The document discusses oral rehydration solution (ORS), including its ingredients, preparation, uses, and treatment of dehydration. It describes the WHO standard and new formulas for ORS and explains how to prepare a liter of ORS from a packet by dissolving the powder in clean water. ORS is the first-line treatment for mild to moderate dehydration to replace lost electrolytes, while intravenous fluids may be needed for severe cases. Zinc and probiotics can also help in treating diarrhea by various mechanisms like inhibiting fluid secretion and improving absorption.

1. Prepare oral rehydration solution from ORS packet and explain its
use. (DOAP)
D - Demonstration
O - Observation
A - Assistance
P - Performance
Dr. Kopal Sharma
Senior Demonstrator
Dept. of Pharmacology
SMS MC, Jaipur

2. S.N Competency Name Level Suggested Teaching
Method
1 PH 2.2- Prepare oral rehydration
solution from ORS
packet and explain its
use
SH DOAP Session

3. Learning Objectives
At the end of session students should be able to
1) Describe the quantity of ingredients of ORS
2) Describe the actions of each ingredient of ORS
3) Enumerate precautions in using ORS
4) Prepare ORS in Lab
5) Demonstrate an understanding of uses of ORS

4. ORS Powder
• This is compound powder which contains sodium chloride, potassium
chloride, trisodium citrate and glucose anhydrous.
• This powder is hygroscopic in nature so attracts moisture when it
comes in contact with air.

5. WHO New Formula ORS
WHO New Formula ORS was introduced in the year of 2002. The ingredients of
ORS (New Formula) for one liter are following:
1. Sodium chloride 2.6gm
2. Potassium chloride 1.5gm
3. Tri sodium citrate 2.9gm
4. Glucose (Anhydrous) 13.5gm
Total osmolarity of ORS (New Formula) salt is 245 mOsm/L.

6. WHO (Standard Formula) ORS
• WHO ORS was introduced in the year of 1984 after the pandemic of Cholera.
• The standard formula ORS has a higher concentration of sodium, which produces
periorbital edema in children.
• The ingredients of ORS (Standard Formula) for one liter are following:
1. Sodium chloride 3.5gm
2. Potassium chloride 1.5gm
3. Tri sodium citrate 2.9g
4. Glucose (Anhydrous) 20 gm
• Total osmolarity of ORS (Standard Formula) salt is 311 mOsm/L

7. Super ORS
• Amino acids like Alanine, glutamine and Glycine are added in ORS to enhance the
absorption of electrolytes like sodium and glucose in the intestine.
• Super ORS is expensive and not proved superior to ORS.

8. Boiled rice powder: 40-50 gm/lit. Which is substituted for glucose.
• Rice starch is slowly hydrolysed at brush border of intestine into glucose and
absorbed.
• It does not cause osmotic diarrhoea even when large quantity is taken. It also
contains amino acids which stimulates Na+ reabsorption.
• It also ↓ stool volume.
• Rice is cheap and readily available source and can be converted to glucose.
• Thus, rice, wheat, maize, potato based ORS is much more superior than WHO-ORS.

9. Substitute of ORS at home
1. Boiled rice water, lemon water, buttermilk, solution of table salt and sugar (in
ratio of 1:6).
2. These are used as adjuvants to ORS and can be used with ORS or till availability
of ORS in case of dehydration. These cannot replace the ORS.

10. Method to prepare oral rehydration solution from ORS packet
1. Mostly ORS packets are available for one-liter solution. But we can prepare the
amount according to need.
2. Wash the hands properly with soap.
3. Take one-liter of clean water in a clean container (Water can be either bottle
packed or can be boiled at home).
4.Check the expiry date of packet. Read instructions. Cut the packet.

11. 5. Whole packet ORS should be dissolved in previously boiled and cooled water.
ORS should be taken in small sips. Unused solutions should be discarded after 24
hours.
6. If small amounts are needed (less than a liter), then tightly pack the packet after
taking the required amount of powder. Use this packet within 24 hrs.

