Spotlight on Disasters: Oral Rehydration Therapy (ORT)

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October 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. 1 tsp salt + 8 tsp sugar + 0.5 cup orange juice or half banana
      2. 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

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