ORS, a potent tool to beat child diarrhoea

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ORS, a potent tool to beat child diarrhoea

Monday, 10 June 2024 | Archana Jyoti

ORS, a potent tool to beat child diarrhoea

Oral Rehydration Salts stands as a potent weapon in the battle against childhood diarrhoea. Now, with a new formula endorsed by WHO, it's poised to deliver even greater impact, saving more young lives worldwide. ARCHANA JYOTI reports

The fight against diarrhoea in children has received a significant boost with the release of a new formula for oral rehydration salts (ORS) by the World Health Organization (WHO) recently.

Since its adoption in 1978, ORS has been a cornerstone in the battle against diarrhoea deaths in children, contributing to a notable reduction in mortality rates. However, recognizing the need for further improvement, WHO spearheaded extensive research, resulting in the development of an enhanced ORS formula.

UNICEF estimated that about 9% of all deaths of young children worldwide — about 1,200 children under 5 every day — occurred because of diarrheal disease in 2021. In India, diarrhoea is the third leading cause of child mortality. Despite the importance of ORS which can easily prevent dehydration caused by diarrhoea, only 60.6% of children receive this essential treatment, according to recent NFHS-5 data.

The new formula, backed by research conducted in five developing countries among children with acute diarrhoea and dehydration, boasts a low-sodium, low-glucose composition. This innovation promises to reduce the need for intravenous fluids by 33%, potentially leading to fewer hospitalizations, diminished secondary infections, and lower healthcare costs.

For over two decades, WHO and UNICEF have recommended a single formulation of glucose-based ORS, which has been effective in combating diarrhoea disease globally. However, ongoing efforts to refine ORS have been underway, aiming to improve its efficacy and clinical benefits.

The latest breakthrough, achieved through a reduction in osmolarity, demonstrates promising outcomes in reducing stool output and vomiting in diarrheal patients.

The recommended ORS formulation, with a total osmolarity of 245 mOsm/l, has shown improved efficacy in treating acute non-cholera diarrhoea in children. Additionally, studies indicate its effectiveness in managing cholera in adults, albeit with careful monitoring due to the risk of transient hyponatremia.

With this advancement, WHO and UNICEF now advocate for the widespread adoption of the new ORS formula, replacing the previous standard formulation. While this single ORS formulation is endorsed, established criteria ensure its quality and effectiveness, reinforcing its role as a frontline treatment for diarrheal disease.

As India grapples with severe heat conditions, doctors have receommended WHO-based ORS for adults as well as children to beat dehyderation and diarrhea.

Pankaj Garg, Senior Consultant in Neonatology at Delhi-based Sir Gangaram Hospital said,  "Diarrhoea results in rapid fluid loss and electrolyte imbalances, leading to dehydration. ORS is a simple yet highly effective solution to replenish lost fluids and electrolytes, preventing complications and promoting faster recovery in young children," said Dr Garg. While ORS is safe and effective, the expert warned against the incorrect mixture of salt or sugar in water as it can be harmful.

"Incorrect homemade solutions or sugary drinks can disrupt this balance, leading to severe health risks such as worsening dehydration or even death in extreme cases," cautioned Dr Garg.

Dr Mohsin Wali, Consultant Physician at Sir Ganga Ram Hospital too stressed on the importance of selecting the correct ORS in the market.

"Choosing the right ORS is crucial for effectively managing diarrhoea and dehydration. It's vital to differentiate between ORS and commercially available sugary drinks.

While these beverages may offer some electrolytes and fluids, they lack the crucial glucose-sodium and potassium balance necessary for rapid and effective rehydration," said Dr Wali.

Sugary drinks may provide temporary relief but do not address the core issue of dehydration.

Dr Wali said one should opt for an ORS formulation approved by the WHO, specifically designed for this purpose. Most of these ORS packages will have "WHO" written on them.

By understanding the benefits of ORS and its appropriate use, we can save the lives of many kids every year particularly during the hot summer months, he added.

NEW ORS FORMULA

The total substance concentration (including that contributed by glucose) should be within the range of 200-310 mmol/l.

The individual substance concentration:

  • Glucose should at least equal that of sodium but should not exceed 111 mmol/l
  • Sodium should be within the range of 60-90 mEq/l
  • Potassium should be within the range of 15-25 mEq/l
  • Citrate should be within the range of 8-12 mmol/l
  • Chloride should be within the range of 50-80 mEq/l

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