ORS
1. Definition and causes of dehydration:
• Dehydration (hypo hydration) is defined as
“excessive loss of body fluid”.
• Occurs when the loss of fluid exceeds the
fluid intake.
• Causes :
• Excessive use of laxatives
Vomiting or • Aggressive diuretic
diarrhea therapy
Excessive • High Fever
perspiration • Excessive fluid removal
Acute renal failure with hemodialysis or
with peritoneal dialysis
polyuria therapy
Abdominal surgery • Hemorrhage
Diabetes mellitus
with
2. Clinical assessment of dehydration.
Ask about any weight loss.
Dry mucous membranes
Sunken-appearing eyes
Check the skin turgor and capillary
refilling time
Check the blood pressure
Check pulse rate, heart rate
3. Different types of ORS with their
composition and actions
Low (Reduced) osmolarity ORS
Citrate based ORS
Sodium bicarbonate based ORS
Home available ORS
ReSomal : Recommended oral rehydration
salt solution
Super ORS
1. Reduced osmolarity ORS ( FOR 1 LTR)
ORS Standard Reduced Reduced
Contents mEq/L mEq/L Contents Gm/Ltr
Glucose 111 75 Glucose 13.5
Sodium 90 75 Sodium 2.6
chloride
Chloride 80 65 Potassiu 1.5
m
chloride
Potassium 20 20 Trisodium 2.9
citrate
Citrate 10 10
Osmolarit 311 245
y
2. Citrate based ORS ( FOR 1 LTR)
ORS Citrate based ORS
Contents gm
Glucose 20
Sodium chloride 3.5
Potassium Chloride 1.5
Trisodium Citrate dihydrate 20
3. Sodium bicarbonate based ORS ( FOR 1 LTR)
ORS Sodium bicarbonate based ORS
Contents gm
Glucose 20
Sodium chloride 3.5
Potassium Chloride 2.5
Sodium bicarbonate 2.5
4. Home made ORS ( FOR 1 LTR)
ORS Citrate based ORS
Contents gm
Sugar (6 TSP) 30
Salt (half TSP) 2.5
Boiled and cooled water 1 LTR
5. ReSoMal
Contents mEq/L
Glucose 125
Sodium 45
Chloride 70
Potassium 40
Citrate 7
Magnesium 3
Zinc 0.3
Copper 0.045
Osmolarity 300
5. Super ORS ( FOR 1 LTR)
ORS Osmolarity
Contents mEq/L
Glucose 75
Sodium 75
Chloride 65
Potassium 20
Citrate 10
Osmolarity 245
With addition of an amino acid ( Alanine/
Glycine)
Actions of each ingredients
• Glucose : Allows the intestines to
absorb the sodium.
• Sodium : Drags the water into the
intestinal cell and the body.
• Potassium : replaces potassium ion,
which is lost during diarrhea and
vomiting.
• Citrate/ bicarbonate : Corrects
acidosis
• 4. Choose the appropriate type of
ORS for a given condition/ patient.
• For mild to moderate dehydration
reduced osmolarity ORS
• For malnourished patients ReSoMal.
• 5.
• A child, weighing 20 kg, has vomiting and
diarrhea, is moderately dehydrated based on
physical exam, vitals and clinical signs.
Calculate the ORT required and the rate of
administration.
According to guidelines ( reference O.P. Ghai), the
daily fluid requirements in children are calculated
as follows.
Up to 10 kg = 100mL/kg
10-20 kg = 50mL/kg
> 20 kg = 20mL/kg
• Data : Child is moderately dehydrated.
Weight is 20 kg
• 10 X 100 + 10X 50 = 1000+500= 1500 mL
• 1500/4 = 375 mL/ hr for next 4 hours.
• So 6.25 mL/ min for next 4hours.
6. Non diarrheal uses of ORS
• Postsurgical, post burn and post-trauma
maintenance of
hydration and nutrition (in place of IV infusion).
• (b) Heat stroke.
• (c) During changeover from intravenous to enteral
alimentation