ORS and ORT managing diarrhoeal dehydration|ICDS Supervisor|ICDS Supervisor Exam Kerala PSC
In this post, the two types of managing diarrhoeal dehydration are explained ie, ORS and ORT. Oral Rehydration Salt and Oral Rehydration Therapy. In the previous posts, we already discussed the types of dehydration in Diarrhoea is explained. Diarrhoea, one of the Infections spread by food and water is explained in another post. The Types of Diarrhoea and the pathogens of Diarrhoea are explained in detail. Other Infections spread by water are Typhoid, Paratyphoid fever, Poliomyelitis, Hepatitis A and Hepatitis E. Those will be explained in the coming posts. Immunization and Vaccines are important topics for ICDS Supervisor Exam.
ORS and ORT managing diarrhoeal dehydration
Managing diarrhoeal dehydration involves:
• rehydration therapy: the rapid correction of fluid and electrolyte deficits, followed by
• maintenance therapy: continued replacement of fluid and electrolyte losses as they occur until diarrhoea stops.
Fluid losses can be replaced either orally or intravenously; the latter route is usually needed only for initial rehydration of patients with severe dehydration.
Oral rehydration therapy (ORT)
ORT is based on the principle that intestinal absorption of sodium (and thus of other electrolytes and water) is enhanced by the active absorption of certain food molecules such as glucose (which is derived from the breakdown of sucrose or cooked starches) or l-amino acids (which are derived from the breakdown of proteins and peptides).
Fortunately, this process continues to function during secretory diarrhoea, whereas most intestinal absorption of sodium is impaired.
Thus, if patients with secretory diarrhoea drink the isotonic salt solution that contains no source of glucose or amino acids, sodium is not absorbed and the fluid remains in the gut, adding to the volume of stool passed by the patient.
However, when an isotonic solution of glucose and salt is given, glucose-linked sodium absorption occurs and this is accompanied by the absorption of water and other electrolytes.
This process can correct existing deficits of water and electrolytes, and replace further faecal losses in most patients with secretory diarrhoea, irrespective of the cause of diarrhoea or the age of the patient.
Oral rehydration salts (ORS)
The principles underlying ORT have been applied to the development of a balanced mixture of glucose and electrolytes for use in treating and preventing dehydration, potassium depletion, and base deficit due to diarrhoea.
To attain the latter two objectives, salts of potassium and citrate (or bicarbonate) have been included as well as sodium chloride.
This mixture of salts and glucose is termed oral rehydration salts (ORS).
When ORS is dissolved in water, the mixture is called ORS solution.
The following guidelines were used in developing the WHO/UNICEF recommended ORS solution:
• The solution should have an osmolarity similar to, or less than that of plasma, i.e. about 300 mOsmol/l or less.
• The concentration of sodium should be sufficient enough to efficiently replace the sodium deficit in children or adults with clinically significant dehydration.
• The ratio of glucose to sodium (in mmol/l) should be at least 1:1 to achieve maximum sodium absorption.
• The concentration of potassium should be about 20 mmol/l in order adequately to replace potassium losses.
• The concentration of base should be 10 mmol/l for citrate or 30 mmol/l for bicarbonate, a satisfactory amount for correcting base-deficit acidosis due to diarrhea.
The use of trisodium citrate dihydrate is preferred since this gives ORS packets a longer shelf life.
Oral rehydration therapy solutions are designed to approximate the composition of gut fluid losses in diarrhoea.
The WHO-recommended composition of oral rehydration solution is:
• 1 liter of clean drinking water (boiled and cooled before mixing if there is any doubt);
• 3.5 g sodium chloride;
• 2.9 g trisodium citrate dihydrate (or 2.5 g sodium bicarbonate);
• 1.5 g potassium chloride; and • 20 g glucose (or 40 g sucrose).
This is the formulation generally recommended for developing countries.
It is possible to buy ORS formulations over the counter in most parts of the world.
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