Management-Oral Rehydration Solution

Summary

• ORS is absorbed in the intestines and can quickly replace the water and electrolytes lost through vomiting and diarrhea.
• ORS is as effective as intravenous therapy in replacing loss fluids due to dehydration.
• The United Nations Children’s Fund (UNICEF) recommends that each child drinks as much as possible but “at least a quarter to a half of a large cup of the ORS drink after each watery stool” for a child less than 2 years of age, and “at least a half to a whole large cup of the ORS drink after each watery stool” for a child more than 2 years of age.
• Drinks high in sugar such as cola or undiluted juice should not be given to a child as it can cause osmotic worsening of diarrhoea and the low sodium content can lead to hyponatremia(abnormally low sodium concentration in blood).
• ORS is usually given to children with mild to moderate dehydration. For children with severe dehydration, intravenous therapy is usually given.
  No/mild dehydration: ≤4% body weight loss
  Moderate 4–6% body weight loss
  Severe >7% body weight loss
• The use of ORS is based on the principle of glucose facilitated sodium transport in the small intestine.
  The Na+/glucose transporter. This transmembrane protein allows sodium ions and glucose to enter the cell together. The sodium ions flow down their concentration gradient while the glucose molecules are pumped up theirs. Later the sodium is pumped back out of the cell by the Na+/K+ ATPase.
  The Na+/glucose transporter is used to actively transport glucose out of the intestine and also out of the kidney tubules and back into the blood
• The preferred ORS are those that are hypotonic with an osmolarity between 200–250 mOsm/L
• A child who is dehydrated as a result of diarrhoea can have a deficit of sodium up to 70-110 mmol/L .
  Thus, in the initial rehydration, a sodium concentration of 90 mmol/L in oral rehydration solution (ORS)would be suitable. However, in the maintenance phase, to replace continuing stool losses in which thesodium concentration is 50-60 mmol/L, an ORS containing 60 mmol/L of sodium would be safe and effective.
  Alternatively, to avoid the confusion of using two types of ORS, one can give ORS containing 90mmol/L sodium together with a normal intake of water and breast milk.

Links

1.
D’Alessandro, D.M. 2006, What is the New Oral Rehydration Salt Solution Made Up Of?, viewed 11 March 2009 from http://www.pediatriceducation.org/2006/12/18/

2.Gastroenteritis in Children 2006, Patient UK. Viewed on 11 March 2009 from http://www.patient.co.uk/showdoc/23068743/

3.
Burkhart, D.M. 1999, Management of Acute Gastroenteritis in Children, The American Academy of Family Physicians. Viewed on 10 March 2009 from http://www.aafp.org/afp/991201ap/2555.html

4. http://www.oley.org/documents/ORS%20Article%20-%20Dr.%20Kelly.pdf

5.
Rice Starch Low Sodium Oral Rehydration Solution (ORS) in Infantile Diarrhoea http://www.mma.org.my/Portals/0/MED%20J%20MALAYSIA%20VOL%2051%20NO%202%20JUNE%201995.pdf

Additional links for GE:

6. http://www.acadmed.org.my/cpg/AMMCOPdiarrhoeaCPG.pdf

7. http://www.racgp.org.au/afp/200504/200504webb.pdf