Oral rehydration therapy

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A cholera patient is given an ORT drink.

Oral rehydration therapy is a treatment for dehydration. It involves drinking water mixed with sugar and salt, while continuing to eat. There is a mixture that is used for severe dehydration: This mixture also includes zinc. Caretakers are taught the signs of worsening dehydration. The World Health Organization and UNICEF specify indications, preparations and procedures for ORT.[1]

The therapy was developed in the second half of the 20th century. It has helped decrease the number of human deaths from dehydration in vomiting and diarrheal illnesses, especially in cholera epidemics occurring in children. It represents a major advance in global public health. It is on the World Health Organization's List of Essential Medicines, a list of the most important medication needed in a basic health system.[2]

Before the introduction of ORT, death from diarrhea was the leading cause of infant mortality in developing nations. Between 1980 and 2006, the introduction of ORT is estimated to have decreased the number of infant deaths, worldwide, from 5 to 3 million per year.[3][4] However, in 2008, diarrhea remained the second most common cause of death in children under five years (17 percent), (after pneumonia (19 percent)).[5] Moreover, by the same year, the use of ORT in children under five had declined.[6]

Preparation[change | change source]

WHO and UNICEF developed official guidelines for the manufacture of ORS. Depending on what materials are available, they propose different alternative preparations. Commercial preparations are available as either pre-prepared fluids or packets of oral rehydration salts (ORS) ready for mixing with the fluid.[7][8]

WHO/UNICEF's formula is 2.6 grams (0.092 oz) salt (NaCal), 2.9 grams (0.10 oz) trisodium citrate dihydrate C6H5Na3O20−
7,
H2O
, 1.5 grams (0.053 oz) KCl, 13.5 grams (0.48 oz) anhydrous glucose (C_{6}H_{12}O_{6}) per litre of fluid.[9]

A basic oral rehydration therapy solution is composed of salt, sugar, and water in solution, made using a standard ratio and is appropriate for use in situations when ORS must be prepared without the standard ingredients.[10][11]

  • 30 ml sugar : 2.5 ml salt : 1 liter fluid
  • 6 teaspoons (tsp). sugar : 0.5 tsp. salt : 1 quart fluid

The Rehydration Project states, "Making the mixture a little too diluted (with more than 1 litre of clean water) is not harmful."[12]

The optimal fluid is plain, clean water. However, fluids such as rice water, coconut water, vegetable broth, yogurt, weak unsweetened tea, unsweetened fresh fruit juice or even nonpotable water are recommended when plain, clean water is unavailable. Water can be boiled or treated with chlorine. However, ORS is not withheld on the basis of potentially unsafe water. Rehydration takes precedence. [1]

The molar ratio of sugar to salt should be 1:1 and the solution should not be hyperosmolar.[13] The Mayo clinic suggests half a teaspoon of salt, six level teaspoons of sugar and 1 litre (34 US fl oz) water.[14] The British Columbia health service suggests sugar free fruit juice mixed with water in a ratio of 1:4.[15]

References[change | change source]

  1. 1.0 1.1 ""The treatment of diarrhea, a manual for physicians and other senior health workers."" (PDF). "World Health Organization. 2005. http://whqlibdoc.who.int/publications/2005/9241593180.pdf.
  2. "WHO Model List of EssentialMedicines". World Health Organization. October 2013. http://apps.who.int/iris/bitstream/10665/93142/1/EML_18_eng.pdf?ua=1. Retrieved 22 April 2014.
  3. Gerline, A. (8 October 2006). "A simple solution". A simple solution. http://www.time.com/time/printout/0,8816,1543876,00.html.
  4. "Water with sugar and salt". Lancet 312 (8084): 300–1. August 1978. doi:10.1016/S0140-6736(78)91698-7 . http://www.sciencedirect.com/science/article/pii/S0140673678916987.
  5. (PDF) The state of the world's children: child survival. UNICEF. December 2007. p. 8. ISBN 978-92-806-4191-2 . http://www.unicef.org/sowc08/docs/sowc08.pdf.
  6. Ram PK, Choi M, Blum LS, Wamae AW, Mintz ED, Bartlett AV (March 2008). "Declines in case management of diarrhoea among children less than five years old". Bull. World Health Organ. 86 (3): E–F. PMC 2647400 . PMID 18368194 . http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0042-96862008000300024&lng=en&nrm=iso&tlng=en.
  7. "Oral rehydration salts and solutions and rice-based solutions worldwide manufacturers and suppliers." Rehydration Project website. Accessed 3 January 2014.
  8. "Oral rehydration therapy (ORT) in children." US Department of Health and Human Services. Accessed 1 January 2014.
  9. Oral rehydration salts
  10. , "WHO position paper on Oral Rehydration Salts to reduce mortality from cholera." World Health Organization, Global Task Force on Cholera Control.
  11. "How to Make an Oral Rehydration Salts Drink (ORS)." Wikihow. Accessed 26 February 2011.
  12. Rehydration Project
  13. Churgay CA, Aftab Z (1 June 2012). "Gastroenteritis in children: part II, prevention and management". Am Fam Physician 85 (11): 1066–70. PMID 22962878 . http://www.aafp.org/afp/2012/0601/p1066.html.
  14. "Dehydration, treatments and drugs." Mayo Clinic. Accessed 1 January 2014.
  15. "Oral rehydration therapy." Parent education and resources, British Columbia Guidelines, Canada. Accessed 1 January 2014.