Timely rehydration and electrolyte replenishment are the cornerstones of managing acute diarrhea, high fever, and other dehydration-related conditions. Among these treatments, Oral Rehydration Salts (ORS) are considered the “gold standard” for preventing shock and mortality due to fluid loss. However, incorrect usage not only diminishes its efficacy but can also lead to severe complications such as hypernatremia or cerebral edema.

Efficacy and Mechanism of ORS

ORS is a precisely formulated dry salt mixture formulated according to osmotic concentration standards. When dissolved in water according to instructions, the solution optimizes the absorption of water and electrolytes (Sodium, Potassium, Chloride) across the intestinal mucosa through the Sodium-Glucose co-transport mechanism.

ORS is widely indicated for:

• Fluid and electrolyte replacement in acute diarrhea for both children and adults.
• Supplementing fluids for patients with high fever, dengue fever, or prolonged vomiting.
• Supporting rehydration for individuals engaging in high-intensity physical activity or working in hot environments.

Standard Guidelines for Preparing ORS

One of the most common mistakes is dividing a single sachet of ORS for dissolution into multiple smaller portions. This practice alters the component ratio, resulting in a solution that is either too concentrated or too dilute.

Users must strictly adhere to the following steps:

1. Verify Sachet Type: The market typically offers two versions: 200ml and 1 L sachets. Always read the label carefully to use the exact volume of water required.
2. Use Filtered Water: Only use cooled, boiled water or purified water. Absolutely do not mix ORS with mineral water, milk, fruit juice, or soft drinks, as these will alter the osmotic pressure.
3. Mix the Entire Sachet: Pour the entire contents of the sachet into the specified volume of water. Stir or shake thoroughly until completely dissolved.
4. Do Not Boil the Solution: Once prepared, do not boil the solution as it may degrade the chemical components.

Safe Dosage and Administration

The method of administration is just as critical as the preparation. The core principle is to drink slowly, in small sips.

• For Children: Administer via a small spoon or a needleless syringe in small increments, spaced 1-2 minutes apart. If the child vomits, wait about 10 minutes, then resume administration at a slower rate.
• Typical Dosage: After each episode of diarrhea or vomiting, children under 2 years old should drink approximately 50 – 100ml; children aged 2 – 10 years should drink 100 – 200ml; adults should drink according to thirst (typically 200 – 400ml).
• Usage Duration: The prepared solution is only valid for 24 hours. After this period, any remaining solution must be discarded to avoid bacterial contamination.

Alternative Rehydration Foods in Emergencies

If ORS is not immediately available, the following rehydration options can be used temporarily, though they should be replaced by medical-grade ORS as soon as possible:

• Fresh Coconut Water: Contains natural electrolytes, is palatable, and is generally safe.
• Salted Rice Water (Congee): Prepared by boiling one handful of rice with a pinch of salt in approximately 1.2 liters of water. Strain and use the liquid.
• Diluted Orange Juice: Ensure not to add too much sugar, as high sugar concentrations can exacerbate diarrhea.

Caution: Many “electrolyte rehydration” drinks available in prepackaged bottles often have electrolyte concentrations below the therapeutic standard. For significant dehydration from diarrhea, patients must use medical-grade ORS to ensure safety.

The information is based on Decision No. 292/QD-BYT issued by the Ministry of Health.

Ho Ngoc Ha – Center for Support & Continuing Education