Oral Oral rehydration rehydration

therapytherapyJervin manoJervin mano

What is oral What is oral rehydration therapy?rehydration therapy? RehydratinRehydratin

g a g a dehydratedehydrated person d person through through oral route oral route is called as is called as ORTORT. .

AIMAIM To correct To correct

the water the water &electrolyte &electrolyte deficietdeficiet

To prevent To prevent dehydrationdehydration

Reduce Reduce mortalitymortality

PROOF?PROOF?

A study in A study in kolkatta kolkatta showed 90-showed 90-95% of all 95% of all cases of cases of cholera cholera &acute &acute diarrhoea diarrhoea can be can be treated with treated with ors aloneors alone . .

Mortality rate in cholera has been reducedMortality rate in cholera has been reduced

to 0.11% from 49.3%to 0.11% from 49.3%

PRINCIPLEPRINCIPLE Glucose when Glucose when

given orally given orally enhances the enhances the intestinal intestinal absorption of absorption of salt & water.salt & water.

Thus it can Thus it can correct correct electrolyte & electrolyte & water deficit.water deficit.

WHOM CAN IT BE WHOM CAN IT BE GIVEN?GIVEN?

IN WHAT CONDITIONS IN WHAT CONDITIONS CAN IT BE GIVEN?CAN IT BE GIVEN? All age All age

groupsgroups All All

aetiologiesaetiologies All All

countriescountries

TYPES OF ORS??TYPES OF ORS??

Sodium bicarbonate Sodium bicarbonate basedbased

Trisodium citrate basedTrisodium citrate based Reduced osmolarity ORSReduced osmolarity ORS Super ORSSuper ORS

Sodium bicarbonate Sodium bicarbonate based ORSbased ORS CompositioCompositio

nnContentsContents

(gm(gm))

NaClNaCl 3.53.5

GlucoseGlucose 20.20.00

KClKCl 2.52.5

Sodium Sodium bicarbonbicarbonate ate

2.52.5

DisadvantagesDisadvantages

Less stableLess stable Stool output Stool output

not reducednot reduced

Trisodium Trisodium citrate based citrate based ORSORS

CompositionComposition

ContenContentsts

(gm)(gm)

NaClNaCl 3.53.5

GlucosGlucosee

20.020.0

KClKCl 1.51.5

TrisodiTrisodium um citratecitrate

2.02.0

OsmolarityOsmolarity

NaNa++ 90mM90mM

Cl Cl ++ 80mM80mM

GlucoseGlucose 110mM110mM

KK++ 20mM20mM

CitrateCitrate 10mM10mM

TOTALTOTAL 310mM310mM

Advantages

More stableMore stable

Less stool Less stool output in output in high output high output diarrhoeadiarrhoea

Tri Na citrate-Tri Na citrate-increases increases intestinal intestinal absorption of absorption of Na & waterNa & water

Possible adverse Possible adverse effectseffects Hyper Hyper

tonicity in tonicity in net fluid net fluid absorptioabsorptionn

To overcome thisTo overcome this

We should reduce the We should reduce the osmolarity of the ORSosmolarity of the ORS

Reduced Reduced osmolarity ORSosmolarity ORS

CompositionComposition

ContentContentss

(g(gm)m)

NaClNaCl 2.62.6

GlucoseGlucose 13.13.55

KClKCl 1.51.5

TrisodiuTrisodium m citratecitrate

2.92.9

OsmolarityOsmolarity

NaNa++ 75mM75mM

Cl Cl ++ 65mM65mM

GlucoseGlucose 75mM75mM

KK++ 20mM20mM

CitrateCitrate 10mM10mM

TOTALTOTAL 245mM245mM

AdvantagesAdvantages

Increased efficacy of ORS in Increased efficacy of ORS in non cholera diarrhoeanon cholera diarrhoea

Need for unscheduled Need for unscheduled supplement IV therapy in supplement IV therapy in children fell by 33%.children fell by 33%.

Stool output decreased by Stool output decreased by 20%.20%.

Vomiting decreased by 30%.Vomiting decreased by 30%. Safe & effectiveSafe & effective..

DOSAGE & DOSAGE & REQUIREMENT?REQUIREMENT?

