Oral rehydration solution--too little or too much

Abstract

Data from studies on actual use of packaged oral rehydration solution (ORS) in Bangladesh are summarized and their impact evaluated. In 6 studies in clinic settings only 2 clinics used enough ORS to meet minimum recommendations, of 50 ml/kg for initial rehydration in mild cases and 100 ml/kg per day of continued diarrhea, plus 100 ml/kg per day for normal requirements. The consumption of ORS in home settings was reported as 1 liter pack in 73 and 77% of adults, and 87% of children; 15 and 23% received 2 packs; 3% received 3 packs. In the authors' survey infants received 0.95 liter per episode, and adults 1.2 liter per episode. In another survey the median daily consumption was 0.3 liters. The authors estimated that the maximum weight of a person given 1 liter of ORS, according to the recommended dose, would be 12.5 kg, or a child less than 2 years old, with moderate dehydration. Considering that there are an estimated 85 million episodes of diarrhea yearly in Bangladesh, and only 4-9% are associated with dehydration, it would be more efficient for the government to provide ORS packs to truly dehydrated patients, rather than to try to treat all cases of diarrhea. Treating 5 million episodes of potentially life-threatening diarrhea with an average of 4 liters, rather than many more cases with inadequate amounts as is being done currently, would cost 1/6 as much. It is necessary to define criteria for communities to distinguish life-threatening dehydration for intensive ORT treatment