O.R.S. The rationale behind

the composition

Oct. 2006

Historical PerspectiveDiscovery of ORS

A Combination of Scientific Vigour & Serendipity

David R. Nalin

Two Approaches

Analyzing the composition of stool.

Analyzing the alteration in the composition of Extracellular Fluid in the body.

Daniel Darrow, et al., J. Pediatr., 1949

1962, Captain PhillipsCombined Glucose & Sodium

Ignorant of Co- transport physiology

Dr David Nalin interview, 1992

The discovery that sodium transport

and glucose transport

are coupled in the small intestine

so that glucose accelerates

absorption of solute and water

(is) potentially the most important

medical advance this century

August, 1978

Glucose

Na+

H2O

K+

ORS

Why Potassium?

Long standing diarrhea leads to Hypokalemia.

Malaise

Muscle Weakness

Paralytic ileus

Why Citrate?

Tri Sodium citrate is a basic salt which corrects Acidosis.

MAGIC BULLET: The History Of Oral Rehydration TherapyJoshua Ruxin, Medical History, 1994.

Content Standard ORS Low Osmolar ORS

Glucose 111 75

Sodium 90 75

Chloride 80 65

Potassium 20 20

Citrate 10 10

Osmolarity 311 245

WHO ORS

.ReSoMal(Rehydration Solution for

Malnourished)

UNICEF Technical Bulletin, Mar 2012

Rice based ORSGlucose replaced by starch

& oligosaccharides

Zinc ORSZinc reduces the duration

of diarrhea in pediatric patients.

M.K.Bhan et al., N Engl J Med., 1995

Home – made ORS

www.rehydrate.org

Substitutes for ORS

Breast milk

Rice porridge – Conjee

Carrot juice

If possible, Orange juice, Banana & coconut water may be added for Potassium

Severe Dehydrationi.v., fluids

Normal Saline

0.9%NaCl

Ringer’s lactate

Sodium Lactate

Sodium Chloride

Potassium Chloride

Calcium Chloride

Further Reading:

Essential Paediatrics, O.P.Ghai.

www.rehydrate.org

Magic Bullet: The History Of Oral Rehydration Therapy, Joshua Ruxin, Medical History, 1994.

Thank you!