Each and every one of us have heard of and used ORS at least once in our lives. It’s one of the perks of living in a country as India, which has particularly hot summers. The full form of ORS is Oral Rehydration Solution and while it may seem like it is not such a big deal, one must remember that dehydration caused due to dysentery and diarrhea can and does claim human lives, especially those of babies. In fact, before ORS was discovered, diarrhea and dysentery were considered as life threatening plagues. So let us understand ORS its benefits, preparation, need and history.
- What is ORS?
- What is Dehydration?
- Rehydration Treatment Plans
- Types of ORS:
- How to Prepare ORS at Home:
- History of ORS: Discovery and Significance
- When is World ORS Day celebrated?
- World ORS Day Special: Infographic
What is ORS?
Oral Rehydration Solution is a drink made to help the body gain its electrolyte balance back. A human body loses electrolyte balance when it is dehydrated. Most ORS solutions focus on increasing the sodium or potassium content on the body because that helps the intestines in absorbing more water. ORS solutions can be made at home, but WHO has also come up with a water soluble formula which is easily available in all chemist stores and is prepared and sold for under INR 20. Now, the question arises, when does one need an ORS?
A person needs to drink ORS when they feel dehydrated. The early symptoms of dehydration:
- Reduced urination and darkening of urine.
As the symptoms of dehydration worsens, one may also exhibit these symptoms:
- Dry Lips
- Muscle Cramps
What is Dehydration?
The human body is made of 75% water which is found in the smallest living blocks in us, our cells and in larger connecting systems like the nervous system. Water is necessary for survival, and it is important for the human body to keep on replenishing the water it loses. A healthy human loses some amount of water while breathing, sweating, urinating and passing stool. Thus, everyone is advised to drink at least 8 glasses of water (250ml) everyday. A person is said to be dehydrated when he/she loses water faster than they can compensate for it. So, now the question becomes, what causes dehydration?
Causes of Dehydration
A person can lose excess water from their systems when they sweat excessively, or have an upset stomach. However, there are some man made food material which can also make the human body lose critical amount of water. Aerated drinks are known as dehydrating agents, as they make the body lose water by eliminating it from the urinary system of the body. Here are a few causes of dehydration:
In a diabetic patient, excess sugar is present in the bloodstream, which carries it to the kidneys, where it spills into the urine. This sugar makes it difficult for the urinary tract to control the flow of water, which results in water loss. Frequent urination and excessive thirst are markers of diabetes.
A normal person sweats in hot or humid weather to keep the body cool. If the temperatures are too high or it is too humid outside, a person can lose considerable amount of liquid as the body works on overdrive to keep itself cool. However, there are other reasons why a person may sweat excessively, anemia and obesity are two such reasons.
Nausea and vomiting could be indicators of several things like indigestion, morning sickness, acidic reflux and so on. If a person vomit for 3 or more times in the time span of a few hours, they may feel exhausted, experience muscle cramps and experience dehydration.
4. Inability to Drink Fluids
Vomiting leads to a feeling of nausea, this nausea makes it difficult for a person to intake any liquid orally. There are several stomach bugs and infections which can also cause excessive vomiting or diarrhea, making it difficult for an individual to hold any liquids in or even drink sips of water.
Diarrhea is a condition when an individual passes stool frequently and the stool passed is more liquid in nature. Sometimes it may also look like a person is only passing water in the name of bowel movement. Diarrhea leads to rapid depletion of liquids in the body causing muscle cramps, lightheadedness even dizziness.
The skin is the largest, single connecting organ. It is also a protective layer which prevents excessive loss of water. When the body suffers third degree burns the skin is not able to stop the bodily fluids from flowing out of the wounds, thus, lot of burn victims also suffer from dehydration.
7. Diarrhea Deaths: Statistics & Prevention
“Diarrhea death” is a term coined to estimate the number of deaths among children caused by diarrhea and diarrhea induced acute dehydration. Yes, diarrhea is that fatal. In 2015, the Lancet published an article mapping the top causes of death among children, globally. While ORS can reduce the chances of death due to diarrhea by 93%, and that the number of diarrhea deaths in children has been reduced by a third, researchers observed that 5,00,000 children still died due to acute diarrhea globally, every year. Of these 5,00,000 children 42% belong to Nigeria and India. Among India and Nigeria, it turns out, India faces the most deaths, with over 1,05,000 diarrhea induced deaths. Researchers have argued that both countries are developing, struggling with poverty, industrial expansion and a lack of clean water sources.
It is also necessary to understand that while dehydration itself is not contagious but viral infections like diarrhea are, many such cases of epidemic proportions among children have emerged from places which generally witness presence of a lot of public: schools, toilets, canteen or other places where children come into contact with each other.
