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Oral Rehydration Salts
By
Dr Utpal Sharma
Assistant Professor
Department of Community Medicine
SMIMS, Gangtok, Sikkim

Introduction
Worldwide, diarrhea claims several million lives
annually, mostly those of infants.
Poverty, crowding, a...

Cont…
More than 5 million children under the age of 5
years die every year due to diarrhoea .
In India, more than 1 m...

What is diarrhoea?
Increases in volume or fluidity of stools, changes
in consistency, and increased frequency of
defec...

Cont….
Diarrhoeal disorders are divided into:
Acute Diarrhoea
 The most usual form of diarrhoeal illness, have an
ab...

Pathophysiology of diarrhea
 Fluid from the body enters the intestinal lumen (isosmotic i.e
approx.142 mEq/L Na+) durin...

Ion exchange in intestine

Physiological basis of using ORT in
Diarrhoea
 Sodium passes into epithelial cells by co-transport via the
SGLT1 prote...

Cont….
The GLUT uniporters then transport glucose across
membrane.
SGLT1 protein requires 2 Na+ to co-transport one
...

Oral rehydration therapy
Most diarrhea-related deaths in children are due to
dehydration……
….loss of large quantities ...

History of ORT
 Over 2,500 years ago, Sushruta described the treatment of
acute diarrhea with rice water, coconut juice...

Oral rehydration solution
So as soon as diarrhoea starts, it is essential to give the
child extra drinks to replace the...

Oral rehydration salts

PRINCIPLE of ORS
Glucose when given orally enhances the intestinal
absorption of salt & water.
Thus it can correct el...

Types of ORS??
Sodium bicarbonate based
Trisodium citrate based
Reduced osmolarity ORS
Super ORS

Sodium bicarbonate based ORS
Composition
Contents (gm)
NaCl 3.5
Glucose 20.0
KCl 2.5
Sodium bicarbonate 2.5

Trisodium citrate based ORS
Composition
Contents (gm)
NaCl 3.5
Glucose 20.0
KCl 1.5
Trisodium citrate 2.0

Bicarbonate vs.
Tricitrate ORS
Bicarbonate-based ORS
 Less stable
 Stool output not reduced
Tricitrate-based ORS
...

WHO ORS Osmolarity
Na+ 90mM
Cl + 80mM
Glucose 110mM
K+ 20mM
Citrate 10mM
TOTAL 310mM

Any adverse effect of this WHO ORS ????
Possible adverse effects is hyper tonicity in net
fluid absorption
How to overc...

Reduced osmolarity ORS
Composition
Contents (gm)
NaCl 2.6
Glucose 13.5
KCl 1.5
Trisodium citrate 2.9

Osmolarity of this new ORS
Na+ 75mM
Cl + 65mM
Glucose 75mM
K+ 20mM
Citrate 10mM
TOTAL 245mM

Advantages of low osmolarity ORS
Increased efficacy of ORS in non cholera diarrhoea
Need for unscheduled supplement IV...

DOSAGE & REQUIREMENT?
Age <4mths 4-11mths 1-2yrs 2-4yrs 5-14yrs ≥15yrs
Wt.(kg) <5 5-7.9 8-10.9 11-15.9 16-29.9 ≥30
Soln...

How to administer???
 Wash your hands with soap and water before preparing solution.
 Prepare a solution, in a clean p...

Cont…..
 Give child alternately other fluids - such as breast milk and juices.
 Continue to give solids if child is fo...

How to prepare oral rehydration solution

How to prepare….

Rules
 <2yrs :- give 1-2 teaspoon every 2-3 minutes
 Older children :- offer frequent sips out of a cup
Adults:- dri...

Cont…..
 If the child wants to drink more than the estimated
amount ?
No harm , give more
 If the child refuses to d...

ORT programme
 First started in 1986-1987
 Implemented through RCH programme
 ORS packets are supplied by the centra...

Achievements & benefits
 Low cost treatment
 Treatment of the patient in their own homes
 Ingredients are inexpensiv...

Thank you

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