If the child’s weight is If the child’s weight is known, the amount of known, the amount of ORS soln.for rehydration ORS soln.for rehydration during the first 4hrs may during the first 4hrs may be calculated as 75ml/kgbe calculated as 75ml/kg

DOSAGE & REQUIREMENT?DOSAGE & REQUIREMENT?

AgeAge <4m<4mthsths

4-4-11mt11mthshs

1-1-2yrs2yrs

2-2-4yrs4yrs

5-5-14yr14yrss

15yr15yrs<s<

Wt.Wt.(kg)(kg)

<5<5 5-7.95-7.9 8-8-10.910.9

11-11-15.915.9

16-16-29.929.9

30<30<

Soln.Soln.(ml)(ml)

200-200-400400

400-400-600600

600-600-800800

800-800-12001200

12001200--22002200

22002200--40004000

HOW TO HOW TO ADMINISTER???ADMINISTER??? Teach the Teach the

mothermotherORSORS

RULESRULES

<2yrs :- give 1-2 teaspoon <2yrs :- give 1-2 teaspoon every 2-3 minutesevery 2-3 minutes

Older children :- offer Older children :- offer frequent sips out of a cupfrequent sips out of a cup

Adults:- drink as much as Adults:- drink as much as they canthey can

Give the estimated Give the estimated amount within 4hrsamount within 4hrs

If the child vomits??If the child vomits??

Wait for 10 minutesWait for 10 minutes Give a teaspoonful Give a teaspoonful

every 2-3 minutesevery 2-3 minutes

If the child wants to drink more If the child wants to drink more than the estimated amount ?than the estimated amount ?

No harm , give moreNo harm , give more

If the child refuses to drink ?If the child refuses to drink ?

See whether the signs of See whether the signs of dehydration has dehydration has disappeareddisappeared

If yesIf yes Treat similar to a non Treat similar to a non

dehydrated diarrheal dehydrated diarrheal child.child.

If the child is breast fed ?If the child is breast fed ?

Nursing + Nursing + treatment treatment with ORS with ORS solutionsolution

Non breast fed infants less Non breast fed infants less than 6 monthsthan 6 months

Along with ORS solution Along with ORS solution give 100-200 ml of clean give 100-200 ml of clean water for first 4 hourswater for first 4 hours

Where is it Where is it available ?available ? PHCPHC Sub Sub

centerscenters HospitalsHospitals Chemist Chemist

shopsshops

Cost?Cost?

FreeFree

How to prepare How to prepare it ?it ? Dissolve the entire Dissolve the entire

contents of the packet in contents of the packet in 1l of drinking water1l of drinking water

It should be used within It should be used within 24 hours24 hours

If ORS packets are If ORS packets are not available ?not available ? Table salt (5gm) + sugar Table salt (5gm) + sugar

(20gm) in 1l of drinking (20gm) in 1l of drinking waterwater

Administer Administer till the till the diarrhea diarrhea stopsstops

Earlier the Earlier the treatment is treatment is instituted instituted the better is the better is for the for the patientpatient

ORT programmeORT programme First started in 1986-1987First started in 1986-1987 Implemented through RCH Implemented through RCH

programmeprogramme ORS packets are supplied ORS packets are supplied

by the central govt.by the central govt. Twice a year 150 packets of Twice a year 150 packets of

ORS are provided as apart ORS are provided as apart of drug kit supplied to all of drug kit supplied to all sub centers in the countrysub centers in the country

ThemeTheme

Adequate nutritional Adequate nutritional care of child with care of child with diarrhoeadiarrhoea

Proper advice to mother Proper advice to mother in feedingin feeding

Achievements & Achievements & benefitsbenefits Low cost treatmentLow cost treatment Treatment of the patient Treatment of the patient

in their own homesin their own homes Ingredients are Ingredients are

inexpensive and readily inexpensive and readily availableavailable

Achievements & Achievements & benefitsbenefits Drinking water is sufficient Drinking water is sufficient

(no need for boiling or other (no need for boiling or other means of sterilization)means of sterilization)

Breakthrough in the fight Breakthrough in the fight against cholera and other against cholera and other diarrheal diseasesdiarrheal diseases

Mortality rate in cholera has Mortality rate in cholera has been reduced to 0.11% from been reduced to 0.11% from 49.3%49.3%