ORS

(ORAL
REHYDRATION
SALT)
 COMPETENCIES

PH 2.2 - Prepare oral rehydration solution

from ORS packet and explain its uses
 SPECIFIC LEARNING
OBJECTIVES

1. Define and enumerate causes of dehydration

2. Describe the clinical assessment of dehydration

3. Enumerate the different types of ORS along with their

composition with actions of each ingredient

4. Choose the appropriate type of ORS for a given

condition/patient
 SPECIFIC LEARNING
OBJECTIVES
5. Calculate the quantity of ORS required to
correct/prevent dehydration

6. Demonstrate preparation of ORS from sachet

7. Enumerate the non-diarrheal uses of ORS

 DIARRHEA DYSENTERY

• Passage of 3 or more loose • Bloody diarrhoea

stools per day • Any diarrhoeal episode in
• Frequent passing of formed which the loose or watery
stools is not diarrhea stools contain visible red

blood
 Diarrhoeal Disease

• 3rd leading cause of death in children under 5 years

old

• Death due to diarrhoeal disease 443,832 children

every year.
Vicious Cycle Of Undernutrition & Infectious
Disease
 DEHYDRATION

• It is the state of the body in which it loses water

more than it can compensate

• The person is said to be dehydrated if they cannot

compensate for the fluid loss
HOW DO YOU MANAGE DEHYDRATION?

Supplementation of fluid
Replace lost fluids

Provide Daily fluid requirement

Prevent Ongoing fluid loss

 Fluid Replacement

Oral fluids available at home

IV Fluids (RL, NS)

ORS
 What is ORS?

• An oral powder containing a mixture of glucose, sodium

chloride, potassium chloride, & sodium tri-citrate

• After being dissolved in the requisite volume of water

they are intended for the prevention and treatment of

dehydration
 ACTIONS OF INGREDIENTS

1. Sodium chloride - replenishes sodium loss

2. Potassium chloride - replenishes potassium loss

3. Water- replaces fluid loss

4. Glucose- facilitates the absorption of sodium (and hence

water) on a 1:1 molar basis in the small intestine.
 Type of ORS Key Components
Sodium Bicarbonate- Sodium bicarbonate, sodium chloride,
Based ORS Glucose anhydrous, Potassium chloride

Trisodium Citrate- Trisodium citrate, sodium chloride,

Based ORS Glucose anhydrous, Potassium

Complex sugar (glycine/alanine/starch),

Super ORS Trisodium citrate, sodium chloride,
glucose, Potassium chloride

Zinc, Complex sugar

Super Super ORS Trisodium citrate, sodium chloride,
glucose, Potassium chloride
 COMPOSITION OF ORS
STANDARD ORS LOW OSMOLARITY ORS
(Osmolarity – 311 Mmol/L) (Osmolarity – 245 Mmol/L)

Component Conc. Component Conc.

(Water – 1000ml) (g/L) (Water – 1000 ml) (g/L)
Sodium chloride 3.5 Sodium chloride 2.6

Glucose, anhydrous 20.0 Glucose, anhydrous 13.5

Potassium chloride 1.5 Potassium chloride 1.5

Sodium bicarbonate 2.5

Sodium tri-citrate 2.9
 ADVANTAGES OF LOW Osmolarity ORS
(245 mmol/L)

Increased efficacy of ORS in non-cholera diarrhea

Stool output reduced by 20%

Vomiting decreased by 30%

Need for unscheduled supplement IV therapy in children

reduced by 33%
Bicarbonate Vs Tri-citrate ORS

Bicarbonate-based ORS Tri Citrate-based ORS

• Less stable • More stable
• Stool output not • Less stool output in
reduced high-output diarrhoea
• Tri Na citrate increases
intestinal absorption of
Na & water
 USES

• Dehydration due to diarrhea and dysentery

Non-diarrheal uses-

• Post-surgical, burns, post-trauma

• Heat stroke

• Change over from parenteral to enteral nutrition

SIGNS OF DEHYDRATION
SIGNS OF DEHYDRATION
 PLAN ABC OF DEHYDRATION

Dehydration
Level Signs and Symptoms Treatment Plan
No If two or more of the signs of "severe Plan A
Dehydration and some dehydration" are NOT present

