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{{Short description|Type of fluid replacement used to prevent and treat dehydration}}{{cs1 config|name-list-style=vanc}}{{Use dmy dates|date=September 2017}}

factoids

Oral rehydration therapy (ORT) is a type of fluid replacement used to prevent and treat dehydration, especially due to diarrhea. It involves drinking water with modest amounts of sugar and salts, specifically sodium and potassium. Oral rehydration therapy can also be given by a nasogastric tube. Therapy can include the use of zinc supplements to reduce the duration of diarrhea in infants and children under the age of 5.BOOK, WHO Model Formulary 2008, 2009, World Health Organization (WHO), 9789241547659, 349–351, ((World Health Organization)), Stuart MC, Kouimtzi M, Hill SR, 10665/44053, Use of oral rehydration therapy has been estimated to decrease the risk of death from diarrhea by up to 93%.Side effects may include vomiting, high blood sodium, or high blood potassium. If vomiting occurs, it is recommended that use be paused for 10 minutes and then gradually restarted. The recommended formulation includes sodium chloride, sodium citrate, potassium chloride, and glucose. Glucose may be replaced by sucrose and sodium citrate may be replaced by sodium bicarbonate, if not available, although the resulting mixture is not shelf stable in high-humidity environments.JOURNAL, Bull World Health Organ, Islam, M R, 3015443, 2490925, Citrate can effectively replace bicarbonate in oral rehydration salts for cholera and infantile diarrhoea, 1986, 64, 1, 145–150, It works as glucose increases the uptake of sodium and thus water by the intestines, and the potassium chloride and sodium citrate help prevent hypokalemia and acidosis, respectively, which are both common side effects of diarrhea.JOURNAL, J Pediatr., Nalin DR, Harland E, Ramlal A, Swaby D, McDonald J, Gangarosa R, Levine M, Akierman A, Antoine M, Mackenzie K, Johnson B, Comparison of low and high sodium and potassium content in oral rehydration solutions, November 1980, 97, 5, 848–853, 10.1016/s0022-3476(80)80287-3, 7431183, A number of other formulations are also available including versions that can be made at home.JOURNAL, Binder, HJ, Brown, I, Ramakrishna, BS, Young, GP, Oral rehydration therapy in the second decade of the twenty-first century., Current Gastroenterology Reports, March 2014, 16, 3, 376, 24562469, 10.1007/s11894-014-0376-2, 3950600, However, the use of homemade solutions has not been well studied.JOURNAL, Munos, MK, Walker, CL, Black, RE, The effect of oral rehydration solution and recommended home fluids on diarrhoea mortality., International Journal of Epidemiology, April 2010, 39, Suppl 1, i75–87, 20348131, 10.1093/ije/dyq025, 2845864, Oral rehydration therapy was developed in the 1940s using electrolyte solutions with or without glucose on an empirical basis chiefly for mild or convalescent patients, but did not come into common use for rehydration and maintenance therapy until after the discovery that glucose promoted sodium and water absorption during cholera in the 1960s.BOOK, Selendy, Janine M. H., Water and Sanitation Related Diseases and the Environment: Challenges, Interventions and Preventive Measures, 2011, John Wiley & Sons, 9781118148600, 60,weblink en, live,weblink 18 September 2017, It is on the World Health Organization's List of Essential Medicines.BOOK, ((World Health Organization)), World Health Organization model list of essential medicines: 21st list 2019, 2019, 10665/325771, World Health Organization, World Health Organization, Geneva, WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO, free, Globally, {{as of |2015|lc=yes}}, oral rehydration therapy is used by 41% of children with diarrhea. This use has played an important role in reducing the number of deaths in children under the age of five.BOOK, The State of the World's Children 2016 A fair chance for every child, June 2016, UNICEF, 978-92-806-4838-6, 117, 129,weblink 14 January 2017, live,weblink" title="web.archive.org/web/20160920001238weblink">weblink 20 September 2016,

Medical uses

ORT is less invasive than the other strategies for fluid replacement, specifically intravenous (IV) fluid replacement. Mild to moderate dehydration in children seen in an emergency department is best treated with ORT. Persons taking ORT should eat within six hours and return to their full diet within 24–48 hours.Oral rehydration therapy may also be used as a treatment for the symptoms of dehydration and rehydration in burns in resource-limited settings.JOURNAL, Vyas, KS, Wong, LK, Oral rehydration solutions for burn management in the field and underdeveloped regions: a review., International Journal of Burns and Trauma, 2013, 3, 3, 130–6, 23875118, 3712407,

Efficacy

File:Cholera rehydration nurses.jpg|thumb|A person with choleracholeraORT may lower the mortality rate of diarrhea by as much as 93%. Case studies in four developing countries also have demonstrated an association between increased use of ORS and reduction in mortality.JOURNAL, Victora, CG, Bryce, J, Fontaine, O, Monasch, R, Reducing deaths from diarrhoea through oral rehydration therapy, Bull World Health Organ, 2000, 78, 10, 1246–55, 11100619, 2560623, ORT using the original ORS formula has no effect on the duration of the diarrheic episode or the volume of fluid loss,JOURNAL, American Academy of Pediatrics, Provisional Committee on Quality Improvement, Subcommittee on Acute Gastroenteritis, Pediatrics, March 1996, Practice parameter: the management of acute gastroenteritis in young children, 97, 3, 424–435, 10.1542/peds.97.3.424, 8604285, 8642629, although reduced osmolarity solutions have been shown to reduce stool volume.

