Author: Dr. Neelam Mohan
Diarrheal diseases are the leading cause of malnutrition and the second-leading cause of mortality and morbidity of children under the age of five worldwide. Despite advances in the last few years, a similar pattern can be seen in India where diarrhea is the third-leading cause of childhood mortality. Out of the 825,000 deaths recorded among children under 5 years in India in the year 2019, 8.9% of these deaths were attributed to diarrheal diseases. The tragedy here is that both of these can be easily avoided through simple preventive steps from your home followed by proper treatment. Given its high incidence during summer months and the resultant consequences, it is imperative that we understand types of diarrheal diseases and their treatment through simple measures like using Oral Rehydration Solution (ORS).
Diarrhea and its types
Diarrhea is a common condition when you experience loose or watery stools. In most cases, it is self-limiting, that is, it goes away in a few days with a proper diet. But in some cases, it can worsen. One of the most severe complications of diarrhea is dehydration. Diarrhea can be broadly divided into three types, as per WHO guidelines.
Acute diarrhea: This is the most common type of diarrhea, usually of infectious origin and usually goes away in a day or two.
Persistent diarrhea: Diarrhea that starts acutely and lasts for more than two weeks is known as persistent diarrhea. It can be caused due to many reasons, such as persistent infection, lactose intolerance, micronutrients deficiency and inadvertent antibiotic use. Other conditions include celiac disease, inflammatory bowel syndrome, food allergies may cause persistent diarrhea. It must be treated by a doctor. .
Chronic diarrhea: A diarrheal condition that starts insidiously and lasts more than 2 weeks is known as chronic diarrhea. It can be a serious health issue and can be life-threatening for someone with a weak immune system. It can be caused due to microbial infection or other factors, such as malabsorption, medications, allergy, inflammatory bowel disease, tumors and so on.
Diarrhea and Dehydration
The most severe consequence of diarrhea is dehydration. The loss of water and electrolytes during diarrhea through watery stools, sweat, vomit, and urine can cause the condition. In children, it can cause increased thirst, sunken eyes, and irritability. But as it persists and becomes severe, it can lead to the child refusing to eat or drink properly. To prevent diarrhea, we have to ensure that the loss of electrolytes and water is compensated. The easiest way to ensure this is through ORS.
The right ORS
According to The World Health Organisation (WHO), while ORS may not treat diarrhea, consuming the correctly formulated ORS helps in rehydration and prevents dehydration, thereby bringing down the need for hospitalisation and IV fluids, and mortality rates drastically.
The proportion of the constituents of the WHO approved ORS are fixed with each playing a specific role and no deviations are permitted. Basically a sodium and glucose solution, ORS contains certain trace elements such as potassium, and tri-sodium citrate in a balanced formula to compensate for the loss of electrolytes. The potassium compensates for its loss and the citrate reduces acidity during diarrhea. Sugar aids the sodium absorption through the intestines. This, in turn, helps the absorption of water.
Therefore, given the careful calibration of its ingredients, one should be very mindful when buying ORS and purchase only the one which has WHO recommended written on the pack. On the other hand, during a diarrheal episode consumption of any other solution which sound or look similar to ORS such as ORSL, QRS, but are essentially energy drinks can be potentially fatal for dehydrated patients. The high glucose load and osmolarity in the formulation can worsen loss of fluid and electrolytes leading to osmotic diarrhea. Apart from this, make sure that the solution is always made with purified water to remove any chance of contamination.
ORS is available in sachets in a fixed quantity of either 21gm or 4.2 gm that has to be mixed into a litre or 200 ml of water respectively, before consumption. There are some brands that have also introduced tetra packs for ease of usage. More importantly, the consumption of ORS can be administered by a non-medical person, such as a family member, at home with ease. For maximised benefits, ORS must be administered in small portions at regular intervals throughout the day to compensate for the losses in diarrhea or vomiting.
Diarrhea is a common health condition that can be treated easily at home. However, as explained above, it still accounts for a disproportionately large number of deaths among children. We can address this by taking some simple precautions, such as following basic hygiene and administrating ORS regularly. Therefore, ORS merits a prominent place in your first–aid kit at home.
