Topic: ARI and Diarrhea of under five and their management.
Question: Write the composition and preparation of the WHO Oral Rehydration Salts (ORS). Describe the preparation and regimen of ORS in acute dehydration among children.
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Here is a detailed composition and explanation of Oral Rehydration Salts (ORS) used to treat acute dehydration in children:Composition of ORS:The World Health Organization (WHO) recommends the following composition of ORS to treat dehydration:
•Sodium chloride: 2.6 grams (provides 75 mmol/L of sodium)
•Potassium chloride: 1.5 grams (provides 20 mmol/L of potassium)
•Trisodium citrate dihydrate: 2.9 grams (provides 10 mmol/L of citrate)
•Glucose: 13.5 grams (provides 75 mmol/L of glucose)
Preparation of ORS:
•Add the contents of one sachet of ORS in 1 litre of clean drinking water. Boiled and cooled water is preferable.
•Mix well until the solution is clear and all salts have dissolved.
•Taste the solution to ensure proper mixing and that the saltiness is correct before giving to the child. The solution should have a mildly salty taste.
•Discard any unused portion after 24 hours. Do not boil the ORS solution.
Regimen for Rehydration:
•Give ORS solution in small quantities frequently, about 5-10 ml every 1-2 minutes. This helps the child to tolerate and absorb the fluid better.
•The volume of ORS required depends on the child’s age and the severity of dehydration.
• If the child vomits, wait 10 minutes and then restart ORS in smaller amounts.
•Continue to breastfeed during rehydration in infants.
•Monitor hydration status. Signs of decreasing dehydration include increased urination, tears, saliva and activity of the child.
•Once rehydrated, continue additional ORS or appropriate home fluids to replace ongoing losses from diarrhea till stools normalize.
Points below summarizes the key steps in ORS rehydration therapy:Steps in ORS rehydration therapy
1. Assess child for signs of dehydration to determine ORS volume needed
2.Prepare ORS solution by mixing contents of one sachet in 1L clean water
3.Give ORS in small, frequent volumes of about 5-10 ml every 1-2 minutes
4. The total volume of ORS required over 3-4 hours depends on the degree of dehydration and age of child
5.Continue feeding and ORS to replace ongoing losses from diarrhea
6.Monitor hydration status and stool output to determine improvement
7. Seek medical care if no improvement in hydration status or for severe dehydration (edited)
The fluid deficit is calculated based on the severity of dehydration, age, and weight of the child. The following table summarizes the fluid deficit calculation:
Table outlining the signs and symptoms of mild, moderate, and severe dehydration in children:
| Dehydration Level | Signs and Symptoms | Immediate Treatment |
|---|---|---|
| Mild | •Restless or irritable behavior •Thirst •Dry mouth •Decreased urine output •Tears present | •Give ORS 50-100 ml every 30 minutes for 2-4 hours. •Continue feeding and increase breastfeeding. •Reassess after 4 hours and continue ORS if improving. If not improving, refer to hospital. |
| Moderate | •Lethargic or drowsy •Sunken eyes •Delayed skin pinch •Very dry mouth/tongue •Minimal tears •Increased thirst, dry mouth and tongue •decreased urine output •lethargy, irritability, headache, muscle cramps | Give ORS 100 ml every 30 minutes for 2-4 hours. •Continue feeding if able to drink. •Reassess frequently. Call health worker if condition deteriorates or does not improve in 4 hours. |
| Severe | •Unconscious or unable to drink •Sunken eyes •Unable to stand or sit up •Very slow capillary refill time •Cyanotic/ashen skin •Absent tears •No urine for 12 hours •Rapid, deep, acidotic breathing •Life-threatening signs: low BP, high pulse, coma, seizures | Refer urgently to hospital for IV rehydration. •On route to hospital, give ORS with spoon, dropper or syringe until IV rehydration is established. •Nasogastric tube or IV hydration in hospital until able to drink and ORS. •Monitor in hospital for at least 6-12 hours after rehydration to ensure recovery and continuation of feeding and ORS. |
| Severity of Dehydration | Fluid Deficit Calculation |
|---|---|
| Mild dehydration (<5%) | 50 mL/kg body weight |
| Moderate dehydration (5-10%) | 100 mL/kg body weight |
| Severe dehydration (>10%) | 100 mL/kg body weight |
WHO recommends:
ORS Solution per Episode of Diarrhea |
| Weight of Child | Amount of ORS Solution per Episode of Diarrhea |
|---|---|
| Less than 4 kg | 200 ml after each loose stool |
| 4-5.9 kg | 400 ml after each loose stool |
| 6-7.9 kg | 600 ml after each loose stool |
| 8-9.9 kg | 800 ml after each loose stool |
| 10-11.9 kg | 1000 ml after each loose stool |
| 12-13.9 kg | 1200 ml after each loose stool |
| 14-15.9 kg | 1400 ml after each loose stool |
| More than 16 kg | 1600 ml after each loose stool |
The dosage of ORS solution in children is based on the severity of dehydration, age, and weight of the child. The following table summarizes the dosage of ORS solution:
| Severity of Dehydration | ORS Solution Dosage |
|---|---|
| Mild dehydration (<5%) | 50-100 mL/kg body weight over four hours |
| Moderate dehydration (5-10%) | 100-150 mL/kg body weight over four hours |
| Severe dehydration (>10%) | 150-200 mL/kg body weight over four hours |