Some Restless, irritable, Sunken eyes Plan B

Dehydration Drinks eagerly, Thirsty
Skin pinch goes back slowly

Severe Lethargic or unconscious Plan C

Dehydration Sunken eyes
Not able to drink or drinking poorly
Skin pinch goes back very slowly
 TREATMENT OF DIARRHOEA AT HOME
PLAN A

1. Give extra fluid

2. Give zinc supplements
3. Continue feeding
4. When to return (Danger signs)
 WHAT FLUIDS TO GIVE ?
Wherever possible, include at least one fluid that normally
contains salt
• Fluids that normally contain salt
• ORS solution
• Salted drinks (rice kanji or a salted yoghurt drink)
• Vegetable or Chicken soup with salt.
• Fluids that do not contain salt
• Plain water
• Water in which cereal has been cooked (e.g. unsalted rice water)
• Unsalted soup
• Yoghurt drinks without salt
• Green coconut water
• Weak tea (unsweetened)
• unsweetened fresh fruit juice
 WHAT FLUIDS TO AVOID?
• Potentially dangerous - Can cause osmotic diarrhoea &
hypernatremia

• Drinks sweetened with sugar

• Carbonated beverages
• Commercial fruit juices
• Sweetened tea

• Stimulant, Diuretic or Purgative effects

• Coffee
• Some medicinal teas or infusions.
 PLAN A: NO DEHYDRATION

Fluid/ORS Administration after loose stool

Age Volume of Fluid

<2 years 50-100 ml

2-10 years 100- 200 ml
> 10 years Ad lib
 PLAN B: SOME DEHYDRATION

ORS Administration after loose stool

Age Volume of ORS

All ages  75 ml/kg in first 4 hours.

 Reassess
 Signs of dehydration +  repeat. (restore lost fluid)
 No Signs of dehydration ORS to (replace ongoing
fluid losses)
 Close monitoring for first 4 hours
 No IV fluids
WHEN TO COME BACK?

DANGER SIGNS
• Inability to eat or drink
• Lethargy
• Convulsions
• Loss of consciousness
 PLAN C: SEVERE DEHYDRATION

• Start IV fluids immediately

• If the patient can drink, give ORS orally until the

drip is set or through nasogastric tube
 PLAN C: SEVERE DEHYDRATION

Treatment Age Timeframe Total Volume

<1 Year First 1 hour 30 ml/kg

IV RL or 0.9 % (6 hours) Next 5 hours 70 ml/kg
NS
& ORS >1 year First 30 mins 30 ml/kg
(3 hours) Next 2 hrs 30 mins 70 ml/kg
ZINC SUPPLEMENTS ADMINISTRATION
INSTRUCTIONS

• Up to 6 months: 10mg tablet once daily for 10-14 days

• > 6 months of age: 20mg tablet once daily for 10-14 days
• Zinc sulphate tablets may be dispersed in breast milk, in oral
rehydration solutions, or water on a small spoon
• Older children can chew the tablets or swallow them with
water
 Importance of zinc supplementation

Repair mucosal barrier

damage which is susceptible
to infection & inflammation

eg; Maltase, lactase 

breakdown disaccharides 
glucose  improves Na+ &
water absorption (SGLT1)
into the intestinal cells
Inhibit Na+ & water
Regulate cytokine &
loss into the intestinal antibody-like B-lymphocyte
lumen production
 DON'TS

1. Prepared ORS solution should not be used after

24 Hours

2. Don’t Refrigerate
 SUPER ORS
1. Contains complex sugar
 rice based
 glycine/alanine based
 glucose polymer based

2. Provide rehydration
3. Reduce stool output
4. More calories (180Kcal/liters)
5. Gradual release of glucose
6. Prevent secondary disaccharide intolerance
7. Contribute to weight gain
 SUPER SUPER ORS

