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Oral rehydration therapy

A cholera patient is given an ORT drink.

Oral rehydration therapy is a treatment for dehydration: the sick person drinks water mixed with sugar and salt. They don't stop eating food. There is a mixture that is used for severe dehydration: This mixture also includes zinc. Those who take care of the sick person are taught how they can see it if the dehydration gets worse. 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 lower the number of human deaths from dehydration in vomiting and diarrheal illnesses, especially in cholera epidemics occurring in children. It is sign for public health getting better all over the world. 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 ORT was used often, most of the children who died in developing nations, died from diarrhea. Between 1980 and 2006, the introduction of ORT is thought to have lowered the number of young children who died anywhere in the world from 5 to 3 million every year.[3][4] However, in 2008, diarrhea is still 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

WHO and UNICEF developed official guidelines for how to make 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 ([math]\displaystyle{ C_{6}H_{12}O_{6} }[/math]) 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 says that making it a bit too thin (using more than 1 liter of fluid) is not bad for the sick person.[12]

The best 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 non-drinking water are recommended when plain, clean water is unavailable. Water can be made safe with chlorine, or by boiling it. However, ORS should still be given even if the water is maybe unsafe. Rehydration is more important. [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 1 part fruit juice without sugar, mixed with 4 parts water.[15]

Oral Rehydration Therapy Media

  • Examples of commercially available oral rehydration salts. On the left from Nepal. On the right from Peru.

  • Examples of commercially available ORS mixing into water.

  • UNICEF-WHO Oral Rehydration Salt (ORS) packet

  • Intestinal epithelium (H&E stain)

  • Crane and his sketch of the sodium-glucose symporter

  • Refugee camp near Goma

References

  1. ↑ 1.0 1.1 ""The treatment of diarrhea, a manual for physicians and other senior health workers."" (PDF). "World Health Organization. 2005.
  2. ↑ "WHO Model List of EssentialMedicines" (PDF). World Health Organization. October 2013. Retrieved 22 April 2014.
  3. ↑ Gerline, A. (8 October 2006). A simple solution. http://www.time.com/time/printout/0,8816,1543876,00.html. Retrieved 15 July 2014. 
  4. ↑ "Water with sugar and salt". Lancet. 312 (8084): 300–1. August 1978. doi:10.1016/S0140-6736(78)91698-7. S2CID 41307983.
  5. ↑ The state of the world's children: child survival (PDF). UNICEF. December 2007. p. 8. ISBN 978-92-806-4191-2. Archived from the original (PDF) on 2019-07-02. Retrieved 2014-07-15.
  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. doi:10.2471/blt.07.041384. PMC 2647400. PMID 18368194.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  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." Archived 2014-01-02 at the Wayback Machine 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.
  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.

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