WHO ORS Formula:
Forms and strengths
Sachet of powder to be diluted in 1 litre of clean water.
WHO formulation:
Dosage
Prevention of dehydration (WHO – Treatment plan A)
- Child under 24 months: 50 to 100 ml after each loose stool (approximately 500 ml daily)
- Child from 2 to 10 years: 100 to 200 ml after each loose stool (approximately 1000 ml daily)
- Child over 10 years and adult: 200 to 400 ml after each loose stool (approximately 2000 ml daily)
Treatment of moderate dehydration (WHO – Treatment plan B)
Child and adult:
- Over the first four hours:
- After four hours:
- If there are no signs of dehydration: follow Treatment plan A.
- If there are signs of moderate dehydration: repeat Treatment plan B.
- If there are signs of severe dehydration: start IV therapy (Treatment plan C).
Treatment of severe dehydration (WHO – Treatment plan C)
- In combination with IV therapy and only to a conscious patient:
- Child and adult: 5 ml/kg per hour
- After 3 hours (6 hours in infants), reassess and choose the appropriate plan A, B or C.
Duration
As long as diarrhoea and signs of dehydration persist.
Contra-indications, adverse effects, precautions
- If the eyelids become puffy during the treatment: stop ORS, give plain water then, resume ORS according to Treatment plan A when the puffiness is gone.
- If case of vomiting, stop ORS for 10 min and then resume at a slower rate (very small, frequent, amounts); do not stop rehydration.
- Pregnancy: no contra-indication
- Breast-feeding: no contra-indication
Remarks
A special ORS-formula, ReSoMal, is used under medical supervision, for severely malnourished children only. However, in malnourished children with cholera, standard ORS- formula is used instead of ReSoMal.
Storage
– Below 25 °C
Do not use the powder if it has turned into a yellow-brownish sticky substance.
Once prepared, the solution must be used within 24 hours.
Ref:
ORAL REHYDRATION SALTS = ORS | MSF Medical Guidelines. Available at: https://medicalguidelines.msf.org/en/viewport/EssDr/english/oral-rehydration-salts-ors-16684387.html
Zinc Sulphate for Diarrhea, treatment; malnourished patient: Limited data available (WHO/UNICEF 2004): Note: Dosage expressed in terms of elemental zinc. Zinc should be started in conjunction with oral rehydration solutions at first sign of diarrhea; zinc therapy may shorten the duration and severity of episodes and prevent subsequent episodes (Bhandari 2008; Lazzerini 2016; Lukacik 2008; WHO/UNICEF 2004):
Infants <6 months: Oral: 10 mg once daily for 10 to 14 days (Bhandari 2008; WHO/UNICEF 2004).
Infants ≥6 months and Children: Oral: 20 mg once daily for 10 to 14 days (Bhandari 2008; WHO/UNICEF 2004). Note: Lower doses of 5 mg or 10 mg once daily for 14 days have shown noninferior efficacy and have been associated with less vomiting (Dhingra 2020).