2. Cont…
More than 5 million children under the age of 5
years die every year due to diarrhoea .
In India, more than 1 million children get killed by
this miserable disease known as diarrhoea .
Before the advent of ORT, death from diarrhea was
the leading cause of infant
Between 1980 and 2006, With the introduction of
ORT, infant deaths, worldwide have decreased the
number of, from 5 to 3 million per year.
3. Introduction
Worldwide, diarrhea claims several million lives
annually, mostly those of infants.
Poverty, crowding, and contaminated water supplies
all contribute.
Almost all of these deaths could have been
prevented with adequate fluid replacement.
Incidence is much lower in developed nations but
remains one of the two most common reasons for
visits to pediatric emergency departments
4. What is diarrhoea?
Increases in volume or fluidity of stools, changes
in consistency, and increased frequency of
defecation.
Blood in stool indicate an acute diarrhoeal
illnesses or dysentery, irrespective of frequency.
“Passage of stools at least three times or a single loose
stool in a 24 h period”
WHO
5. Cont….
Diarrhoeal disorders are divided into:
Acute Diarrhoea
The most usual form of diarrhoeal illness, have an
abrupt onset, resolve within 14 days and are mostly
caused by infections
Persistent Diarrhoea
Diarrhoea which persists for longer than 14 days
Chronic Diarrhoea
Duration of symptoms is longer than a month
6. Pathophysiology of diarrhea
Fluid from the body enters the intestinal lumen (isosmotic i.e
approx.142 mEq/L Na+) during digestion.
A healthy individual secretes 2000–3000mg of sodium per day
into the intestinal lumen.
Nearly all of this is reabsorbed so that sodium levels in the body
remain constant.
In a diarrheal illness, sodium rich intestinal secretions are lost
before they can be reabsorbed.
This can lead to a life-threatening hyponatraemia within hours.
This is the motivation for sodium and water replenishment in ORT.
8. Physiological basis of using ORT in
Diarrhoea
Sodium passes into epithelial cells by co-transport via the
SGLT1 protein.
From the intestinal, sodium is pumped by active transport
by the Na+ K + pump through to extracellular space.
The Na+ K + ATPase pump moves 3 Na+ in exchange for 2
K +
This creates a “downhill” sodium gradient within the cell.
SGLT proteins use energy from sodium gradient to
transport glucose into the cell against the glucose
gradient..
9. Cont….
The GLUT uniporters then transport glucose across
membrane.
SGLT1 protein requires 2 Na+ to co-transport one
molecule of glucose (as galactose).
Without sodium, intestinal glucose is not absorbed.
This is why oral rehydration salts (ORS) include
both sodium and glucose.
For each cycle, hundreds of water molecules move
into the epithelial cell, slowly rehydrating the patient.
10. Oral rehydration therapy
Most diarrhea-related deaths in children are due to
dehydration……
….loss of large quantities of water and
electrolytes from the body in the liquid stool.
Many of these deaths can be prevented with the use of
oral rehydration therapy (ORT).
Oral rehydration therapy (ORT) is a type of fluid
replacement used as a treatment for dehydration.
It involves drinking water mixed with sugar and salt and
other home available fluids, while continuing to eat.
11. Oral rehydration solution
So as soon as diarrhoea starts, it is essential to give the
child extra drinks to replace the liquid being lost.
Oral Rehydration solution (ORS) is the cheap, simple and
effective way to treat dehydration caused by diarrhoea.
ORS drink contains the main elements that are lost from
the body during diarrhoea.
effective in treating dehydration resulting from all types of
acute diarrhoeal diseases.
ORS drinks should be given to the child every time a
watery stool is passed.
13. PRINCIPLE of ORS
Glucose when given orally enhances the intestinal
absorption of salt & water.
Thus it can correct electrolyte & water deficit.
WHOM CAN IT BE GIVEN?
All age groups
IN WHAT CONDITIONS CAN IT BE GIVEN?
All aetiologies
All countries
14. Types of ORS??
Sodium bicarbonate based
Trisodium citrate based
Reduced osmolarity ORS
Super ORS
17. Bicarbonate vs.
Tricitrate ORS
Bicarbonate-based ORS
Less stable
Stool output not reduced
Tricitrate-based ORS
More stable
Less stool output in high
output diarrhoea
Tri Na citrate-increases
intestinal absorption of
Na & water
19. Any adverse effect of this WHO ORS ????
How to overcome this????
Possible adverse effects is hyper tonicity in net
fluid absorption
We should reduce the osmolarity of the ORS
21. Osmolarity of this new ORS
Na+ 75mM
Cl + 65mM
Glucose 75mM
K+ 20mM
Citrate 10mM
TOTAL 245mM
22. Advantages of low osmolarity ORS
Increased efficacy of ORS in non cholera diarrhoea
Need for unscheduled supplement IV therapy in children
fell by 33%.
Stool output decreased by 20%.
Vomiting decreased by 30%.
Safe & effective.
23. DOSAGE & REQUIREMENT?
Age <4mths 4-11mths 1-2yrs 2-4yrs 5-14yrs ≥15yrs
Wt.(kg) <5 5-7.9 8-10.9 11-15.9 16-29.9 ≥30
Soln.(ml) 200-400 400-600 600-800 800-1200 1200-
2200
2200-
4000
If the child’s weight is known…..
….. the amount of ORS soln.for rehydration
during the first 4hrs may be calculated as 75ml/kg
24. How to administer???
Wash your hands with soap and water before preparing solution.
Prepare a solution, in a clean pot, by mixing 1 packet of Oral
Rehydration Salts (ORS) with one litre of clean drinking water.
Stir the mixture till all the contents dissolve.
Wash your hands and the baby's hands with soap and water
before feeding solution.
Give the sick child as much of the solution as it needs, in small
amounts frequently.
25. Cont…..
Give child alternately other fluids - such as breast milk and juices.
Continue to give solids if child is four months or older.
If the child still needs ORS after 24 hours, make a fresh solution.
ORS does not stop diarrhoea. It prevents the body from drying up.
The diarrhoea will stop by itself.
If child vomits, wait ten minutes and give it ORS again. Usually
vomiting will stop.
If diarrhoea increases and /or vomiting persists, take child over to a
health clinic.
28. Rules
<2yrs :- give 1-2 teaspoon every 2-3 minutes
Older children :- offer frequent sips out of a cup
Adults:- drink as much as they can
Give the estimated amount within 4hrs
Wait for 10 minutes
Give a teaspoonful every 2-3 minutes
If the child vomits??
29. Cont…..
If the child wants to drink more than the estimated
amount ?
If the child refuses to drink ?
If the child is breast fed ?
Non breast fed infants less than 6 months
No harm , give more
See whether the signs of dehydration has disappeared
If yes
Treat similar to a non dehydrated diarrheal child.
Nursing + treatment with ORS solution
Along with ORS solution give 100-200 ml of clean water for
first 4 hrs
30. ORT programme
First started in 1986-1987
Implemented through RCH programme
ORS packets are supplied by the central govt.
Twice a year 150 packets of ORS are provided as apart of
drug kit supplied to all sub centers in the country
31. Achievements & benefits
Low cost treatment
Treatment of the patient in their own homes
Ingredients are inexpensive and readily available
Drinking water is sufficient (no need for boiling or other
means of sterilization)
Breakthrough in the fight against cholera and other
diarrheal diseases
Mortality rate in cholera has been reduced to 0.11% from
49.3%