(Oral Rehydration
Salts)ORS
By : Dr. Pratibha Pandey
Assistant professor
Department of
pharmacology
GBMC, Dehradun
PH2.2 – Prepare Oral Rehydration Solution
from ORS packet & Explain its use.
Exercise
To
prepare Oral Rehydration Solution from ORS
packet & Explain its use to a
Subject/Standardised Patient.
OralRehydration Salt (ORS) Solution is
a simple cheap & effective treatment
for diarrhoea-related dehydration.
E.g. Cholera, Rotavirus
Consists of solution of salts & ither
substances like glucose, sucrose,
citrates or molasses.
Administered orally
WHO formula for 1L solution
Sodium chloride: 2.6 gm
Potassium chloride: 1.5 gm
Sodium citrate: 2.9 gm
Glucose: 13.5 gm
Objectives of giving ORS
To prevent Dehydration
To reduce mortality
ORS day – celebrated every year on 29th-
july
Procedure
1. Get the ORS Packet & Check information on the packet
including expiry date.
2. Get 1 l of cooled freshly boiled water or filtered water into a
jug.
3. Cut the packet with clean scissors as depicted with cut lines
on the packet.
4. Pour the content into the jug & mix.
5. Instruct the patient to take it at frequent intervals. The
frequency of sips will depend on level of dehydration.
6. Do not add ORS to milk , soup , juice or any soft drinks.
7. Do not add sugar
8. Prepared ORS solution should be covered & used within 24
hours due to risk of bacterial contamination.
How much ORS to give?
Encourage child to drink as much as he/she can.
A child < 2yrs , give ¼ to ½ of a large (250 ml) cup of ORS drink
after each watery stool followed by 1-2 teaspoons every 2-3
mins.
A child 2 yrs or older, give ½ to 1 whole large (250 ml) cup of
ORS drink after each watery stool .
If child vomits , wait for 10 mins & then give a teaspoon every 2-
3 mins.
If child is breastfeeding , continue breast feeding along with ORS.
Pharmacological Actions
Loss of water & electrolytes occur in
Diarrhoea → Dehydration
Hence both water & electrolytes are given
for treatment.
Water if given alone → dilutes the salts
present in body & aggravates the condition.
Earlier
ORS has osmolarity of 311 mOsm/L ;
now reduced osmolarity ORS is used
(245 mOsm/L)
Composition
197
2003
8
Individual ingredients
Sodiumchloride: facilitates replenishment of
sodium, which is lost in diarrhea
Potassium chloride: an important intracellular cation
which is to be replenished due to loss in
diarrhea.Which may cause dysfunction of nerves
and muscles.
Sodium citrate: to correct acidosis that has occurred
due to loss of alkali in stools. It also promotes salt &
water absorption.
Glucose: it helps in co-transport of sodium, sodium
absorption is increased by thousand folds.
Properties of ORS-citrate
The particular advantage of citrate containing
ORS (over bicarbonate containing ORS) is its
stability in tropical countries, where - up to
temperatures of 60°C - no discoloration occurs.
A shelf-life of 2-3 years can be assumed
without any particular storage precautions.
Composition
Therapeutic Uses of ORS
1. DIARRHOEA:
Bestmethod for combating dehydration due
to diarrhoea and/or Vomiting.
ORSis recommended in mild to moderate
cases of Diarrhoea
Severe cases require intravenous fluids.
Amount of rehydration required depends on
size of individual & degree of dehydration.
Degree of Dehydration can be assessed by
following parameters:
1. Pulse
in dehydration has low volume & is
Thready
2. No tears, dry mouth in case of moderate
to severe dehydration
3. Decreased urine output
Therapeutic Uses of ORS
Rough guide to amount of ORS solution needed in first
4-6 hours of treatment in mildly dehydrated person is:
Up to 5 Kgs 200-400 mL
5-10 Kgs 400-600 ml
10-15 Kgs 600-800 ml
15-20 Kgs 800-1000 ml
20-30 Kgs 1000-1500 ml
30-40 Kgs 1500 – 2000 ml
40 plus Kgs 2000 – 4000 ml
Therapeutic Uses of ORS
2. Post surgical, post burn, post trauma patients for
maintaining of hydration.
3. In patients with heat-stroke.
4. For nutrition in place of i.v infusion.
5. Also used during shifting the patient from parenteral
nutrition to enteral nutrition.
6. High grade fever
Super ORS
Thisis made up by adding certain actively
transported Amino acids
E.g: Alanine & Glycine which co-transport
with sodium but their efficacy is marginal &
they are not effective in non-cholera
diarrhea.
They are not cost effective & on other hand
substances like boiled rice powder 40-50 gm
/liter is an effective substitute for glucose.
Uses: Addition to rehydration, also leads to
decrease in purging rate(frequency of stool)
improvement of diarrhea
Home based ORS:
Ina glassful of water, add 1 teaspoonful of sugar & a
pinch of salt. You can also add half a lemon.
OR
To1L freshly boiled & cooled water add 8 level
teaspoons of sugar & 1 Level teaspoon of salt & mix.
You can also add ½ cup orange juice or half mashed
banana to each liter to add potassium & improve
taste
Certainhome based preparation like daal water, juice
water, fruit juices, coconut water can be used in
place of ORS.
Precautions
1. Hotwater should not be used as it may lead
to breakdown of bicarbonate & alteration in
flavour
2. Do not use the solution if it is coloured
3. Always use freshly prepared solution
4. Thesolution made should not be used 24
hours after its preparation as glucose in fluid
can lead to development of infection.
5. Use clean utensil to prepare the solution.
Thank you
