Zinc and ORS - Introduction,ORT,Diarrhea Treatment

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Zinc and ORS

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Results

ZINC AND ORS

Related topics

New Reduced Osmolarity ORS

Composition Of Reduced Osmolarity ORS

Zinc as Adjuvant in Rehabilitation of Patients with Diarrhea

Recommendations of IAP National Task Force for use of Zinc in Diarrhea

Santosh Singh
Medical Sciences Department, Pediatric Oncall, Mumbai

Address for Correspondence:

Dr Santosh Singh, Medical Sciences Department, Pediatric Oncall, 1/B Saguna, 271/B St. Francis Road, Vile Parle (W), Mumbai 400056.

Introduction

Diarrhea is associated with 18% mortality among children aged <5 years, accounting for 1.9 million deaths ¹, primarily in developing countries. Despite advances in the use of oral rehydration therapy (ORT), diarrhea-associated mortality has not declined significantly in the past few years. The continued high mortality underscores a need for further improvements in case management and primary prevention. Dietary deficiency of some micronutrients has been shown to increase the susceptibility of infants and children to gastrointestinal infections and to have direct adverse effects on gastrointestinal tract structure and function.^2-7

ORT and ORS

Oral rehydration solutions (ORS) are now widely used to treat diarrhea and have greatly reduced mortality from dehydration. A major limitation, so far only partially overcome, is that oral rehydration therapy (ORT) is effective at rehydration and correcting electrolyte imbalance, but generally is less impressive at reducing the purging rate. ORS is a cost effective medication in the world.

Despite the advent of a number of antidiarrheal drugs, none has found a place in the routine management of acute diarrhea. This is particularly relevant to developing nations, where the financial burden of public health results in a poor distribution of meager resources. Mortality due to dehydration and hyponatremia, especially in infancy accounts for several millions each year. 8, 9 If properly administrated by caregivers, ORS can not only reduce mortality but also diminish the need for hospitalization and intravenous rehydration. This shortcoming lessens the acceptance of ORT by primary caregivers and increases the risk of an early interruption of the rehydration process, the introduction of inappropriate feedings and reinfection causing the perpetuation of a vicious cycle.

The physiologic characteristics of the small intestine present challenges and opportunities to achieve a successful therapeutic intervention. Improving the efficacy of ORS has been a persistent effort involving clinicians, field workers and researchers.

The most important factors influencing the success of an ORS are: electrolyte and base content, carbohydrate type and concentration and osmolality.

Table 1 - Schematic History and Possible Trends in the Formulation of ORS¹⁰

Early Formulas	Attempted Modifications	Current Formulas	Future Developments
High carbohydrate Low Sodium	Better Glucose/Sodium Balance	Sodium < 75 mM	Sodium: Glucose ratio > 0.5
Iso or Hypertonic ORS	Amino Acids (Gly, Ala, Gln)	Glucose < 111 mM (or rice extract powders; local or commercial)	Rice (wheat) extracts (glucose polymers)
	Iso or Hypertonic ORS	Iso or Hypotonic ORS	Live or killed Lactobacilli
			Soluble Fibers or non-absorbable carbohydrates
			Zinc salts

Next : New Reduced Osmolarity ORS

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