrheal episodes, decrease
stool output, and lessen the need for hospitalization.
■ Zinc may also prevent future diarrhea episodes for
up to three months.
 ADVICE
■ REST THE GUT Theory
■ Give as much as ORS –NO Harm in feeding excess
■ DO NOT stop breast feeding during ORT
■ Non breast fed infants(<6m)- additional 100-200ml of
clean water during first 4 hrs
■ <2yrs -1 teaspoon q1-2M
■ Older children – freq. sips in a cup
■ If child vomits – wait for 10 mins & start again slowly
■ Avoid high fibre diet during ORT
■ Staple foods – to be enriched with fats& oils/sugars
eg:rice +milk/curd &sugar
 REFERENCES
■ The New England Journal Of Medicine
■ http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&d
b
■ http://www.pjonline.com/Editorial/20040508/articles/p580oralreh
ydration.html
■ http://www.rehydrate.org/ors/rice_based_ors.htm
■ http://www.rehydrate.org/ors/solution_for_survival.htm
■ http://www.unu.edu/unupress/food/8F172e/8F172E04.htm
■ http://www.supply.unicef.dk/Catalogue/bulletin9.htm
■ http://www.eddcontrol.org/index.htm#ORS
■ PARK Textbook of medicine
■ Text book on PAEDIATRICS by O.P.Ghai
■ Control of diarrhoeal diseases by WHO
■ ORS