E-drug: Oral rehydration salts (ORS) - formulation (cont'd)
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Dear E-druggers,
On Prof Tripathi's query about the composition of WHO/UNICEF ORS
salts solution, this has been heavily discussed, although mainly in the
1980s. Especially after sodium bicarbonate (which turned brown after
a while) was changed for sodium citrate, most professionals in the
world seemed to be fine with it. The majority of research on optimal
ORS composition was done in Bangladesh.
The question of "what is wrong if one deviates from such prescribed
formula qualitatively or quantatively" is relatively easy to answer; the
solution will become less effective, which does not mean that it will
become worthless. The amounts of glucose, sodium and potassium in
the WHO/UNICEF formula are such that water absorption in the
intestines is optimal. Deviation from the WHO/UNICEF formula will
lead to a lower water absorption, something that may count in cases
of severe dehydration. WHO has plenty of evidence, particularly on
this issue, as they were challenged heavily by the medical community
in the 1980s when doctors were convinced that dehydrated children
needed intravenous rehydration and that such a "simple solution"
simply could not work.
WHO seems to have become more relaxed about the use of fluids
other than ORS. Whereas it initially promoted the use of only ORS
in cases of dehydration (other fluids were recommended for prevention
of dehydration), these days it recognizes that any fluid is better than
no fluid at all. Plain water is the least effective, breastmilk for infants
and food based fluids (rice water, gruels, soups, etc) is better, and
ORS solution (provided it is prepared with the right amount of water)
the most desirable.
What has been an ongoing discussion, was the question whether
home-made sugar/salt solution isn't just as good as the industry-made
ORS bags. The felt need to "empower" the community played a role in
these discussions. WHO had research data showing that measuring
quantities of salt and sugar is not that easy and in some countries
dangerously hypertonic solutions were made by caretakers of children.
Some countries (Zimbabwe) did not buy this argument and continued
the promotion of sugar/salt solution for treatment of dehydration. For
me, the whole issue is a bit of an academic debate, when ORS bags
cost something like 7-8 dollar cents on the world market, and
community members often spend a multitude of that on a variety of
non-recommendable drugs.
WHO has prepared a number of documents on the issue and I take the
liberty to forward your request to the colleagues in WHO and ask
them to answer you and to prepare an answer for E-drug.
Hilbrand Haak
Consultants for Health and Development
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Sleedoorntuin 7 tel: +31-71-523.2052
2317 MV Leiden fax: +31-71-523.3592
The Netherlands e-mail: haakh@compuserve.com
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