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Oral Rehydration Solution
Aka: Oral Rehydration Solution, Oral Rehydration Therapy, Pedialyte, Infalyte, WHO-ORS, Homemade Cereal Based ORS
- See Also
- Pediatric Dehydration
- Pediatric Dehydration Management
- Oral Rehydration Therapy Protocol in Pediatric Dehydration
- Efficacy
- ORS use worldwide is associated with a 50% mortality reduction since the 1980's
- Kosek (2003) Bull World Health Organ 81(3): 197-204 [PubMed]
- ORS is as effective as Intravenous Fluids for mild to moderate Pediatric Dehydration
- Atherly-John (2002) Arch Pediatr Adolesc Med 156(12):1240-3 [PubMed]
- ORS has advantages over intravenous therapy
- Faster initiation of Fluid Replacement without the pain of Intravenous Access initiation
- Administered at home by parents
- Same solution used for rehydration, maintenance and replacement of losses (e.g. Diarrhea)
- Fewer emergent follow-up visits and a higher parent satisfaction with Oral Rehydration Therapy
- Duggan (1999) Pediatrics 104(3): e29 [PubMed]
- Dosing
- See Oral Rehydration Therapy Protocol in Pediatric Dehydration
- Preparations: Preferred - Commercial ORS
- Commercial products (available in liter containers, juice boxes and popsicles)
- Pedialyte
- Rehydrate
- Infalyte
- Resol
- Naturalyte
- Ingredients (similar to WHO, but with 50% of Sodium to match Rotavirus losses)
- Sodium: 45-50 meq/L
- Glucose (Dextrose): 25 g/L
- Bicarbonate: 30 mEq/L
- Potassium: 20 mEq/L
- Preparations: Preferred - WHO-ORS (newer, low-osmolality solution)
- More effective than the higher osmolality, older WHO formulation
- Instructions
- Dissolve WHO packet in 1 Liter Water
- Ingredients of WHO packet (245 meq/L)
- Sodium Chloride 2.6 grams (75 meq/L Sodium)
- Potassium Chloride 1.5 grams (20 meq/L Potassium)
- Glucose (Dextrose) 13.5 grams (75 meq/L)
- Trisodium Citrate 2.9 grams (10 meq/L, used instead of Sodium Bicarbonate)
- Total osmolality: 245 meq/L (includes 65 meq/l chloride)
- Preparations: WHO-ORS (older original osmolality solution)
- Replaced by the more effective, lower osmolality ORS solution
- Instructions
- Dissolve WHO packet in 1 Liter Water
- Ingredients of older WHO packet (311 meq/L)
- Sodium Chloride 3.5 grams (90 meq/L Sodium)
- Potassium Chloride 1.5 grams (20 meq/L Potassium)
- Glucose (Dextrose) 20 grams (2% Carbohydrate)
- Sodium Bicarbonate 2.5 grams (30 meq/L bicarbonate)
- Alternative: Trisodium Citrate 2.9 grams
- Total osmolality: 311 meq/L
- Preparations: Alternative - Half-strength gatorade
- Not ideal (not an exact substitute, low in sugar)
- Could be used for brief Diarrhea as temporizing measure
- Ingredients
- Sodium: 55 mEq/L
- Carbohydrates: 7 g/L
- Potassium: 15 mEq/L
- Preparations: Alternatuve - Simple replacement formula
- Not ideal
- Does not include Potassium Replacement
- Components
- Salt 1 level teaspoon
- Sugar 8 level teaspoon
- Water (clean drinking water) 5 measuring cups
- Preparations: Alternative - Homemade Cereal Based ORS
- Not ideal
- Risk of errors in preparation
- Advantages
- Better nutrient absorption
- Easy and safe to prepare
- Preparation
- Solution should be thick, but pourable and drinkable
- Ingredients
- 1/2 cup of dry, precooked baby rice cereal
- 2 cups water
- 1/4 teaspoon salt
- Precautions
- Commercial products and WHO-ORS are preferred due to potential for errors in home preparation
- Meyers (1997) Pediatrics 100(5): E3 [PubMed]
- Avoid potentially harmful solutions in the replacement of Diarrhea losses
- Boiled skim milk or concentrate (too much salt)
- Diet soda (Glucose is needed)
- Hypoosmolar fluids (water, sodas, kool-aid) due to Hyponatremia risk
- However, in mild cases, half strength apple juice has been used safely and effectively
- Freedman (2016) JAMA 315(18): 1966-74 [PubMed]
- Alternative products
- Half-strength gatorade approximates correct Sodium and Potassium
- References
- Canavan (2009) Am Fam Physician 80(7): 692-6 [PubMed]