Diarrhea is one of the most common ailments in our routine practice. It is also one of the most common causes of morbidity and mortality if we don’t intervene promptly.

What is acute diarrhea?

The WHO defines diarrhea as the passage of three or more loose, watery stools in 24 hours. The most common cause of acute diarrhea is an infection (viral/bacterial). In India, diarrheas are more common in the summertime.

What happens in diarrhea?

• Loss of water and salts: The body loses water and salts in the stools because of active secretions by the inflamed gut. Salts can be sodium, potassium, chloride, etc.; the body needs them in the correct proportion and quantity to carry out the business of living.
• Poor absorption of nutrients: The intestine is inflamed and cannot fully absorb nutrients like glucose for energy, water, and salt that the child may ingest.
• Poor intake: There is a general feeling of being unwell, and children lose their appetite. Because of the loss of fluids and salts, they become listless and are less likely to seek replenishing foods and salts.
  All this leads to the body’s depletion of fluids and salts, which can cause significant illness.

The overwhelming need of the hour is to urgently replace and replenish the lost water and salts in the body.

Why ORS?

ORS – Oral Rehydration Solution is a specially constituted solution that mimics the lost fluid from the bowel. It can quickly correct the existing deficiency and help maintain hydration until the child recovers from his illness and his appetite returns to normal.

When will your doctor prescribe ORS?

Your doctor will first assess your child. If she determines that your child has either no or mild dehydration, she will prescribe ORS. Children above the age of six months will also receive oral zinc.
If she feels that the child is moderately dehydrated, ORS will remain the mainstay of therapy, but in these cases, it should be administered in a supervised setting.
Severely dehydrated children need admission to a hospital setting and urgent correction of fluid and salt deficits.

How to give ORS?

Rehydration Phase

Your doctor will assess the fluid deficit and rapidly replace it over 3-4 hours.

• Give small quantities of ORS frequently and small volumes (If you give larger volumes, the child may vomit). Even 5 ml of fluid every 1-2 minutes can replace 300-400 ml every hour.
• Continue breastfeeding: Breast milk provides water, nutrients, salts, and immunological agents that help your child fight infection.
• If the child cannot take enough orally, we may put a tube from the nose into the stomach and give ORS.

Maintenance Phase

We continue with ORS until the child can eat and drink normally.

Ongoing Losses due to diarrhea and vomiting

• Vomiting: 2 ml/kg for each episode of vomiting
• Diarrhea: 10 ml/kg for each loose stool

Can I give Glucon D/Tang? They are so much tastier!

The million-dollar question! Yes, indeed! Tastier, for sure, but it can actually harm your child. Glucon D, Tang, and other ‘energy drinks’ contain a lot of glucose and very little or no salts. Unless glucose and salt are in the right proportion in the ingested fluid, they can actually worsen diarrhea. Too much glucose increases the osmolality of the intestinal contents and pulls even more fluid out of the body to counterbalance the excess osmolality.
Fluids containing excess salt increase the blood’s salt content, which can be dangerous.

Have a look at the composition of ORS vs. Glucon D vs. Tang – You can see that both Glucon D & Tang contain waaay more sugar than necessary

Avoid any energy drinks as a substitute for ORS. They can cause serious harm.

Nathani Clinic

We have dealt with energy drinks here.

Can I make ORS solutions at home?

Sure, you can!

ORS can be simply prepared at home:

• One liter water
• 6 tablespoons sugar
• One pinch of salt.
• Add some lemon juice to flavor it if your child likes that.

Please feel free to comment or put your questions in the comments below.

This article has been written by Dr. Ankita Bhandari in collaboration with Dr. Rajesh Nathani