The rehydration treatment programs aggressively promoted by the government have been able to reduce the number of death substantially. The condition being that treatment is provided immediately and as we have discussed in our previous write up on the impact of population on healthcare, it turns out, there is shortage of healthcare providers in far flung villages, where such cases rise up the most.
Rehydration Treatment Plans
Treatment for dehydration depends on the degree of dehydration, if the severity of dehydration is extremely mild, home based solutions can do the trick. However, higher degrees of dehydration require proper plans and stages of normalization. We now describe the two types of treatments made available to patients:
Oral Rehydration Therapy (ORT)
Oral rehydration therapy is probably the most effective and painless way of treating dehydration. ORS solutions are available in the market as powder packs or prepared solutions in 200 ml tetra packs (you can buy some from shop.medlife.com). In case of mild dehydration the patient is required to drink between 250 ml- 500 ml of ORS. The tetrapacks serve this purpose well. In case of moderate dehydration, a patient should drink 500 ml of ORS. A patient should drink the solution, one to two mouthfuls at a time and each mouthful should be taken in measured time gaps. Please note, that any amount of ORS should not be drunk at the same time. This solution is to allow the body to absorb more water through the intestines.
If a patient starts vomiting or losing even more liquids by orally taking the ORS, he/she should immediately be treated for severe dehydration.
In case of children, even 100 ml ORS is enough to handle mild to moderate dehydration. Children should drink the solution one sip at a time and not more than half a cup at one time. Babies can be given ORS through a dropped or spoon and the dosage should be less than half a cup after every bowel movement.
Rehydration Therapy through IV
When a person exhibits symptoms of severe dehydration, oral rehydration is not a viable option as they may vomit everything out and lose more water. In such circumstances, the best alternative is to supply the body with necessary salts and nutrients through an IV tube which would supply the necessary liquids intravenously.
Associated Therapies To Be Given Along With Rehydration Treatment
It is important to remember that dehydration not just robs the body of essential liquids it also depletes the body’s core of important minerals. Attention should also be paid to the fact that a person’s normal diet is disrupted and if one is given antibiotics without taking care of balancing other bodily needs, it may have a negative effect on the patient. Therefore, there are a few associated therapies one must take care of along with rehydration treatment:
1. Malnutrition Care
Dehydration becomes lethal in malnourished children as more often than not it is underestimated in edematous children while overestimated in wasted children. To briefly explain, edematous children are severely deficient in proteins, which leads to a fatty liver and swollen abdomen. Wasted children on the other hand, are children who extremely malnourished, body weight of such children is below 65% of the expected BMI for their age.
When such children suffer from diarrhea, they may also suffer with a form where they are not losing water through bowel, such a situation is known as “septic shock”. Such children should be given Rehydration Solution for Malnutrition (ReSoMal), which contains more potassium and less sodium.
Malnourished children need special care, they should be given semi-solid within 3-4 hours of starting with the oral rehydration therapy and should be fed frequently from there on. UNICEF and WHO have shared a list of food items along with their amount a malnourished child should be fed, as he/she recovers from dehydration, such children also require constant supervision.
It is also important to note that malnourished and dehydrated children require medical supervision too, thus, a medicine practitioner or healthcare provider should also constantly check on the child to decide effectively on the next course of treatment.
2. Normalizing of Solid Food Intake:
Food intake in a person suffering from dehydration may also be impacted, especially, if that person is suffering from diarrhea or constant vomiting. However, children as well as adults should be given semi-solid foods within 3-4 hours of starting with the oral rehydration therapy or as soon as they start responding to treatment. They should be fed small amount of food every 3-4 hours from there on, till their diet is back to normal. Children should be given an extra meal for two-three weeks after they recover from dehydration. Malnourished children should be fed an extra meal for a much longer period.
3. Zinc Diet:
To ensure a speedy recovery, WHO suggests that a person should be given zinc supplements, 20 mg at most, daily for the next ten to fourteen days after recovery to prevent a relapse as well as to expedite recovery.
The World Health Organization has clearly instructed health agencies to ensure that children with malnutrition and suffering from dehydration must be given broad range antibiotics to be safe. If on further tests, cholera is detected, proper medications can reduce volume loss due to diarrhea by 50%.