Treatment algorithm

The degree of dehydration should be assessed before initiating ORT. ORT is suitable for people who are not dehydrated and those who show signs and symptoms of mild to moderate dehydration. People who have severe dehydration should seek professional medical help immediately and receive intravenous rehydration as soon as possible to rapidly replenish fluid volume in the body.WEB, Oral Rehydration Therapy,weblink Rehydration Project, 29 October 2014, live,weblink" title="web.archive.org/web/20141014020822weblink">weblink 14 October 2014,

Contraindications

ORT should be discontinued and fluids replaced intravenously when vomiting is protracted despite proper administration of ORT; or signs of dehydration worsen despite giving ORT; or the person is unable to drink due to a decreased level of consciousness; or there is evidence of intestinal blockage or ileus. ORT might also be contraindicated in people who are in hemodynamic shock due to impaired airway protective reflexes.WEB, King, Caleb, Glass, Roger, Bresee, Joseph, Duggan, Christopher, Managing Acute Gastroenteritis Among Children,weblink CDC MMWR Recommendations and Reports, 29 October 2014, live,weblink" title="web.archive.org/web/20141028174056weblink">weblink 28 October 2014, Short-term vomiting is not a contraindication to receiving oral rehydration therapy. In persons who are vomiting, drinking oral rehydration solution at a slow and continuous pace will help resolve vomiting.JOURNAL, Nutrition Committee, Canadian Paediatric Society, Oral Rehydration Therapy and Early Refeeding in the Management of Childhood Gastroenteritis, The Canadian Journal of Paediatrics,weblink 1994, 1, 5, 160–164, live,weblink" title="web.archive.org/web/20141014020822weblink">weblink 14 October 2014,

Preparation

File:ORT saches.JPG|thumb|Commercially available oral rehydration salts: left, from Nepal; right, from PeruPeru(File:DripDrop ORS Flavor packets and cup of watermelon DripDrop.jpg|thumb|Commercially available ORS in water.)WHO and UNICEF have jointly developed official guidelines for the manufacture of oral rehydration solution and the oral rehydration salts used to make it (both often abbreviated ORS). They also describe other acceptable solutions, depending on material availability. Commercial preparations are available as prepared fluids and as packets of powder ready to mix with water."Oral rehydration salts and solutions and rice-based solutions worldwide manufacturers and suppliers." {{webarchive|url=https://web.archive.org/web/20141207213450weblink |date=7 December 2014 }} Rehydration Project website. Accessed 3 January 2014.WEB,weblink Oral rehydration therapy (ORT) in children,weblink" title="web.archive.org/web/20140102192829weblink">weblink 2 January 2014, US Department of Health and Human Services, 1 January 2014, A basic oral rehydration therapy solution can also be prepared when packets of oral rehydration salts are not available.WEB, 2005, The Treatment Of Diarrhea, A manual for physicians and other senior health workers,weblink live,weblink" title="web.archive.org/web/20111019172153weblink">weblink 19 October 2011, World Health Organization, Sometimes needs to be downloaded twice. See "4.2 Treatment Plan A: home therapy to prevent dehydration and malnutrition," "4.3 Treatment Plan B: oral rehydration therapy for children with some dehydration," and "4.4 Treatment Plan C: for patients with severe dehydration" on pages 8 to 16 (12–20 in PDF). See also "8. Management of Diarrhoea with Severe Malnutrition" on pages 22–24 (26–30 in PDF) and "Annex 2: Oral and Intravenous Rehydration Solutions" on pages 33–37 (37–41 in PDF)., Rehydration Project, WEB, Diarrhoea, Diarrhea, Dehydration, Oral Rehydration, Mother and Child Nutrition, Water, Sanitation, Hygiene – Rehydration Project,weblink live,weblink" title="web.archive.org/web/20150608064953weblink">weblink 8 June 2015, 22 June 2015, Homemade Oral Rehydration Solution Recipe. The molar ratio of sugar to salt should be 1:1 and the solution should not be hyperosmolar.JOURNAL, Churgay CA, Aftab Z, Gastroenteritis in children: part II, prevention and management, Am Fam Physician, 85, 11, 1066–70, 1 June 2012, 22962878,weblink live,weblink" title="web.archive.org/web/20140102193746weblink">weblink 2 January 2014, The Rehydration Project states, "Making the mixture a little diluted (with more than 1 litre of clean water) is not harmful."WEB,weblink Diarrhoea, Diarrhea, Dehydration, Oral Rehydration, Mother and Child Nutrition, Water, Sanitation, Hygiene - Rehydration Project, rehydrate.org, 22 June 2015, live,weblink" title="web.archive.org/web/20150608064953weblink">weblink 8 June 2015, The optimal fluid for preparing oral rehydration solution is clean water. However, if this is not available, the usually available water should be used. Oral rehydration solution should not be withheld simply because the available water is potentially unsafe; rehydration takes precedence.When oral rehydration salts packets and suitable teaspoons for measuring sugar and salt are not available, the WHO has recommended that homemade gruels, soups, etc., may be considered to help maintain hydration.REPORT, ((World Health Organization)), Diarrhoeal Disease Control Programme, 1986, Oral rehydration therapy for treatment of diarrhoea in the home, Geneva, World Health Organization (WHO), 10665/60117, WHO/CDD/SER/80.2, A Lancet review in 2013 emphasized the need for more research on appropriate home made fluids to prevent dehydration.JOURNAL, Sanders, 2013, Excellent can be the enemy of good: the case of diarrhoea management, The Lancet, 382, 9889, 307–308, 10.1016/S0140-6736(13)61633-5, 23890040, 13337829, etal, Sports drinks are not optimal oral rehydration solutions, but they can be used if optimal choices are not available. They should not be withheld for lack of better options; again, rehydration takes precedence. But they are not replacements for oral rehydration solutions in nonemergency situations.{{Citation |last=Dousma |first=M |display-authors=etal |year=2003 |title=[Sport drinks: not a suitable rehydration solution for children] |journal=Ned Tijdschr Geneeskd |volume=147 |issue=5 |pages=213–214 |pmid=12645356 |postscript=.}}

