Oral Rehydration Solution

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

1. See Also
   1. Pediatric Dehydration
   2. Pediatric Dehydration Management
   3. Oral Rehydration Therapy Protocol in Pediatric Dehydration
2. 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 [PubMed]
   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 [PubMed]
   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
         1. 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 [PubMed]
3. Dosing
   1. See Oral Rehydration Therapy Protocol in Pediatric Dehydration
4. 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
5. Preparations: Preferred - WHO-ORS (newer, low-osmolality solution)
   1. More effective than the higher osmolality, older WHO formulation
   2. Instructions
      1. Dissolve WHO packet in 1 Liter Water
   3. Ingredients of WHO packet (245 meq/L)
      1. Sodium Chloride 2.6 grams (75 meq/L Sodium)
      2. Potassium Chloride 1.5 grams (20 meq/L Potassium)
      3. Glucose (Dextrose) 13.5 grams (75 meq/L)
      4. Trisodium Citrate 2.9 grams (10 meq/L, used instead of Sodium Bicarbonate)
      5. Total osmolality: 245 meq/L (includes 65 meq/l chloride)
6. Preparations: WHO-ORS (older original osmolality solution)
   1. Replaced by the more effective, lower osmolality ORS solution
   2. Instructions
      1. Dissolve WHO packet in 1 Liter Water
   3. Ingredients of older WHO packet (311 meq/L)
      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
      5. Total osmolality: 311 meq/L
7. 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
8. Preparations: Alternatuve - Simple replacement formula
   1. Not ideal
      1. Does not include Potassium Replacement
   2. Components
      1. Salt 1 level teaspoon
      2. Sugar 8 level teaspoon
      3. Water (clean drinking water) 5 measuring cups
9. 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
10. Precautions
    1. Commercial products and WHO-ORS are preferred due to potential for errors in home preparation
       1. Meyers (1997) Pediatrics 100(5): E3 [PubMed]
    2. Avoid potentially harmful solutions in the replacement of Diarrhea losses
       1. Boiled skim milk or concentrate (too much salt)
       2. Diet soda (Glucose is needed)
       3. Hypoosmolar fluids (water, sodas, kool-aid) due to Hyponatremia risk
          1. However, in mild cases, half strength apple juice has been used safely and effectively
          2. Freedman (2016) JAMA 315(18): 1966-74 [PubMed]
    3. Alternative products
       1. Half-strength gatorade approximates correct Sodium and Potassium
11. References
    1. Canavan (2009) Am Fam Physician 80(7): 692-6 [PubMed]