ORAL REHYDRATION SALTS = ORS



Therapeutic action

– Prevention and treatment of dehydration from acute diarrhoea, cholera, etc.

Forms and strengths

– Sachet of powder to be diluted in 1 litre of clean water.
– WHO formulation:

Dosage

– Prevention of dehydration (WHO - Treatment plan A)
Child under 24 months: 50 to 100 ml after each loose stool (approximately 500 ml daily)
Child from 2 to 10 years: 100 to 200 ml after each loose stool (approximately 1000 ml daily)
Child over 10 years and adult: 200 to 400 ml after each loose stool (approximately 2000 ml daily)

– Treatment of moderate dehydration (WHO - Treatment plan B)
Child and adult:
Over the first four hours:

Age

under
4 months

4 to 11
months

12 to 23
months

2 to 4
years

5 to 14
years

15 years
and over

Weight

under 5 kg

5 to 7.9 kg

8 to 10.9 kg

11 to 15.9 kg

16 to 29.9 kg

30 kg and over

ORS in ml

200 to 400

400 to 600

600 to 800

800 to 1200

1200 to 2200

2200 to 4000

After four hours:
If there are no signs of dehydration: follow Treatment plan A.
If there are signs of moderate dehydration: repeat Treatment plan B.
If there are signs of severe dehydration: start IV therapy (Treatment plan C).

 Treatment of severe dehydration (WHO - Treatment plan C)
In combination with IV therapy and only to a conscious patient:
Child and adult: 5 ml/kg per hour
After 3 hours (6 hours in infants), reassess and choose the appropriate plan A, B or C.

Duration

– As long as diarrhoea and signs of dehydration persist.

Contra-indications, adverse effects, precautions

– If the eyelids become puffy during the treatment: stop ORS, give plain water then, resume ORS according to Treatment plan A when the puffiness is gone.
– If case of vomiting, stop ORS for 10 min and then resume at a slower rate (very small, frequent, amounts); do not stop rehydration.
– Pregnancy: no contra-indication
– Breast-feeding: no contra-indication

Remarks

– A special ORS-formula, ReSoMal, is used under medical supervision, for severely malnourished children only. However, in malnourished children with cholera, standard ORS- formula is used instead of ReSoMal.
– Storage: below 25 °C -
Do not use the powder if it has turned into a yellow-brownish sticky substance.
Once prepared, the solution must be used within 24 hours.