The Power Of a Simple Oral Rehydration Salt Solution

The Power Of a Simple Oral Rehydration Salt Solution

Medically Reviewed By
Dr. Seema Sharma
MBBS, MD Paediatrics
Sr. Consultant

The Power Of A Simple Oral Rehydration Salt Solution

ORS solution comprises a blend of electrolytes (salts) and sugar in the right proportion to improve water & electrolytes absorption from the intestine so that it averts, and reverses dehydration and replaces salt.


-WHO adopted ORS as the main strategy to combat dehydration caused due to diarrhea in 1978.

-Until that period IVF was the gold standard for treatment of moderate-severe dehydration.

-The Indo-Pakistani war of 1971 provoked a Public Health Emergency cholera spread in the refugee camps set up to house those fleeing the violence.

– In the refugee camps where ORS was being used the death rate was only 3% compared to 20-30% in those camps using only IVF.

-B/W 1980-2000, ORT decreased the number of children under 5 dying of diarrhoea from 4.6 million worldwide to 1.8 million – a 60% reduction.

“ORT is considered potentially the most important medical discovery of the 20th century.

There are pieces of evidence to suggest that ORS is-

Safe & Effective

  • ORS is effective against diarrhoea mortality in home, community and facility settings.
  • Can alone successfully rehydrate 95-97% of patients with diarrhoea.
  • May prevent 93% of diarrheal death.

Cost saving

Reduces hospital admission rates by 50% and cost of treatment by 90%- So, this is the improvement of ORS.

It is on the WHO’s List of essential medicines.

As per WHO classification of dehydration, ORS (WHO) can be used as per the plan of treatment as-

Severe dehydration – Plan C

  • Start IV fluids immediately; give ORS by mouth while the drip is set up.

Some dehydration- Plan B

  • ORS (WHO) should be given under supervision in health facilities.
  • Give 75 ml/kg of ORS in the first 4 hours.
  • If the child wants more, give more.

After 4 hours:

  • Reassess and classify the degree of dehydration.


  • During 4 hours- Ask the mother to give recommended amounts of ORS solution by spoonful or sips.
  • If the child vomits wait for 10 minutes before giving more ORS solution. Give it more slowly.
  • Encourage breastfeeding whenever the child wants to. When breastfeeding is done then, resume with ORS solution.

No Dehydration- Plan A

When there is no dehydration, the focus is on the prevention of dehydration

Four rules of home treatment-

  1. Give Extra fluids (ORS & Home fluids)
  2. Give oral zinc for 14 days.
  3. Continue feeding.
  4. When to return (Advice to mother)

Give extra fluids- there are other suitable salted fluid options-

Suitable Salted Fluids

-Oral Rehydration Solution

-Salted rice water

-Salted yoghurt drink

-Vegetable soup with salt

-Chicken soup with salt

Suitable Unsalted Fluids

-Plain water

-Water in which a bowl of cereal has been cooked, e.g., unsalted rice water.

-Unsalted soup

-Green coconut water

-Unsweetened fresh fruit juice.

Unsuitable Fluids

-Commercial carbonated beverages.

-Commercial fruit juices

-Sweetened fruit juices


-Energy drinks

-Sweetened tea


At this point in time, Recommendations from WHO/ UNICEF/Govt. of India

Low Osmolarity ORS containing 75meq/L of sodium and 75mmol/L of Glucose (osmolarity245 mosmol /L) should be used as a universal single solution for treating and preventing diarrhoea in children.

Low Osmolarity ORS is also safe and effective for children with cholera.

Keep in mind that there are 2 different formulations available in the market for ORS.

  • One for 200 ml (about 6.76 oz) water
  • One for 1-litre water

Tell the mother to-

  • Breastfeed frequently and for longer at each feed.
  • If exclusively breastfeed gives ORS for replacement of stool loss.
  • If not exclusively breast fed-give suitable fluids
  • Amount of fluids to give in addition to the usual fluid intake:
  • Up to 2 years: – 50-100ml (about 3.38 oz) after each loose stool.
  • 2 years or more: – 100-200ml (about 6.76 oz) after each loose stool.
  • After 5 years: – Ad libitum.

It has been proved that there is improved G1 physiology in low osmolarity ORS. Feeding to the net flow of water into blood and decrease in stool output, there are pieces of evidence to suggest that low osmolarity ORS has more advantages over standard ORS.

  • 39% reduction in the need for unscheduled IVF fluids.
  • 19% reduction in stool output.
  • 29% reduction is vomiting.

Low osmolarity ORS is safe and effective for all ages.

  • Should be given to young in facts (<2m) including neonates if there is dehydration.
  • In exclusive breastfeeding, infants are fed with no supplementation and encouraged to breastfeed frequently and for longer durations to ensure they stay adequately hydrated.

ORT may be ineffective in following conductions, hence IV fluids should be given

  • High stool purge (> 10ml 1kg 1hr or > 10 loose stools/day).
  • Persistent vomiting despite proper administration of ORT.
  • Unable to drink due to decreased level of consciousness.
  • Incorrect preparation of ORS.
  • Abdominal distension and ileus.
  • Hemodynamic shock due to impaired airway protective reflexes.

ORS low usage possible reasons

  • Not perceived as a drug.
  • Lack of awareness
  • Taste factor (less of a problem now with the use of low osmolarity ORS) so we’ll need to do is to educate the family on the need for ORS in the management of diarrhoea to prevent and treat dehydration.


Rule -2: Give Zinc.

  • 20 mg per day of zinc supplementation for 14 d starting as early as possible after the outset of diarrhoea.
  • 10mg per day for infants 2- 6 months.
  • Administration: once or twice daily why zinc should be promoted because of biological functions.
  • Zinc influences the activity of over 300 enzymes, some of them responsible for DNA replication and transcription.
  • Zinc promotes immunity, skin, and mucosal resistance to infection, growth and development of the nervous system.
  • Zinc is also an important antioxidant and preserves cellular membrane activity.

Why is zinc deficiency common in children from developing countries?

  • Breast milk is not a sufficient source for >6 months.
  • Intake of complementary foods is low particularly if animal source food intake is low.
  • Bioavailability; phytates from cereals.
  • High faecal losses during diarrheal illness.
  • Low content of zinc in soil and food.

It has been reported that with the use of zinc.

  • 24% reduction in time to recovery.
  • 39% reduction in treatment failure/ death.

Zinc is useful in the prevention of subsequent episodes of diarrhoea.

  • Zinc is useful for cholera and dysentery.
  • Zinc is useful in decreasing the prevalence of pneumonia and diarrhoea.

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