• Addition of Zinc to super ORS

• Improve absorption of water and electrolyte in intestine

• Faster regeneration of gut epithelium

• Increase level of enterocyte brush border enzyme

• Enhanced immune response leading to increased clearance

of the pathogen
 ORS SUBSTITUTES

• Rice kanji

• Tender Coconut water

• Home made ORS: Plain boiled and cooled water (250ml)

added with 1 pinch of salt and 1 teaspoon of sugar

• Super ORS: add rice/ maize/ potatoes (Amino acids help in

better absorption of sodium)
 PRESCRIPTION OF ORS

Name: Baby Divya

Age: 6 months
Gender: Female
Weight: 12 kgs
Directions to use:
Dissolve the ORS contents in 100ml of boiled and cooled
water (potable water)
About 1-2 teaspoons to be given every minute until
dehydration is corrected

Date :14/11/24 Signature: xyz

Place: Bangalore Register No:
KMC145443
 PREPARATION OF ORS

• Aim: To prepare and dispense 100ml of ORS solution

• Procedure: 0.26g of sodium chloride, 0.15g of potassium

chloride, 0.29g of tri-sodium citrate, 1.35g of glucose were

exactly weighed, mixed, packed and labeled

• To be dissolved in 100ml of boiled & cooled (potable) water

for use when required

 PREPARATION INSTRUCTIONS

1. Put the contents of ORS in a clean container. Add the

exact amount of previously boiled and cooled clean water
(one litre).

2. Add only water, never add Fruit Juice, Coke, Milk or Soup
etc.
 ADMINISTRATION INSTRUCTIONS

1. Should begin immediately.

2. Can be given by spoon, dropper, cup, tumbler, syringe or nasogastric

tube.

3. Give 250 ml of ORS after each episode of loose stool.

4. A Child Less than 2 years a Teaspoon every one to two minutes

5. A Child above 2 years or older give 250 ml after each episode of loose
stool.

6. Vomiting if occurs wait for 10 minutes.

7. Breast feeding to continue

 PLAN ABC OF DEHYDRATION
Dehydration
Level Signs and Symptoms Treatment Plan
No If two or more of the signs of Plan A
Dehydration "severe and some  Treat for diarrhea at home
dehydration" are NOT present  Counsel the mother to give extra fluid and zinc
 Counsel the mother to continue feeding
 Advise the mother when to return for follow-up
Reassess
Some Restless, irritable Plan B
Dehydration Sunken eyes  Treat for some dehydration with ORS
Drinks eagerly,  Treat the child with ORS solution and zinc
Thirsty  Breastfed children should continue breastfeeding
Skin pinch goes back slowly  Children not breastfed should receive their usual milk or
some nutritious food after 4 hours of treatment with ORS
 Reassess
Severe Lethargic or unconscious Plan C
Dehydration Sunken eyes  Treat for severe dehydration quickly
Not able to drink or drinking  Provide fluids intravenously (IV), if not, by nasogastric
poorly tube (NG) as in Plan C
Skin pinch goes back very  Refer the child to a hospital for IV fluids if IV fluid
slowly administration is not possible in your setting
 Reassess
 ACTIVITIES
Roll numbers

201-210 A 4-year-old child following a day of diarrhea caused by viral gastroenteritis.

Symptoms: Thirsty, slightly dry mouth. The child remains alert and has no fever.

211-220 A 65-year-old woman after several days of diarrhea and vomiting due to
food poisoning.
Symptoms: Weakness, dry mouth, and low urine output.

221-230 A 2-year-old child with acute diarrhea from a bacterial infection.

Symptoms: Sunken eyes, lethargy, very dry mouth, and minimal urine output.
The child has a fever and is irritable.

231-240 A 35-year-old man after intense physical exercise on a hot day.

Symptoms: Feeling very thirsty, slight headache, dry mouth, but otherwise stable
and alert. No vomiting or diarrhea.

241-250 A 50-year-old patient with diabetes had a single episode of nausea and
vomiting.
Symptoms: Dry mouth, slight dizziness, and low appetite, but blood sugar is
stable. The patient is conscious and cooperative.
REFERENCES

1. https://iris.who.int/bitstream/handle/10665/43
209/9241593180.pdf;jsessionid=2436DFD67
6458DBA4DE99EB388AEE52E?sequence=1
THANK YOU