The document discusses oral rehydration solution (ORS) including its ingredients, preparation, and uses. It provides the standard WHO formula from 1984 and new formula from 2002. The new formula has a lower osmolarity and different ingredient amounts. The document outlines how to prepare ORS and its role in treating mild to moderate dehydration. It also discusses the roles of individual ingredients, assessing dehydration severity, and treatment plans A, B and C depending on dehydration level. The roles of zinc and probiotics in treating diarrhea are also summarized.

1. ORS Powder
Shivankan Kakkar, MD

2. Preparation of ORS for 1-liter solution
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

3. ORS Powder- Standard Formula
WHO (Standard Formula) ORS
WHO Standard Formula 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.
Total osmolarity of ORS (Standard Formula) salt is 311 mOsm/L

4. ORS Powder- New Formula
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
This powder is hygroscopic in nature so attracts moisture when it comes in contact with air.

5. 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 proven superior to ORS.

6. 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.
3. These cannot replace the ORS.

7. How to prepare oral rehydration solution from
ORS packet
1. Most 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 the packet. Read instructions. Cut the packet.
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.

8. 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

9. Role of individual ingredients
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.
Sodium Chloride (Na)- It is a major extracellular element. It is a principle and essential element of
blood which maintains 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.

10. 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/drinks poorly)
Treatment Plan Plan-A Plan-B Plan-C

11. Treatment Plan-A
1. ORS- 50 ml/kg in 4 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 teaspoons of
sugar.
4. Rice water with added salt.
5. Lassi with added salt or sugar.
6. Lemon water, coconut water.

12. Treatment Plan-B
1. ORS- 100 ml/kg in 4 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 teaspoons of
sugar.
4. Boiled rice water with added salt.
5. Lassi with added salt or sugar.
6. Lemon water, coconut water.

13. Treatment Plan-C
1. IV Fluid- 50 ml/kg in 4-6 hours. Should be given every ½ to 1 hour
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.

14. 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 enzymes.
5.Enhances the immune response, allowing for a better clearance of the pathogens.

15. Role of Probiotics in Diarrhoea
Probiotics are "friendly bacteria'' that are similar to organisms that occur naturally in the digestive
tract.
The potential mechanisms by which probiotics fight infectious diarrhoea include exclusion of
pathogens by means of competition for binding sites and available substrates, lowering of luminal pH
and production of bacteriocins, and promotion of the production of mucus.
For e.g Lactobacillus, bifidobacteria, saccharomyces boulardi.