ORS: THE WONDER DRUG


ORS saves the lives of children with diarrhoea'.

Diarrhoeal diseases constitute a leading cause of morbidity and mortality among children under five years of age in developing countries. More than 3 million deaths are estimated to result each year the world over as a consequence of diarrhoeal diseases in children under five. 80 per cent of these deaths occur in the first 2 years of age, the main cause being dehydration.


Despite India's enormous progress over the past decade, about 6 lakh children under 5, die every year. Repeated and prolonged episodes of diarrhoea can result in malnutrition-diarrhoea — malnutrition cycle resulting in high mortality. Most of these children can survive if they are given ORS (WHO composition), breast milk and food early, throughout diarrhoea.


Watery stools


Diarrhoea caused by bacteria or viruses is the passage of watery stools, three or more in a 24-hour period. It is the change in consistency and character of stool and its watery content rather than number of stools that is important.


The key factors are unclean water, dirty hands at mealtime and spoilt food. Diarrhoea can be prevented through exclusive breast-feeding, improved weaning practices, measles immunisation, use of toilets, washing hands (baby's as well), keeping water and food clean, washing with soap before touching food and by sanitary disposal of stools.


Dehydration


Dehydration is the most common and life-threatening consequence of diarrhoea. Young children are more susceptible to develop dehydration. Loss of water and electrolyte in the diarrhoeal stool results in depletion of electrolyte water imbalance and results in clinical manifestation of dehydration.


The first symptom of dehydration appears after body fluid loss of about 5 per cent of body weight. When fluid loss reaches 10-15 per cent shock often sets in, and the many events that follow can culminate in death unless there is immediate intervention to rehydrate.


Oral Rehydration Therapy (ORT) is the process of replacing essential body fluids and salt that a child loses in critical quantities during attacks of diarrhoea. The treatment consists of common salt and sugar mixed in one litre of clean drinking water given to child orally. By replacing lost body fluids, ORT prevents dehydration and nurses the child back to health.


The concept of ORT has revolutionised the management of diarrhoea with the discovery of Coupled Active Transport of glucose and sodium in the small intestine resulting in passive absorption of water and other electrolytes even during copious diarrhoea. Therefore, WHO formula has been recommended for rapid rehydration of dehydrated children.


ORS is the most cost-effective development of the century — The panel of doctors from WHO worked out the right mixture of rehydrating salts. No private company can now acquire a patent for the solution. Or else, the price of the life-saver could have become prohibitive.


History


Between 1964-67, investigators in both Dhaka and Calcutta were aware of reports of Carrier mediated sodium-glucose transport and took this knowledge to the bedside of cholera patients.


In 1971, during India-Pakistan war, East Pakistan proclaimed its independence as the new State of Bangladesh, and nine million refugees poured into India. This led to cholera epidemic in which 30-40 per cent of the infected patients died. Investigators from John Hopkins University present in Calcutta were able to apply, on a massive scale what had been learnt from clinical studies. The administration of ORS alone reduced mortality to 3 per cent. By mid 1970s, a standard oral rehydration solution was agreed upon. In 1978, the diarrhoea disease control programme instituted by WHO employed ORS as the centre piece of its global efforts to reduce deaths due to dehydrating diarrhoeal illness.


In 1978, a Lancet editorial titled "Water with sugar and salt" stated that the discovery that sodium transport and glucose transport are coupled in the small intestine, so that glucose accelerates absorption of solute and water was potentially the most important medical advance of this century. It could save millions of lives each year without the need for hospitals, trained staff or advanced technologies. The discovery of oral rehydration therapy is as important as the discovery of penicillin. ORS can rightly be called medical miracle of 20th century. According to current American Academy of Pediatrics Practice Guideline, ORT is as effective as IV Therapy for treatment of mild to moderate dehydration.


Citrate-based ORS


WHO has currently recommended citrate-based ORS to replace bicarbonate. Sodium citrate at 2.5 g/ltrs will give a concentration of 10meq/ltr of citrate.


Advantages of citrate-based ORS are: it increases shelf life, improves taste, cheaper, sodium absorption in high output diarrhoea and no soiling of pockets.


WHO-recommended ORS brands are Coslyte, Electrobion, Punarjal, Relyte, Walyte-S.


Prevention and treatment


The objective of treatment is prevention of dehydration and malnutrition. The management can be successfully carried out at home by the mother or caretaker by using WHO-recommended ORS.


1. Give more fluids than normal.


2. Continue feeding.


Guidelines for replacement of fluids and electrolyte in children with 'No Dehydration'


Age: 15 years: >2200 ml, 12-20 glass.


ORS administration


Use only local measures like tumblers and cups. Give 1-2 teaspoonful frequently for children aged less than 2 years and frequent sips from cup for older children. If the child vomits, wait for 10 minutes and then try a teaspoonful of ORS frequently.


Contra Indication for the use of ORS


1. Persistent vomiting


2. Dehydration worsening (no improvement within 8 hours).


3. Severe Dehydration


4. Refusal to take ORS


5. Complications like abdominal distention, respiratory distress, convulsions and with no or very low urine output.


ORS use is optional in the absence of dehydration. In case of severe dehydration, consulting a qualified paediatrician and hospitalisation are must.


What you should know?


1. Wash hands with soap and water before preparing solution.


2. Put clean water to the mark from top of the bottle. This is equal to one litre. Keep the water in a clean pot.


3. Empty the contents of 1 packet of Oral Rehydration Salts (ORS) into the water, keeping it stirred.


4. Give the sick child as much of the solution as it needs, in small amounts frequently.


5. Give the child alternatively other fluids—breast milk and juices.


6. Continue to give solids if the child is six months or older.


7. If the child still needs ORS after 24 hours, make a fresh solution.


8. ORS does not stop diarrhoea. It prevents the body from drying up. The diarrhoea will stop by itself.


9. If the child vomits, wait for ten minutes and give it ORS again. Usually vomiting will stop.


10. If diarrhoea increases and / or vomiting persists, take the child to a health clinic.