Dr Ravinder K Gupta & Dr Harkirat Kaur
Acute diarrheal diseases are one of the leading causes of mortality in infants and children in many developing countries. According to World Health Organization (WHO), diarrheal disease is the second leading cause of death in children under 5 years. Diarrhoea, which is frequently caused by poor sanitation and hygiene, can have serious, even deadly results, typically as a result of diarrhea related dehydration.
It particularly affects infants, children and old people. Diarrhoea generally lasts for several days, leaving the body without salt and water, which is necessary for survival. Most people who die from diarrhea actually die from severe dehydration and loss of fluid from the body.
Dehydration from diarrhea can be prevented by giving extra fluids at home, or it can be treated simply and effectively by giving adequate glucose electrolyte solution called ORS (oral rehydration solution). Every year, ORS day is celebrated on 29th July to highlight the importance of ORS salts as a cost effective method of health intervention. ORS Jodi (ORS and Zinc) has proven to be successful in the prevention and management of acute diarrhea and dehydration. If vomiting occurs, it is recommended that use be paused for 10 minutes and then gradually restarted
Oral rehydration salts contain a variety of sugar and salts specifically sodium and potassium. The combination of electrolytes and sugar stimulates water and electrolyte absorption from the gut. The recommended formulation includes sodium chloride, sodium citrate, potassium chloride, and glucose. Glucose may be replaced by sucroseand sodium citrate may be replaced by sodium bicarbonate, if not available. It works as glucose increases the uptake of sodium and thus water by the intestines. It, therefore, prevents or reverses dehydration and replaces lost salts in conditions such and diarrhea and vomiting. Use of oral rehydration therapy decreases the risk of death from diarrhea by about 93 percent.
Oral rehydration therapy was developed in the 1940s, but did not come into common use until the 1970s . Until 1960, ORT was not known in the West. Intravenous (IV) therapy was considered the “gold standard” for the treatment of moderate and severe dehydration. Captain Phillips of the US Army in 1964 first successfully tried oral glucose saline on two cholera patients. The efficacy of standard ORS was first demonstrated by Pierce et al and others during 1965-69.The World Health Organization in 1978 launched the global diarrheal diseases control program with ORS at its heart and the short-term objective of reducing mortality due to diarrhea.
In the early 1980s, “oral rehydration therapy” referred only to the preparation prescribed by the World Health Organization (WHO) and UNICEF. In 1988, the definition changed to encompass recommended home-made solutions. The definition was again amended in 1988 to include continued feeding as an appropriate associated therapy. In 1991, the definition became, “an increase in administered hydrational fluids” and in 1993, “an increase in administered fluids and continued feeding”. In 2003, WHO and UNICEF recommended that the osmolarity of oral rehydration solution be reduced from 311 to 245 mOsm/L to overcome the potential risk of hypernatremia in children with noncholeradiarrhoea.
ORT is one of the principal elements of the UNICEF “GOBI FFF” program (growth monitoring; ORT; breast feeding; immunization; female education; family spacing and food supplementation). The program aims to increase child survival in developing nations through proven low-cost interventions.
FREQUENTLY ASKED QUESTIONS
How to make ORS drink which is available in powder form:
* Put the contents of the ORS packet in a clean container. There are 2 types of ORS compositions available in the market in terms of the amount of water used for preparation: small packet in 200 ml and big packet in one liter .
* Check the packet for directions and add the correct amount of clean water. Too little water could make the diarrhoea worse. Too much water makes the solution unpalatable.
* Add water only. Do not add ORS to milk, soup, fruit juice or soft drinks. Do not add sugar.
* Stir well, and feed it to the child from a clean cup. Do not use a bottle.
How to prepare ORS solution at home:
Give the child a drink made with 6 level teaspoons (1 scoop approx) of sugar and 1/2 level teaspoon (1 pinch approx) of salt dissolved in 1 litre of clean water. Add lemon as per taste. Be very careful to mix the correct amounts. Too much sugar can make the diarrhoea worse. Too much salt can be extremely harmful to the child
Storage of ORS solution:
Store the liquid in a cool place. Chilling the ORS may help. Use the ORS solution within 24 hrs of its preparation.
Amount of ORS solution for rehydration:
Feed after every loose motion.
For a child under the age of two: Between a quarter and a half of a large cup.
For older children: Between a half and a whole large cup.
For Severe Dehydration: Drink sips of the ORS (or give the ORS solution to the conscious dehydrated person) every 5 minutes until urination becomes normal.
Type of water used: Use boiled or filtered water.
Prepacked ORS vs home prepared solution: The prepacked ORS solution is referred to as a “complete formula” and contains potassium and a base – either bicarbonate or citrate which corrects acidosis which small infants particularly suffer with dehydration. Potassium depletion results in fatigue, apathy & muscular weakness.
Other fluids for management of dehydration:
Rice gruels, cereal gruels, yoghurt drinks like butter milk, green coconut water, carrot soup, rice water (congee).
In which situations ORS should not be used :
ORT should be discontinued and fluids replaced intravenously when vomiting is protracted despite proper administration of ORT, signs of dehydration worsen despite giving ORT, the person is unable to drink due to a decreased level of consciousness, or there is evidence of intestinal blockage or ileus. ORT might also be contraindicated in people who are in hemodynamic shock due to impaired airway protective reflexes. Short-term vomiting is not a contraindication to receiving oral rehydration therapy. In persons who are vomiting, drinking oral rehydration solution at a slow and continuous pace will help the vomiting to resolve.
Important aspects to the management of diarrhea:
First of all, prevention of diarrhea by breastfeeding, environmental sanitation, personal hygiene, clean drinking water, clean preparation and storage of food. Secondly, maintaining or increasing food and fluid intake during and after an attack of diarrhoea.
The WHO theme for ORS day 2018 is “ORS-ORS all day keeps dehydration at bay”
(The author are from Department of Pediatrics Acharya Shri Chander College of Medical Sciences ( ASCOMS) Jammu )
Dr Ravinder K Gupta & Dr Harkirat Kaur