ORAL REHYDRATION SALTS (ORS)

Fluid and electrolyte replacement powder containing sodium, potassium, citrate, and glucose. Used to prevent and treat dehydration

Dosage Forms

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Powder for Solution

World Health Organisation (WHO) formula

Uses

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  • Diarrhoea
  • Prevent dehydration where it has not yet occurred
  • Treatment of dehydration and electrolyte disturbances
  • Supplement IV rehydration in severe dehydration

Dose and Duration

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Give according to the treatment plans below

Plan A: Prevention of dehydration

Adult and child >10 years: 200–400 ml after each loose stool

Child 2–10 years: 100–200 ml after each loose stool

Child <2 years: 50–100 ml after each loose stool

Plan B: Treatment of moderate dehydration

Give 75 ml/kg in small amounts and at regular intervals over 4 hours

Larger amounts may be given if a child continues to have frequent loose stools

Continue ORS as long as diarrhoea or signs of dehydration continue

Plan C: Severe dehydration (in combination with IV rehydration)

Initially 20 ml/kg per hour (while IV infusion is being prepared), then 5 ml/kg per hour (during IV infusion administration)

Monitor patient and continue treatment as appropriate with plan A, B, or C

Preparation

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  • Dissolve 1 sachet of ORS in 1 litre of drinking water

Side Effects

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  • Vomiting

Patient Instructions

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  • Dissolve one sachet in 1 L of clean, freshly boiled and cooled drinking water
  • Do not dissolve in less than 1 L of water
  • Do not give quickly, as it will cause vomiting. If a child vomits, stop giving for 10 minutes then resume at a slower rate
  • Pour away leftover solutions after 24 hours from time of preparation, then prepare a fresh solution
  • ORS should always be a free-flowing white powder. If it is a compact mass, brownish, and insoluble, it is unfit for use even if the expiry date is not yet reached
  • Continue breastfeeding and giving food as usual

Pregnancy

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  • Can be used

Breast-feeding

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  • Can be used

Storage

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  • Dissolved ORS can be used for 24 hours. Pour away leftover solution after 24 hours.

⚠️ Caution

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  • ORS should always be given with zinc tablet to children
  • Give 2 sachets of ORS to the caretaker for Plan A at home, following rehydration at the health facility
  • If IV rehydration is unavailable, use a nasogastric tube to give ORS at a rate of 20 ml/kg every hour for 6 hours
  • Reassess the child's status every 1–2 hours to classify the degree of dehydration