E-drug: Re: New WHO ORS formula
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Dear E-druggers,
A few comments on the new WHO ORS formula.
Wilbert asked why WHO did not use its new decision process on new
essential drugs, with respect to this new ORS formula. The quick
answer is that this is not a "new" essential drug. It only concerns an
adjustment of a formula, and the far as I know essential drugs do not
go through the decision procedure when a new formulation is launched
on the market. By the way, the sodium reduction is less dramatic than
it sounded, from 90 MEq/l to 75 mEq/l, so less than 20%. One could
argue for even a more serious reduction (children may get sodium by
food intake as well). Glucose has been reduced more seriously, from
111 mmol/l to 75 mmol/l, and is therefore responsible for most of the
reduction of total osmolarity from 311 to 245 mOsm/l. As discussed,
the ORS composition did not change.
A more important question is why it took WHO so long to reduce
sodium and glucose contents. Over 10 years ago there were already
serious complaints about the high osmolarity of the WHO formula and
diarrhoeal disease control programmes were told to be wary (yes
'wary'!) of osmotic diarrhoea, which occurred after giving children too
much of that high glucose ORS. In industrialised countries,
hypernatraemia occurred due to additional sodium in infant formulas.
Andy's question on what this means for the use of home-based "ORS"
is important, but one should keep in mind that the uses of ORS (the
discussed WHO formula) and the home based fluids, such as gruels,
rice water, coconut water etc, are not the same. WHO maintains that
the ORS formula is indicated when children have reached a degree of
dehydration, as the speed of rehydration is higher with the optimal
WHO formula (although apparently it could be made "more optimal").
The home-based fluids are indicated to prevent dehydration, when
children have diarrhoea, but have not yet reached a degree of
dehydration. Over the years there have been violent debates over this
policy, involving arguments such as the empowerment of communities
to take control of their rehydration fluids, versus making them
dependent of industrialised products. However, I know very well
what I would give to my children when they develop any degree of
dehydration.
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 haakh@chd-consultants.nl
Visit CHD's website at www.chd-consultants.nl
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