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LETTER TO EDITOR
Year : 2017  |  Volume : 6  |  Issue : 1  |  Page : 173-174  

Oral rehydration solution in infantile diarrhea: Make sure it is given properly!


1 Department of Pediatrics, Chacha Nehru Bal Chikitsalaya, New Delhi, India
2 Department of Pediatrics, Sitaram Bhartia Institute of Science and Research, New Delhi, India

Date of Web Publication18-Sep-2017

Correspondence Address:
Amitabh Singh
Department of Pediatrics, Chacha Nehru Bal Chikitsalaya, New Delhi - 110 031
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jfmpc.jfmpc_49_17

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How to cite this article:
Anand R, Mandal A, Singh A. Oral rehydration solution in infantile diarrhea: Make sure it is given properly!. J Family Med Prim Care 2017;6:173-4

How to cite this URL:
Anand R, Mandal A, Singh A. Oral rehydration solution in infantile diarrhea: Make sure it is given properly!. J Family Med Prim Care [serial online] 2017 [cited 2019 Jul 15];6:173-4. Available from: http://www.jfmpc.com/text.asp?2017/6/1/173/214990

Dear Editor,

A 10-month-old previously asymptomatic boy was admitted with complaints of frequent (15–20 times/day) watery stools for 4 days, vomiting (3–4 times/day, nonbilious) for 3 days, and lethargy along with poor feeding for 1 day. There was no history of fever, cough, blood, or mucus in stool or decreased urine output. The child was predominantly breastfed and received diluted cow's milk by bottle. He was appropriately immunized and developmentally normal for age. For the current episode of illness, the child was given the World Health Organization oral rehydration solution (ORS), zinc and antiemetic (ondansetron), as prescribed by a private practitioner. On examination, the child had signs of severe dehydration. There was acidotic breathing along with signs of poor perfusion (feeble pulses, tachycardia, and prolonged capillary filling time) though blood pressure was maintained. His anthropometric parameters were within normal limits. Initial fluid resuscitation was done with isotonic saline followed by improvement in perfusion. Investigations showed severe hypernatremia (serum sodium 182 meq/L) though rest of the parameters (complete blood count, random blood sugar, serum potassium, and renal function test) were within normal limits. On further probing, his mother revealed that she prepared ORS by diluting 1 packet of ORS meant for 1 L of water only in around 500 ml water. The child was started on fluid therapy for hypernatremic dehydration along with frequent monitoring of serum sodium. However, there was further deterioration in sensorium and he had 2 episodes of generalized seizures followed by hypotension. Fundus examination ruled out papilledema. He was put on mechanical ventilation along with anticonvulsants and vasopressor support. However, despite all efforts, the child succumbed after 24 h of admission.

Diarrhea is the second leading cause of under 5 mortality, accounting for more than 3 million under 5 children deaths annually. Majority (60%–70%) of diarrhea-related deaths are due to dehydration which can be treated easily by replacing fluid loss with ORS.[1] Considering the number of lives saved, it is indeed not an exaggeration to label ORS to be the most important medical advancement in the twentieth century.[2] Although the United Nations International Children's Emergency Fund data showed that ORS use in diarrhea increased from 19% in 1993 to 69% in 2000 in South Asia region;[1] unfortunately, most of the parents still do not have the correct information and knowledge regarding the proper preparation of ORS. This is exemplified in the study by Bhatia et al.[3] from rural Chandigarh, India, where only 18.7% mothers of under 5 children could tell the correct method of ORS preparation. Hypernatremic dehydration and subsequent poor outcome including mortality due to improperly diluted ORS have been reported previously in literature.[4]

Another important aspect in the proper use of ORS in diarrhea is the availability of smaller packets (4.2 g) of ORS which are to be dissolved in 200 ml of water. An interesting study from rural areas of Maharashtra, India,[5] revealed that though 23.6% of mothers of under 5 children knew the correct method of preparation of ORS, only 16% were aware about small sachets to be prepared in 200 ml of water and 14% were aware of both. Further, despite having the correct knowledge, 51.3% mothers followed wrong practice of preparing ORS! Incorrect practice most commonly involved dissolving partial contents of the packets in different quantities of water. The mother of the index child was also aware of the correct method of ORS preparation, but she dissolved it in only 500 ml of water as she thought that the child would not be able to take 1 L of ORS in a day. Deaths due to confusion between 2 different sizes of ORS packets leading to preparation of standard ORS packet in 200 ml of water causing hypernatremic dehydration are known.[4] On the other hand, dissolving the smaller packet in 1 L of water also carries the risk of hyponatremia in children with diarrhea.

Thus, a great emphasis is needed to include actual demonstration of correct method of preparation of ORS as a part of health education system at various levels.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Victora CG, Bryce J, Fontaine O, Monasch R. Reducing deaths from diarrhoea through oral rehydration therapy. Bull World Health Organ 2000;78:1246-55.  Back to cited text no. 1
[PUBMED]    
2.
Centers for Disease Control and Prevention. Ten Great Public Health Achievements in the 20th Century; 2013. Available from: https://www.cdc.gov/about/history/tengpha.htm. [Last accessed on 2017 Feb 01].  Back to cited text no. 2
    
3.
Bhatia V, Swami HM, Bhatia M, Bhatia SP. Attitude and practices regarding diarrhoea in rural community in Chandigarh. Indian J Pediatr 1999;66:499-503.  Back to cited text no. 3
[PUBMED]    
4.
Quereshi UA, Bhat JI, Ali SW, Mir AA, Kambay AH, Bhat IN. Acute salt poisoning due to different oral rehydration solution (ORS) packet sizes. Indian J Pediatr 2010;77:679-80.  Back to cited text no. 4
[PUBMED]    
5.
Kadam DM, Hadaye R, Pandit D. Knowledge and practices regarding oral rehydration therapy among mothers in rural area of Vasind, India. Nepal Med Coll J 2013;15:110-2.  Back to cited text no. 5
[PUBMED]    




 

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