Importance of Oral Rehydrating Solution (ORS)

ORS is the preferred first-line treatment of fluid and electrolyte losses caused by diarrhea due to acute gastroenteritis in children with mild to moderate dehydration.

Globally, the diarrheal disease remains one of the leading causes of childhood mortality and morbidity. Loss of intestinal fluid caused by acute gastroenteritis (AGE) may lead to severe dehydration, shock, and death, particularly in children younger than five years of age in areas of the world with limited resources. In developed countries, such as the United States, diarrhea caused by acute gastroenteritis remains a major cause of hospitalization.

Although the total number of deaths globally from diarrheal diseases from acute gastroenteritis remains high, the overall mortality rate has steadily declined over the last few decades. This decline, especially in developing countries, is largely due to the use of early and appropriate oral rehydration therapy (ORT), improved nutrition and water sanitation measures, and effective vaccination for rotavirus.

Death due to dehydration is an important cause of mortality in resource-limited settings. It can occur because the initial dehydration status is underestimated and/or because the extent of ongoing fluid loss is underappreciated.

The degree of dehydration should be assessed at presentation based on physical signs and symptoms. Several studies have demonstrated that using a combination of three to four physical signs reliably predicts dehydration of 3 to 5 percent or greater. The World Health Organization (WHO) has issued recommendations for assessing dehydration based on history of increased thirst, decreased urine output or irritability; increased pulse and respiratory rate; low blood pressure and delay in capillary refill.

(ORS) oral rehydration solution is a simple but life-saving remedy made of salt and sugar first formulated in the late 1960s by American and Bengali doctors and researchers working in Dhaka, the capital of Bangladesh. ORS is a mixture of electrolytes (salts) and carbohydrates (in the form of sugar) dissolved in water. They are used to replace salts and water that the body loses when you have persistent diarrhea and vomiting.

ORT reduces childhood mortality from diarrheal disease. This was best illustrated in a 2010 meta-analysis that included three low-quality studies showing diarrhea-specific mortality was lower in communities in which ORS was promoted compared with control communities without ORS promotion. In addition, clinical trials and meta-analyses have shown that ORT is as effective as intravenous (IV) rehydration therapy in treating dehydration due to acute gastroenteritis. It was also associated with a shorter length of hospitalization, lower costs, and fewer complications.

ORT is the preferred first-line treatment of fluid and electrolyte losses caused by diarrhea due to acute gastroenteritis in children with mild to moderate dehydration. It is used to treat dehydration caused by acute gastroenteritis independent of age, causative agent, or initial sodium values. Advantages of ORT compared with IV hydration include lower cost, easier to administer, less invasive intervention, a treatment that can be done or continued at home, and a lower rate of revisits to the emergency department.

Commercially available ORS solutions have similar concentration of glucose and sodium with our body. Based on the available data, differences in the composition of commercially available products and the 2002 WHO ORS do not appear to be clinically significant when administered to children with diarrhea in developed countries. All commercial ORS contain 2 to 3 percent carbohydrates as glucose, rice, or other cereal; this amount is sufficient to promote intestinal water absorption. Studies in the United States demonstrated the successful treatment with commonly used commercial ORS in children with mild to moderate dehydration. In children between 5 and 10 years of age, sucralose-sweetened ORS solutions appear to be more palatable than comparable rice-based solutions.

It is advised that ORS solution is taken at the start of diarrhea and/or vomiting and prepared exactly as the packaging says to replace electrolytes, water, and glucose effectively.