Spotlight on Disasters: Oral Rehydration Therapy (ORT)
Leave a commentOctober 22, 2015 by dailybolusoflr
Submitted by: Michael Ehmann, MD
On behalf of the Johns Hopkins Disaster FAST
1. Acute diarrhea
- >3 loose or watery stools per day
- Normal fluid loss via stool: 5 mL/kg body weight per day
- Fluid loss via diarrheal illness: up to >200 mL/kg body weight per day [1]
- Most common worldwide cause of mortality due to volume depletion
- Annual deaths due to diarrhea
- From >5 million in 1978 to 2.6 million in 2009 [2]
- Mortality improvement largely due to widespread use of ORT [3]
2. Oral Rehydration Solution (ORS) Preparation
- All require clean water!
- Filter or boil water and allow to cool before use
- 2002 WHO/UNICEF guidelines introduced reduced-osmolarity formula [4]
 |
| Adapted from Iserson, p.133 [3] |
- Pre-made commercial packets
- Add 1 packet to 1 liter of clean water and stir until contents dissolve
- Home-made ORS [4]
- Mix until dissolved in 1 liter clean water:
- 1 tsp salt + 8 tsp sugar + 0.5 cup orange juice or half banana
- 0.25 tsp baking soda + 0.25 tsp salt + 2 Tbsp sugar or honey + 0.5 cup orange juice or half banana
3. ORT Administration
- Infants
- Small aliquots every 1-2 minutes with clean eyedropper or needle-less syringe
- Children < 2 years old
- One teaspoonful every 1-2 minutes
- Children > 2 years and adults
- Sip from a clean cup every 1-2 minutes
- Continue until diarrhea resolves and urination returns to normal color and frequency (4-5 times/day)
- Large children and adults require ~3L ORS per day
4. ORS Alternatives [2,3]
- Appropriate
- Pedialyte (250 mOsm/L), Enfalyte (200 mOsm/L)
- Electrolyte tablets commercially available at most outdoor retailers
- Dissolve in clean water per package instructions adjusting for appropriate concentration depending on tablet composition
- Inappropriate (due to osmolarity and/or electrolyte composition)
- Soda, Kool-Aid, fruit juices, Gatorade
- Nasogastric, parenteral, subcutaneous, rectal rehydration therapy
- Require more equipment and personnel resources than ORT
5. Tips
- Chill ORS to make more palatable (even so, it doesn’t taste great)
- Home-made ORS should have the general saltiness of tears
- If patient vomits, wait 10 minutes then begin again
- WHO ORS shelf-life ~3 years at temperatures up to 140°F [4]
[1] WHO. The Treatment of Diarrhoea: A Manual for Physicians and Other Senior Health Workers. Geneva, Switzerland: WHO, 1995.
[2] UNICEF/WHO. Diarrhoea: Why Children Are Still Dying and What Can Be Done. Geneva: UNICEF, 2009.
[3] Iserson KV. Improvised Medicine: Providing Care in Extreme Environments. New York: McGraw Hill; 2012.
[4] WHO. Oral Rehydration Salts: Production of the New ORS. Geneva: WHO, 2006: 46-47
