Wednesday, December 27, 2006

The Oral Rehydration Solution

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