Oral rehydration therapy Jervin mano 2. What is oral rehydration therapy?

Rehydrating a dehydrated person through oral route is called as ORT .

3. AIM To correct the water &electrolyte deficiet To prevent dehydration Reduce mortality

4. PROOF? A study in kolkatta showed 90-95% of all cases of cholera &acute diarrhoea can be treated with ors alone . Mortality rate in cholera has been reduced to 0.11% from 49.3%

5. 6. PRINCIPLE Glucose when given orally enhances the intestinal absorption of salt & water. Thus it can correct electrolyte & water deficit.

7. WHOM CAN IT BE GIVEN? IN WHAT CONDITIONS CAN IT BE GIVEN? All age groups All aetiologies All countries

8. TYPES OF ORS?? Sodium bicarbonate based Trisodium citrate based Reduced osmolarity ORS Super ORS

9. Sodium bicarbonate based ORS Composition 2.5 Sodium bicarbonate 2.5 KCl 20.0 Glucose 3.5 NaCl (gm) Contents

10. Disadvantages Less stable Stool output not reduced 11. Trisodium citrate based ORS 12. Composition 2.0 Trisodium citrate 1.5 KCl 20.0 Glucose 3.5 NaCl (gm) Contents

13. Osmolarity 310mM TOTAL 10mM Citrate 20mM K + 110mM Glucose 80mM Cl + 90mM Na +

14. Advantages More stable Less stool output in high output diarrhoea Tri Na citrate-increases intestinal absorption of Na & water

15. Possible adverse effects Hyper tonicity in net fluid absorption 16. To overcome this 17. We should reduce the osmolarity of the ORS 18. Reduced osmolarity ORS 19. Composition Trisodium citrate KCl Glucose NaCl Contents 2.9 1.5 13.5 2.6 (gm)

20. Osmolarity TOTAL Citrate K + Glucose Cl + Na + 245mM 10mM 20mM 75mM 65mM 75mM

21. Advantages Increased efficacy of ORS in non cholera diarrhoea Need for unscheduled supplement IV therapy in children fell by 33%. Stool output decreased by 20%. Vomiting decreased by 30%. Safe & effective .

22. 23. DOSAGE & REQUIREMENT? If the childs weight is known, the amount of ORS soln.for rehydration during the first 4hrs may be calculated as 75ml/kg

24. DOSAGE & REQUIREMENT? 2200-4000 1200-2200 800-1200 600800 400-600 200-400 Soln.(ml) 30< 16-29.9 11-15.9 8-10.9 5-7.9 <5 Wt.(kg) 15yrs< 5-14yrs 2-4yrs 1-2yrs 4-11mths <4mths Age

25. HOW TO ADMINISTER??? Teach the mother ORS 26. RULES <2yrs :- give 1-2 teaspoon every 2-3 minutes Older children :offer frequent sips out of a cup Adults:- drink as much as they can Give the estimated amount within 4hrs

27. If the child vomits?? Wait for 10 minutes Give a teaspoonful every 2-3 minutes

28. If the child wants to drink more than the estimated amount ? No harm , give more

29. If the child refuses to drink ? See whether the signs of dehydration has disappeared If yes Treat similar to a non dehydrated diarrheal child.

30. If the child is breast fed ? Nursing + treatment with ORS solution 31. Non breast fed infants less than 6 months Along with ORS solution give 100-200 ml of clean water for first 4 hours

32. Where is it available ? PHC Sub centers Hospitals Chemist shops 33. Cost? Free 34. How to prepare it ? Dissolve the entire contents of the packet in 1l of drinking water It should be used within 24 hours

35. If ORS packets are not available ? Table salt (5gm) + sugar (20gm) in 1l of drinking water

36. Administer till the diarrhea stops Earlier the treatment is instituted the better is for the patient

37. ORT programme First started in 1986-1987 Implemented through RCH programme ORS packets are supplied by the central govt. Twice a year 150 packets of ORS are provided as apart of drug kit supplied to all sub centers in the country

38. Theme Adequate nutritional care of child with diarrhoea Proper advice to mother in feeding

39. Achievements & benefits Low cost treatment Treatment of the patient in their own homes Ingredients are inexpensive and readily available

40. Achievements & benefits Drinking water is sufficient (no need for boiling or other means of sterilization) Breakthrough in the fight against

cholera and other diarrheal diseases Mortality rate in cholera has been reduced to 0.11% from 49.3% 41. 42. THANK YOU