Types of ORS:
In the previous section we discovered that there is a possibility that different types of ORS exist, catering to the express needs of the patient. Before we take a look at the different types of ORS, lets understand “osmolarity” in very simple terms, when salt (NaCl) is mixed in water, it breaks into ions of Sodium (Na) and Chlorine (Cl) to form saltwater. Osmolarity is the total number of particles in a solution. This is a very basic understanding of the phenomenon but gives a clear picture. A normal ORS solution whether powdered or as a drink has a higher concentration of Sodium, than Potassium and while this works for most, some bodies may require more Potassium. Keeping these explanations in mind, let us now look at the different types of ORS solutions:
1. Home Made ORS:
Home made ORS is the first preventive solution given to a patient who is showing symptoms of dehydration. In extremely mild cases, even this solution is enough to restore the patient’s fluid balance. In other cases, this helps the patient in not losing too much volume before he/she gets proper medical attention.
2. Rice Based ORS:
Rice based ORS reduces the loss of volume due to diarrhea or cholera by 40%, it also provide more glucose to counter loss of glucose along with some carbs. Rice based ORS is also more culturally acceptable in some areas. Research has also shown that other starch based substances like maise or wheat also, provide similar results, without increasing the osmolarity of the solution.
3. TriSodium Citrate ORS:
Trisodium citrate increases the intestines capacity to absorb more sodium and water. Trisodium citrate also stabilizes the solution and increases its shelf life, which is why UNICEF and WHO is encouraging the use of Trisodium citrate.
4. Low Osmolarity ORS:
Low osmolarity ORS decreases stool by 30% and vomiting by 20%. It also reduces the amount of glucose and sodium in the solution, making them more tolerable for the body, thereby, reducing the need for intravenous fluids.
5. Super ORS:
Super ORS can be any kind of ORS mentioned above, but they also contain more complex sugar as well as some trace amounts of zinc. This improves rehydration, provides more nutrition, helps in weight gain, helps regain the electrolyte balance as well as strengthens immune response to pathogens.
How to Prepare ORS at Home:
An emergency ORS solution is easy to make. Here is a recipe for the same:
To prepare 250 ml of ORS solution at home, you require:
- 1 pinch salt
- 1 tablespoon sugar
- 250 ml water
- Few drops of lemon (optional)
How to Prepare the Solution:
Pour water in a glass till it is a little shy of completely full.
Add the sugar and salt and mix well, till all sugar particles have been dissolved.
If you wish to change the taste a little, add a few lemon drops.
History of ORS: Discovery and Significance
It is believed that diseases like cholera and dysentery, which are communicable took epidemic proportions because mankind finally settled down and developed into civilization. The historical argument being, that the hunter-gatherers or nomads, were isolated units and thus, one unit could barely infect another, however, with the development of cities and civilizations and stored and shared resources like water could lead to simple diseases become pandemic. Black Plague, Bubonic plague and Cholera were such pandemics. In the year 1829, the western world suffered great loss of human life during the Cholera epidemic. A healthcare provider, William Brooke O’Shaughnessy then observed that the cause of death was loss of salts and water suffered by the body due to the frequent passing of stools. To remedy this, in 1831, O’Shaughnessy developed the intravenous rehydration therapy, which brought down the mortality rates to 40%. For decades after this therapy was developed, it became the standard treatment for curing dehydration.
This practice continued for over 120 years, till 1957 when an Indian physician by the name of Hemendra Nath Chatterjee discovered the results of oral therapy, however, since Chatterjee had failed to do a controlled test, it wasn’t able to gain the limelight it should have. However, in 1960s Robert Crane established the sodium-glucose-transport absorption that takes place in the intestines. This process seemed unaffected during cholera, thus, oral rehydration became the most viable and effective option for someone suffering from cholera.
In 1967-68 two scientists, by the names of Norbert Hirschhorn and Nathaniel F. Pierce, working separately in Dhaka and Calcutta, discovered that patients suffering from cholera can absorb electrolytes better when given orally. In 1968, David Nalin proved that when adults were given an electrolyte solution orally, can reduce the need for IV treatment by nearly 80%. In the early 1970s, Hirschhorn conducted some further studies and discovered that babies and children can take the oral rehydration to the amount they need and continue with their feeding, making oral rehydration more popular for dealing with dehydration in children and preventing child mortality.
The campaigns for promoting the use of ORT started around the 1980s and from 2006 onwards the UNICEF and WHO got onboard and started a global scale promotion for the use of ORT.
When is World ORS Day celebrated?
In 2002, Doctors Norbert Hirschhorn, Nathaniel Pierce, Dilip Mahalanabis, and David Nalin were recognized for their work on ORT as well as creating awareness around it. July 29, was selected as the day for creating more and more awareness about the diarrhea induced dehydration, which is the second largest preventable killer in the world. July 29, is thus celebrated as a day to remember the epidemics that have been caused because of dehydration and the journey mankind has been through to win over it.
World ORS Day Special: Infographic