Sunday, September 09, 2007

The Rehydration Solution


# 1118


Yes, this is a reprint of one of my older blogs.  But it's an important one. Perhaps even lifesaving.   I try to reprint this one every six months or so.   With the news very slow this weekend, this seems like an ideal time to do so.





Dehydration, and severe diarrheal disease, particularly among children in the third world, is a massive killer. Recognizing this threat, more than 25 years ago the WHO (World Health Organization) came up with what is now called ORS, or an Oral Rehydration Solution.


Hundreds of millions of sachets, or packets of this powder, are shipped each year to various third world countries, and there is no doubt that their use has greatly decreased the loss of life due to cholera, dysentery, and other diseases.


In a Flu Pandemic, the need for ORS will be great throughout the world. In western societies, where modern medical care is common, IV’s are generally used instead of ORS. There are economic and psychological reasons for this, although many doctors argue that ORS would be just as effective for the majority of patients.


Dehydration, from a prolonged bout of flu; with it’s fever, vomiting, and diarrhea, can easily kill patients that might have otherwise survived the virus. As IV’s may well be in short supply, or simply unavailable during a pandemic, the use of ORS may well be the most beneficial treatment that most patients can receive. Certainly, with home care being the most likely venue for most patients, ORS will play a large role in the tratement of pandemic flu.


There are, however, conflicting opinions as to what constitutes the proper formula for making your own ORS. All formulas use a base of sugar and salt, in an appropriate ratio. Some formulas, however, add potassium and Sodium Bicarbonate.


A little Biochemistry


When the human body becomes dehydrated, it loses both water and essential electrolytes, particularly sodium. This condition can quickly become life threatening.


In the human body, fluids tend to move from a less salty environment to the saltier one. As an example, if someone drowns in fresh water, the water in the lungs is less salty than the blood, and so this water is quickly absorbed from the lungs into the surrounding tissues. If a person drowns in salt water, the water in the lungs is saltier than the blood, and so additional fluid is pulled into the lungs to `dilute’ the salt water. In other words, the body tries to balance both sides of the equation.


This is an important concept when dealing with rehydration therapy.
Ingesting plain water does not help restore the salt content of the body. But ingesting water with too much salt will draw fluids from the body, and make the dehydration worse.


While many believe the exact ratios of sugar and salt to be writ in stone, the truth is, if you have to err, err on the side of less salt.


Sugar is added to the ORS solution for two reasons. First, it was discovered in the early 1960’s that sugar helped with the transport of fluids across the cellular membranes in the bowel. In 1977, the British Medical Journal Lancet called this `possibly the most important medical discovery of the 20th century’.


Sugar also provides needed calories, and as a carbohydrate, can help prevent ketoacidosis from occurring.


But, as with salt, too much sugar can be detrimental, it can promote diarrhea, and make the loss of fluids worse.


This is one concern regarding the use of sports drinks, such as gatoraid, for rehydration therapy. Many of these commercially available mixtures simply have too much sugar.


Making your own ORS

The bottom line, of course, is how to make a cheap, safe, and effective ORS powder yourself.


The simplest formula is 3 Tablespoons of sugar, and 1 teaspoon of salt, dissolved in 1 quart of potable water.


An alternative simple formula is 8 teaspoons of sugar, and 1 teaspoon of salt, dissolved in 1 quart of potable water.



This basic formula has been used effectively for more than 30 years by WHO, UNICEF, and other relief agencies and has saved millions of lives.


Over the past year, there has been some debate over the amount of salt and sugar in this formula. The old formula certainly works, and is safe. But some doctors have argued that a lower salt and sugar level might reduce fluid loss by curbing diarrhea.


I’ve elected to create single-serve packets of ORS powder, with each packet designed to be added to 1 liter of water. Two packets would be used for a 2-liter bottle.


I’ve located small, reclosable baggies, called bagettes sold at Michaels Art Supplies. You will find them in the bead section. Snack sized baggies, though lighter gauge plastic, would work as well. The small 2”x3” bagettes are just a little too small for the amount of powder required. You will need to go to the next size up, which are 3”x5”.


Along with these baggies, you will need table salt and sugar. I am electing to use non-iodized salt, although I am not aware of any reason why iodized salt would present a problem. The only other things you will need are measuring spoons and a felt tipped marker.


Into each baggie I am placing 3 TABLESPOONS of Sugar, and 1 TEASPOON of salt. These do not need to be mixed. I am writing on each Baggie “ORS POWDER- ADD TO 1 LITER OF WATER”.


This is the basic formula recommended by Dr. Grattan Woodson in his GOOD HOME TREATMENT OF INFLUENZA guide.


In his home medical guide, Dr. Woodson writes:

"Preventing or treating dehydration in people with flu will save more lives than any other intervention during the influenza pandemic."

Identification of dehydration

When patients have a fever, vomiting, and/or diarrhea, they lose much more water from the body than is commonly appreciated. Symptoms of dehydration include weakness, dizziness, headache, confusion, and fainting. Signs of dehydration include dryness of the mouth, decreased saliva, lack of or very small urine volume that is dark and highly concentrated, sunken eyes, loss of skin elasticity, low blood pressure, especially upon sitting up or rising from the sitting to the standing position, and fast pulse rate, especially when moving from the lying to sitting or standing positions


You may elect to add a flavoring to this mixture. Unsweetened Koolaid would add flavor and color, and make the drink more palatable to some. It might, however, prove to be an intestinal irritant to some people. I intend to leave mine unflavored, and will add koolaid to individual liters of solution if desired.


