ORS Powder – WHO-recommended oral rehydration salts study

What is Powder and its types:-

It is the solid dosage form of the drug which is in a finely divided state and homogeneously mixed. It is one of the oldest dosage forms and extremely convenient to administer.

1. Simple powder:- having only one ingredient.
2. The compound powder:- having more than one ingredient.

ORS Powder – oral rehydration salts:-

1. Sodium Chloride 650 mg
2. Potassium Chloride 375 mg
3. Tri-sodium Citrate 725 mg
4. Glucose (anhydrous) 3.375 gm

To be dissolved in 250 ml of boiled and cooled water.

Functions of different ORS ingredients:-

Sodium Chloride and Potassium Chloride:- It is given to compensate for the loss of sodium and potassium from the body during diarrhea and vomiting. Potassium loss mostly occurs in vomiting.

Tri-Sodium Citrate:- Sodium citrate corrects the acidosis caused by diarrhea due to loss of sodium bicarbonate. In the earlier ORS preparation Sodium bicarbonate(NaHCo) was used but later on, it was replaced by citrate to prevent bicarbonate-induced discoloration and decomposition of sugar in the packet. Thus citrate makes the ORS packet more stable and also reduces the stool output.

Glucose:- It facilitates the absorption of sodium from the intestine even when other mechanisms of absorption fail. When intestinal secretions are excessive (as in secretory diarrhea) secreted fluid lacks glucose which cannot be reabsorbed. It also provides energy.

Based on WHO/UNICEF recommendations, the Government of India has adopted low osmolarity ORS as a single universal ORS to be used for all ages and for all types of diarrhea.

WHO recommended modified ORS Composition (Low osmolarity ORS):-

1. Sodum chloride (NaCl) 2.6 gm
2. Potassium chloride (KCI) 1.5 gm
3. Trisodium Citrate 2.9 gm
4. Glucose-13.5 gm

To be dissolved in one liter of water.

Comparison between low osmolarity ORS and standard ORS:-

Low osmolarity ORS	Standard ORS
Sodium(Na+)- 75 mM/I	90
Potassium(K)-20 mM/I	20
chloride(Cl-)-65 mM/I	80
Citrate 10 mM/I	10
Glucose-75 mM/I	111
Osmolality-245 mM/I	311

Advantages of low osmolarity ORS over standard ORS:-

It decreases chances of hypernatremia If taken in excess amount then also it does not cause osmotic diarrhea.

Composition of RESOMAL (for malnourished children in mol/l):-

1. Glucose 125
2. Sodium 45
3. Potassium 40
4. Chloride 70
5. Citrate 7
6. Magnesium 3
7. Zinc 0.3
8. Copper 0.045

Total osmolarity 300 mmole/I

Different kinds of ORS Powder:-

Cereal-based ORS:- ORS in which rice or other cereals which are sources of starch are substituted for glucose are called cereal-based ORS. Starch is a large polymer of glucose that supplies a larger no. of glucose molecules for the transfer of sodium ions. Cereal proteins also provide small peptides and amino acids which also facilitate the absorption of additional sodium ions Rice has a direct effect on chloride channels which are involved in fluid secretion. It is an example of Super ORS.

Super ORS:- ORS in which instead of sugars, more complex sugar (starch) or amino acids (alanine and glycine) are added then it is called super ORS.

Super super ORS:- If zinc is added to Super ORS, it becomes super super ORS.

Degree of dehydration with signs and symptoms:-

Factors	Mild < 5%	Moderate 5-10%	Severe >10%
General Condition	Well, alert	Restless, Thirsty, Irritable	Drowsy, cold extremities, Lethargic
Eyes	Normal	Sunken	Very sunken, dry
Anterior fontanelle	Normal	Depressed	Very Decreased
Tears	Present	Absent	Absent
Mouth + tongue	Moist	Sticky	Dry
Skin turgor	Slightly decrease	Decreased	Very Decreased
Pulse (N-110-120 beat/min)	Slightly increase	Rapid, week	Rapid, sometimes Impalpable
BP (N=90/60 mm Hg)	Normal	Decreased	Decreased, maybe unrecordable
Respiratory rate	Slightly increase	Increased	Deep, rapid
Urine output	Normal	Reduced	Markedly reduced

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Uses of ORS powder:-

1. In Dehydration due to diarrhea and vomiting (mild & moderate).
2. In heat stroke.
3. In post-surgical, post-burn, and post-trauma cases for maintenance of dehydration and nutrition.
4. During the change over from parenteral to enteral nutrition.

Amount of ORS to be used in diarrheal illness:-

Age	Amount
Children < 2 years	50-100 ml after each episode
Children 2 to 9 years	100-200 ml after each episode
Children 10 years or >	As much as wanted.

Contraindication to ORS use:-

1. Unconsciousness.
2. Evidence of intestinal obstruction/ileus.
3. Patients with hemodynamic shock due to impaired airway protective reflexes.
4. Excessive vomiting.

Indications of intravenous fluid:-

In severe diarrhea, burn cases, excessive vomiting, and patients in coma.

Different intravenous fluids used:- Ringer’s Lactate, Normal Saline, 5%DNS, 1/2DNS, etc.

Other drugs used in diarrhea:- Antimotility drugs like Diphenoxylate, Loperamide.

Antisecretory drugs like Racecadotril

Racecadotril:-It is a prodrug.Its active ingredient is Thiorphan which is an Enkephalinase Inhibitor. It is safe in neonates and children also.

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