ORS history, its composition, various type of ORS and home-based fluid for dehydration

1. Oral Rehydration
Salt (ORS)
Dr Nishant Kumar
Assistant Professor
Department of Community Medicine
Madhubani Medical College , Madhubani , Bihar

2. Introduction - A Brief History
Captain Robert Allan Phillips -NAMRU-2( Naval Medical
Research Unit)-1961
Dr Richard Cash , Dr David Nalin - 1967 , National Institute of
Health - Dacca , East Pakistan.
Chittagong Protocol
Second Protocol
Matlab-UNICEF , WHO
Hemendra Nath Chatterjee - 1953.

3. ORS
It is a firmly established strategy to successfully
treat acute diarrhoea's due to all aetiologies.
The aim is to prevent dehydration and reduce
mortality.
It is based on the observation that glucose given
orally enhance the intestinal absorption of salt and
water and is capable of correcting the electrolyte
and water deficit.

4. ORS - Composition
Sodium chloride 2.6gm/lts
Glucose anhydrous 13.5gm/lts
Potassium chloride 1.5gm/lts
Trisodium Citrate,
dehydrate
2.9gm/lts
Total weight 20.5gm/lts

5. ORS- Reduced Osmolarity
Sodium 75 mmol/liters
Chloride 65 mmol/liters
Glucose ,anhydrous 75 mmol/liters
Pottassium 20mmol/liters
Citrate 10 mmol/liters
Total Osmolarity 245 mOsm/l
Original ORS had 90meq/l of Sodium and total Osmolarity was 311
mOsm/l

6. Benefits Reduced osmolarity
Reduced osmolarity of ORS avoids adverse affects
of hypertonicity on net fluid absorption by reducing
concentration of glucose and sodium chloride
Lower sodium osmolarity improve the efficacy of
ORS in children due to acute non cholera diarrhoea
It causes decline in reduction in unscheduled IV
fluid intervention by 33% , Stool output decrease by
20% and vomiting decrease by 30%.

7. Different Types of ORS- Rice Based
ORS
Taste better, provide more calories than glucose based ORS
Culturally accepted , reduced stool volume( by 40%, ),
shortens duration of diarrhoea in both cholera and other
diarrhoea diseases.
Starch other than rice , including wheat flour and maize can
be used
Decrease diarrhoea by adding more substrate to the gut
lumen without increasing osmolality.

8. Super ORS
These are special type of ORS which instead of mono sugar contains
complex sugars. They may be rice based, or otherwise starch free.(
glycine,/alanine based or glucose polymer based)
They provide rehydration
Reduce stool output
Provide increase amount of calories (180Kcal/liters)
With gradual release of glucose , prevent secondary disaccharide
intolerance
Contribute to weight gain , in malnourished children
Have Short half life ( less than 10 hours) and to be prepared 2- 3 times a
day.

9. Super Super ORS
Addition of Zinc to Super ORS
Improve absorption of water and electrolyte in
intestine
Faster regeneration of gut epithelium
Increase level of enterocyte brush border enzyme
Enhanced immune response leading to increased
clearance of the pathogen.

10. Home Based ORS
Home based solutions to be used by children to
give to their child immediately after attack of
diarrhoea starts.
Breast milk , Gruel , Carrot Soup, Rice water,
Green coconut water , Orange juice and mashed
banana.

11. Thank You