12. Indications of ORS
1. Mild to moderate cases of dehydration due to vomiting, diarrhea, burns, excess
sweating, sun stroke.
• Dose of ORS in mild cases- 50 ml/kg in 4 hours.
• Dose of ORS in moderate case- 100 ml/kg in 4 hours.
• Patients should be encouraged to drink ORS every ½ to 1 hour.
2. Shifting from IV fluids to oral rehydration therapy.

13. Role of ORS
• ORS is first line treatment in case of mild to moderate dehydration. In case of
dehydration many electrolytes are lost in stool, vomitus, sweating or other fluid loss
from the body.
• ORS contains all of these electrolytes in perfect ratio. So these electrolytes are
replaced and maintained in the body during losses.
• ORS does not prevent the cause of dehydration. It is just replacement therapy.

14. Action of individual ingredient
• Sodium Chloride (Na)- It is a major extracellular element. It is a principle and
essential element of blood which maintain the osmotic tension of blood and tissue.
• Potassium Chloride (K)- It is a major intracellular element.
• Glucose- Facilitates sodium and water absorption through the intestine.
• Trisodium Citrate- It corrects acidosis due to electrolyte losses.

15. Assessment of Dehydration
A (No/mild dehydration) B (Moderate dehydration) C (Severe
dehydration)
Condition Well Alert Restless, Irritable Lethargic, Floppy
Eyes Normal Sunken Vey sunken
Tears Present Absent Absent
Mouth And
Tongue
Moist Dry Very dry
Skin Pinch Goes back quickly Goes back slowly Goes back very
slowly
Thirst No Thirst (Drinks normally) Thirsty (Drinks eagerly) No Thirst
(Not able to
drink/drink poorly)
Treatment Plan Plan-A Plan-B Plan-C

16. Treatment plan -A
1) ORS- 50 ml/kg in 4-6 hours. Should be taken every ½ to 1 hour.
2. Oral Zinc* 10mg/day (<6 months) and 20 mg/day (6months- 5 years) for 14 days
*In case of diarrhoea.
In Addition/or
3. Home-made sugar-salt solution- For a one-liter solution take 1 teaspoon of salt and 6
teaspoon of sugar.
4. Rice water with added salt.
5. Lassi with added salt or sugar.
6. Lemon water, coconut water.

17. Treatment plan -B
1. ORS- 100 ml/kg in 4-6 hours. Should be taken every ½ to 1 hour.
2. Oral Zinc* 10mg/day (<6 months) and 20 mg/day (6months- 5 years) for 14 days
*In case of diarrhoea.
In addition, may be given
3. Homemade sugar-salt solution- For a one-liter solution take 1 teaspoon of salt and 6
teaspoon of sugar.
4. Boiled rice water with added salt.
5. Lassi with added salt or sugar.
6. Lemon water, coconut water.

18. Treatment plan -C
1. IV Fluid- 50 ml/kg in 4-6 hours.
Treatment of Severe case of dehydration
• As ORS is not enough and patients may be unable to take it orally. I.V fluids should
be given.
• Dhaka fluid and alternatively Ringer lactate can also be given in this case.

19. Composition of Dhaka Fluid-
1. Sodium chloride (NaCl)- 5 gm
2. Potassium chloride (KCl) 1 gm
3. Sodium bicarbonate (NaHCO3) 4 gm

20. Role of Zinc in diarrhoea
1.Zinc inhibits cAMP-induced, chloride-dependent fluid secretion by inhibiting
basolateral potassium (K) channels.
2.Zinc also improves the absorption of water and electrolytes.
3.Improves regeneration of the intestinal epithelium.
4.Increases the levels of brush border enzyme.
5.Enhances the immune response, allowing for a better clearance of the pathogens.

21. Role of Probiotics in diarrhoea
• Probiotics are "friendly bacteria" that are similar to organisms that occur
naturally in the digestive tract.
• The potential mechanisms include:
a) Exclusion of pathogens by means of competition for binding sites and
available substrates.
b) lowering of luminal pH.
c) production of bacteriocins, and promotion of the production of mucus.
for e.g Lactobacillus, bifidobacteria, sacchromyces boulardi.