For roughly $15 here in the United States, you can buy 400 bagettes, 15 pounds of sugar, and a couple of pounds of salt, and have enough supplies on hand to make 100 gallons of ORS. Personally, I intend to make up at least 600 packets, so I will have plenty to hand out to neighbors who might need them.


I am figuring that a patient, over a week or two, might require as much as 10 gallons of ORS solution. For most adults, ingesting 3 to 4 liters a day would not be excessive. Patients that are very ill, may only be able to take a teaspoon at a time, but every attempt should be made to force fluids.


At 15 cents a gallon, the price is right. And for someone who is dehydrated, having this solution on hand can be lifesaving.



You should never attempt to force fluids by mouth on anyone who is unconscious. An eye dropper may be used to slowly infuse liquids in semi conscious pateints but there is a risk of choking.


Better to dilute this powder too much, than too little. DO NOT SKIMP ON THE WATER.


For more complete information on oral rehydration fluids visit the Healthlink Worldwide webpage at


sanctuary said...

This is very valuable information. I have printed it off, and will post it in every bathroom in my work site. It is a gem!

Larry Austin said...

This is very interesting information regarding the idea of adding a mixture of sugar and salt to water to aid rehydration. I can't understand the salt, nor do I understand the sugar part. This is really different. The story has always been how you will die drinking sea water. I'll have to study this more. I'm going to consult my doctor on this idea. Maybe there is something for somebody who is near death, but generally, sugar is understood to be unhealthy empty calories. As a new resident of Las Vegas, NV, proper hydration has become a passion of mine. And with this, I've been studying alkaline ionized water. Learning that disease thrives in an acid body environment, I'm hoping to avoid disease with a diet of alkaline water. The ionization of water is supposed to make water better hydrating.

Anonymous said...
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Anonymous said...

Larry, salt is absolutely necessary to stay alive. Once a patient is severely dehydrated, they lose their electolytes (salts) that the body depends upon to keep basic electrical impulses, such as synapses, firing. Excessive sugar in a normal diet is indeed a bad thing, but some sugars are vital to body processes. The basis of our metabolism is carbohydrates, which convert to energy-producing sugars in the body. Without them, we get hypoglycemic (low blood sugar) which again -- if extreme -- can be fatal. I am grateful for this information, and plan on burning up some ink to print it out. Hopefully, I'll never have to use it. --Kristi N. :)

Karen Vaughan said...

While it is valuable to have oral rehydration salts made up, I also suggest having some Pedialite or similar bottled rehydration solution available on the lowest shelf of a pantry.

I suffered from a severe diarrheal attack that left me barely conscious two years ago. Although I had rehydration salts in my medicine closet, I was in no shape to find them and reconstitute them. I could barely crawl on the floor. Now I keep Pedialite on the floor of my pantry so all I would need to do is to find it and open it.

jim.carroll said...

A suggestion: instead of using regular table salt, try using sea salt. Since sea salt contains trace minerals that the body loses during diarrhea, it might do even more to minimize the effects of dehydration.

Anonymous said...

Found this on another site and thought I would add the link:

The key note in the question here was to PREVENT dehydration which salt is indeed a factor especially in certain survival situations that force a person to lose salt due to eating a survival based diet.

First, The use of salt tablets are used only when plenty of water is avail.. Never use salt when dehydrated or when there is a lack of water. Salt is lost through sweat and also has the effect of bringing on thirst causing the body to drink more.

This is NOT a wives tale but something that was used back with the Roman soldiers (They were even paid in salt) and is even in use today by the US Army.

I suggest looking into things before taking a casual QI/Clinical consultant's or whoevers response. It is upsetting to see the lack of knowledge in our medical staff of today.

Check out the below link. I hope it can get you a started:

Anonymous said...

I've used this formula when our dog became severely sick and dehydrated. The vet gave a poor prognosis, but gave us the medication in hope of recovery. I found this formula, and knowing how dehydrated our dog was, gave her batches of it daily. She fully recovered after about a week of formula. However the medication may of done a bulk of the work, I'm not really sure.

Martin said...

This is VERY out of date. The World Health Organisation now confirm that less sugar be used and it should be brown (containing molasses) not white. My successful formula and used several times now and as recently as this week (Dec 2012) following quite severe gastroenteritis was:-
1 litre of cooled boiled water, 1 level teaspoon of salt and 6 (old formula was 8) level teaspoons of brown sugar. 2 litres were taken through the day and no solids for 12 hours, after consuming the first two litres I added to the next batch of solution half a crushed banana because the high potassium content of this food works well with the sodium. It is important to ensure that the solution is taken regularly through the day and certainly after each loose motion. On the 2nd day I also took 2 followed by one Imodium tablet. My symptoms were initially VERY severe but had entirely disappeared in just over 24 hours - not bad for a 73 year old.

anon said...

I have been searching for this for YEARS. Since I've not had the proper words to describe it, the red cross people that I have asked have not been able to help me. I saw it mention on a program during an outbreak in a poor nation decades ago.
Thank you so much for helping by putting this on the Internet. I really did wonder I'd I had imagined the whole thing. Im going to make all my friend read this, people I know that are preparing for any disasters, the local PTA (children get sick), etc.