Reduced-osmolarity

(File:UNICEF-ORS.jpg|thumb|UNICEF-WHO Oral Rehydration Salt (ORS) packet)In 2003, WHO and UNICEF recommended that the osmolarity of oral rehydration solution be reduced from 311 to 245 mOsm/L.WEB, New formulation of Oral Rehydration Salts (ORS) with reduced osmolarity,weblink UNICEF, 27 April 2022,weblink" title="web.archive.org/web/20140716043018weblink">weblink 16 July 2014, dead, JOURNAL, Oral rehydration of malnourished children with diarrhoea and dehydration: A systematic review, Wellcome Open Research, 2, 66, Houston KA, Gibb JG, Maitland K, 27 October 2017, 5657219, The current standard (hypo-osmolar) WHO ORS, with lower sodium and glucose content, was developed in order to reduce the intensity of diarrhoea in children., 29090271, 10.12688/wellcomeopenres.12357.1, free, These guidelines were also updated in 2006. This recommendation was based on multiple clinical trials showing that the reduced osmolarity solution reduces stool volume in children with diarrhea by about twenty-five percent and the need for IV therapy by about thirty percent when compared to standard oral rehydration solution. The incidence of vomiting is also reduced. The reduced osmolarity oral rehydration solution has lower concentrations of glucose and sodium chloride than the original solution, but the concentrations of potassium and citrate are unchanged.WEB, Improved formula for oral rehydration salts to save children's lives, UNICEF,weblink 15 July 2008, live,weblink" title="web.archive.org/web/20080803155940weblink">weblink 3 August 2008, JOURNAL, Hahn, S., Kim, S., Garner, P., 2002, Reduced osmolarity oral rehydration solution for treating dehydration caused by acute diarrhoea in children, The Cochrane Database of Systematic Reviews, 1, CD002847, 10.1002/14651858.CD002847, 1469-493X, 11869639, 6532752, JOURNAL, Musekiwa A, Volmink J, Oral rehydration salt solution for treating cholera: ≤ 270 mOsm/L solutions vs ≥ 310 mOsm/L solutions, Cochrane Database Syst Rev, 12, CD003754, 2011, 2011, 22161381, 10.1002/14651858.CD003754.pub3, 6532622, The reduced osmolarity solution has been criticized by some for not providing enough sodium for adults with cholera.JOURNAL, Nalin DR, Hirschhorn N, Greenough W 3rd, Fuchs GJ, Cash RA, Clinical concerns about reduced osmolarity oral rehydration solution, JAMA, 291, 21, 2632–5, 2 June 2004, 15173156, 10.1001/jama.291.21.2632, Clinical trials have, however, shown reduced osmolarity solution to be effective for adults and children with cholera. They seem to be safe but some caution is warranted according to the Cochrane review.{|class=wikitable right!grams/L!oz/L!grams/L!oz/L

			|0.092

Trisodium citrate dihydrate>			|0.100

			|0.053

glucose>			|0.480

!Total!!27.9!!0.981!!20.5!!0.725{|class=wikitable right|+ Molar composition for the WHO standard and low-osmolar-oral rehydration solution! rowspan=2 | Component!!Standard!!Low-osmolar!!Acceptable range!mmol/L!mmol/L!mmol/L

			isbn=978-0-7216-0240-0 |pages=840 }} Further reading BOOK, ((World Health Organization)), 2006, Oral rehydration salts : production of the new ORS, World Health Organization (WHO), 10665/69227, WHO/FCH/CAH/06.1,weblink External links {{Commons category|Oral rehydration therapy}} Rehydration Project {{cholera}}{{Water-electrolyte imbalance and acid-base imbalance}}{{Gastroenterology}}{{Infants and their care}}