Diarrhoea and Oral Rehydration Therapy

Diarrhoea or acute gastroenteritis is a universal problem. The most frequent cause of acute gastroenteritis is an infection of the intestines. Such an infection results in an outpouring of fluid and electrolytes (sodium, potassium, chloride and bicarbonate) from the intestinal epithelial cells into the intestinal lumen, which is then purged out as diarrhoeal stool. Diarrhoea has been defined as passing of three or more loose or watery stools in a day. If there is vomiting along with loose stools; loss of large amount of body water and salts is imminent and would lead to dehydration. Infants and young children develop dehydration faster than adults especially in hot climates, when diarrhoea is also associated with fever. So the most significant harmful effect of diarrhoea is major loss of fluid and electrolytes. However during the infective diarrhoea the intestinal ability to absorb of glucose, salts, water and nutrients remain well preserved. Since the absorptive ability of intestines is not altered by diarrhoea, so the management of diarrhoea or acute gastroenteritis is possible with oral rehydration therapy (ORT).

For ORT, a standard solution of oral rehydration salts (ORS) prepared under the recommendations of World Health Organization (WHO) is administered through mouth in small amounts (50 to 100 ml) depending on the age of patient at regular intervals of time. For preparing a standard solution of ORS, the powder is dissolved in known quantity of boiled cooled or purified drinking water as mentioned on the packet of ORS. With oral rehydration therapy the death rate of people dying of severe dehydration due to diarrhoea has significantly come down and the requirement of intravenous drips has become almost negligible.

A packet of ORS contains 27.5 grams of essential salts to be dissolved in a litre of boiled cooled or purified drinking water. An ORS packet contains 20 grams of glucose, 3.5 grams of sodium chloride (common salt or table salt), 2.5 grams of sodium bicarbonate (backing soda) and 1.5 grams of potassium chloride. Packets of ORS are supplied free of cost at Primary Health Centers and Government Hospitals and dispensaries. Low salt content home-made fluids are equally good in emergency if a packet of ORS is not available immediately. Children with diarrhoea should be treated with ORS without loss of time.

The solution of ORS should be kept covered and used within 20 hours. If need be, fresh ORS solution should be prepared after 20 hours. Adults and older children should drink as much as they like from a cup or tumbler of ORS. A child under two years of age should be given half to one cup of ORS solution after each stool to compensate the loss of water and salts. Older children and adults should drink at least one to two cups after each stool. Easily digestible solid food such as boiled rice, soups, porridge, banana shake, curd, eggs, fish and well cooked meat are allowed even during diarrhoea. Treatment in hospitals and health centers depends on the degree of dehydration and other complications like fever and shock.