Different Types Of Ors

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 NaCl -3.5g NaHCo3 -2.5g KCl -1.5g Glucose -20g Water -1L

ORS Citrate NaCl -3.5g Trisod.citrate dehydrate -2.9g KCl -1.5g 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 /litre

Reduced osmolarity ORS

Mmol/ 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 Osmolarity

245

Total Weight

20.5

Standard ORS solution

Reduced Osmolarity ORS solutions

(mEq or mmol/l)

(mEq or mmol/l)

(mEq or mmol/l)

(mEq or 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