Oral Rehydration Solution

Aka: Oral Rehydration Solution, Oral Rehydration Therapy, Pedialyte, Infalyte, WHO-ORS, Homemade Cereal Based ORS

1. Efficacy
   1. ORS use worldwide is associated with a 50% mortality reduction since the 1980's
      1. Kosek (2003) Bull World Health Organ 81(3): 197-204
   2. ORS is as effective as intravenous fluids for mild to moderate Pediatric Dehydration
      1. Atherly-John (2002) Arch Pediatr Adolesc Med 156(12):1240-3
   3. ORS has advantages over intravenous therapy
      1. Faster initiation of fluid replacement without the pain of Intravenous Access initiation
      2. Administered at home by parents with the same solution used for rehydration, maintenance and replacement of losses (e.g. Diarrhea)
      3. Fewer emergent follow-up visits and a higher parent satisfaction with Oral Rehydration Therapy
      4. Duggan (1999) Pediatrics 104(3): e29
2. Preparations: Preferred - Commercial ORS
   1. Commercial products (available in liter containers, juice boxes and popsicles)
      1. Pedialyte
      2. Rehydrate
      3. Infalyte
      4. Resol
      5. Naturalyte
   2. Ingredients (similar to WHO, but with 50% of sodium to match Rotavirus losses)
      1. Sodium: 45-50 meq/L
      2. Glucose (Dextrose): 25 g/L
      3. Bicarbonate: 30 mEq/L
      4. Potassium: 20 mEq/L
3. Preparations: Preferred - WHO-ORS
   1. Instructions
      1. Dissolve WHO packet in 1 Liter Water
   2. Ingredients of WHO packet
      1. Sodium Chloride 3.5 grams (90 meq/L Sodium)
      2. Potassium Chloride 1.5 grams (20 meq/L Potassium)
      3. Glucose (Dextrose) 20 grams (2% Carbohydrate)
      4. Sodium Bicarbonate 2.5 grams (30 meq/L bicarbonate)
         1. Alternative: Trisodium Citrate 2.9 grams
4. Preparations: Alternative - Half-strength gatorade
   1. Not ideal (not an exact substitute, low in sugar)
      1. Could be used for brief Diarrhea as temporizing measure
   2. Ingredients
      1. Sodium: 55 mEq/L
      2. Carbohydrates: 7 g/L
      3. Potassium: 15 mEq/L
5. Preparations: Alternative: Homemade Cereal Based ORS
   1. Not ideal
      1. Risk of errors in preparation
   2. Advantages
      1. Better nutrient absorption
      2. Easy and safe to prepare
   3. Preparation
      1. Solution should be thick, but pourable and drinkable
   4. Ingredients
      1. 1/2 cup of dry, precooked baby rice cereal
      2. 2 cups water
      3. 1/4 teaspoon salt
6. Precautions
   1. Commercial products and WHO-ORS are preferred due to potential for errors in home preparation
      1. Meyers (1997) Pediatrics 100(5): E3
   2. Avoid potentially harmful solutions in the replacement of Diarrhea losses
      1. Kool-Aid or soda (lacks salt)
      2. Boiled skim milk or concentrate (too much salt)
      3. Diet soda (Glucose is needed)
   3. Alternative products
      1. Half-strength gatorade approximates correct sodium and potassium
7. References
   1. Canavan (2009) Am Fam Physician 80(7): 692-6