Oral Rehydration Salts, Package of (3)
The following is a description of the value of and causes for use of the oral rehydration salts, written by Dr. Monique Schwartz, Chief Hospitalist Physician and Rural Heath Care Specialist.
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Life Saving Oral Rehydration Solution
Every year, first year medical students are taught to calculate Total Body Water for patients. It’s a seemingly simple calculation. And it seems like such a waste of time to most students. The truth is, hydration is often the key to survival for our patients. So much so, the Lancet, a leading medical periodical, described oral rehydration therapy as "potentially the most important medical advancement of the 20th Century."
According to the Annuals of Epidemiology, in 2004, dehydration leads to over 518,000 hospitalizations per year. Nearly $5.5 billion in hospital charges resulted from dehydration related hospital admissions. Almost 90% of those admissions were emergent or urgent admissions. And 2% of those admissions died. From dehydration.
Our bodies are dependent on adequate hydration and electrolytes to regulate every function in the body from the electrical current required to maintain the internal pacemaker that allows our hearts to continue to beat to allowing our kidneys to process waste from our blood streams. Because of the vital nature hydration plays in our survival, our bodies developed redundant “fail-safes” to help protect us from becoming dehydrated.
Yet over half a million people are admitted annually because of dehydration. And it’s often preventable.
Who’s at risk? Though almost anyone can fall prey to dehydration in the face of vomiting and diarrhea, there are are some folks who are at a much higher risk for dehydration than others. Those populations include: infants and children, older adults and people with chronic illnesses. Endurance athletes, people living at high altitudes, people working or exercising outside in hot, humid weather are all at risk of dehydration even in the absence of vomiting or diarrhea.
What are the symptoms of dehydration? The earliest signs of dehydration are subtle. They include lassitude (mental weariness), fatigability, increased thirst, muscle cramps, and becoming dizzy with standing. More severe fluid loss can lead to abdominal pain, chest pain, or lethargy and confusion due to decreased blood flow to the blood vessels that feed the intestines, heart and brain. These symptoms are usually reversible, although tissue death may develop if the low-flow state is allowed to persist.
As dehydration becomes more severe, there is more and more reduction of blood flow to our vital organs (brain, kidneys, heart), resulting in a clinical syndrome doctors refer to as hypovolemic shock. Our bodies attempt to compensate by engaging our “fight or flight” response. Our heart rate increases, our blood vessels to “non-essential” areas clamp down in an effort to get blood to our vital organs which causes cold, clammy hands and feet that turn blue. As dehydration progresses, our kidneys stopped producing urine and we can no longer clear toxins from our blood stream. Decreased blood flow to our brain and increased toxins in our blood stream make us agitated and confused.
What conditions cause dehydration? Many scenarios can lead to life-threatening dehydration. Here are just a few (and some you might not expect)
- Viral Gastroenteritis
- Bacterial Gastroenteritis
- Food Poisoning
- Drinking alcohol
- Prescription medications
- Low Carb diets
- Heavy workouts
- Dietary supplements
- High altitudes
How to prevent dehydration? According to the American College of Sports Medicine, to avoid dehydration, active people should drink at least 16- 20 ounces of fluid one to two hours before an outdoor activity. Then you should drink 6 to 12 ounces of fluid every 10 to 15 minutes that you are outside. When you are finished with the activity, you should continue to drink another 16 to 24 ounces more to replace what you’ve lost.
Important guidelines to preventing dehydration:
- Drink before you get thirsty. Thirst is an early warning sign of dehydration.
- Not all fluids are hydrating! Alcoholic and caffeinated beverages, such as coffee, teas, and colas, are not hydrating. These fluids tend to pull water from the body and promote dehydration instead of combat it.
- Follow the “Half Rule”! To figure out how much water you need in a given day, you should drink half your weight in ounces. So an average guy who weighs 150 lbs needs about 75 ounces of water in a day to avoid dehydration.
What role to Oral Rehydration Solutions have? Oral rehydration therapy was first introduced in 1945. But use of the first Oral Rehydration Solutions (ORS) declined because of reports of electrolyte imbalances mainly due to high carbohydrate contents of early solutions. In the 1960s, efforts to develop safe and effective ORS was renewed. As medical science gained more understanding of the intricacies of the electrolyte co-transport in the gut, ways of using this knowledge was used to develop ORS formulas almost as effective as IV hydration. The World Health Organization (WHO) was instrumental in development of modern ORS and created recommendations for ORS properties to optimize rehydration. Its remarkable effectiveness is why it is used in lieu of sports drinks, pediatric electrolytes, and IV hydration to save millions of lives every year.
Common fluids such as gelatin, tea, fruit juice, sports drinks, and soft drinks have too little sodium, and nearly all have a much higher carbohydrate and electrolyte content than recommended by the WHO. These fluids should not be used in people with diarrhea, as they may increase diarrhea. Other fluids, such as chicken soup, have a high sodium concentration should be avoided as they can replace sodium too quickly and disrupt the balance of electrolyte transport throughout the body with dangerous results.
In addition to using ORS to actively combat dehydration, it can also be used to proactively prevent dehydration. ORS starts reversing the side effects of dehydration within minutes of drinking it. Multiple studies have shown it’s safe for all age groups, even babies.
Basic recommendations for Oral Rehydration Treatment are based on guidelines from the Centers from Disease Control and Prevention (CDC), American Academy of Pediatrics and other international medical societies.
Two Phase Treatment:
1. Rehydration phase: Fluid deficits are replaced over three to four hours. ORS is given in frequent, small amounts by spoon or syringe. One teaspoon, every two minutes will provide almost 1/3 of a liter an hour. Such small amounts are given to decrease “stretch” on the stomach which can trigger nausea and vomiting.
2. Maintenance phase. Once rehydration is achieved, maintenance of hydration with ORS should be provided for ongoing losses. This is especially important in the case of diarrhea, two teaspoons of ORS per 2 pounds of body weight should be given for each watery or loose stool and half a teaspoon per 2 pounds of body weight for each bout of vomiting. In the absence of vomiting and diarrhea, normal fluids are sufficient to maintain hydration.