Oral Rehydration Therapy - Essay Example

Oral Rehydration Therapy was found at the outset of millions of deaths due to dehydration caused by Diarrhoea. Children are more vulnerable to die from this disease than adults because they get dehydrated fast. Malnutrition among children is the major cause of Diarrhoea. In developing nations around 2.2 million people (mostly children) lose their lives due to inadequate safe drinking water, poor sanitation and hygiene and overcrowding in their locale. Ninety percent of these children are under the age of five.

Oral Rehydration Therapy is a dream solution to avert these millions of death through awareness, prevention, treatment and intervention strategies. The application of ORT gained momentum from the medical point of view when it was discovered that when sodium transport and glucose transport is combined in the small intestine, glucose hastens the absorption of solute and water content into the body potentially. This has been referred as one of the significant advancement of medical science in the treatment of diarrhoeal dehydration in this century.(Anon, Rehydration Project).

Until the use of ORT was found the only way to treat diarrhoea was to assist IVT (intravenous therapy) by qualified medical staff in a medical clinic or hospital. Dehydration can now be brought under control with a simple solution of sugar, salt and water that can be administered through mouth by the parents in a child’s home. Oral Rehydration salt solution is used for children and adults with diarrhea if preliminary consumption of normal fluids does not stop dehydration.
Oral Rehydration Salts

The ingredients of ORS in grams per litre are Sodium Chloride (2.6 gm/l), Anhydrous Glucose (13.5 gm/l), Potassium Chloride (1.5 gm/l) and Trisodium citrate; dehydrate (2.9 gm/l). Potassium is essential to supplement the mineral lost during diarrhea. Research indicates that undernourished children who have persistent diarrhea are likely to lose huge amounts of potassium resulting in a low level of potassium in the blood. Hence potassium should be replaced during rehydration through procedures like ORS. Citrate is included in ORS to treat acidosis that usually forms during dehydration. The glucose in ORS solution accelerates absorption of sodium into the body and it is not for the particular release of energy. ORS sachets are distributed around the world with the special initiative of UNICEF.

Cost

Packaged ORS costs only 10 cents per sachet in the US. But the challenge lay in the distribution of the sachet to every household. That is the reason for the campaign of do-it-yourself campaigns that teach mothers to control dehydration from home made ingredients. The do-it-yourself approach makes the formula available for a majority of patients around the world in a situation where people do not have proper health care centers. In the near future, ORT can be canvassed to half of the families around the world and that could mean the formula would save nearly two million children in a year.

Paramedics

The advantage of Oral Rehydration Therapy can be communicated to mothers and families by health workers and paramedics. Health professional can guide people on the proper use of ORT to fight dehydration.  This therapy is suitable for primary health care from home. If Oral Rehydration Therapy is communicated with proper feeding practices the therapy will gain better recognition by decreasing the bad effects of diarrhea on the nutrition of the patient.

Safe to use

Oral Rehydration Therapy is a safe method to rehydrate a person with diarrhea even before preliminary diagnosis or treatment. The amount of rehydration for adults is similar to the amount of rehydration required by children though children should be treated quickly because they lose body fluid fast. (Anon, Rehydration Project)

The use of Oral Rehydration salts is well established in controlling diarrhoeal sickness among children and the elderly. It is suggested that it is not necessary for elders to consume ORS but they can substitute the water content in the body by drinking sugary drinks and by consuming salt crackers. It is however recommended that elders also use electrolyte sachets in case of emergency, if sugary drinks are not readily available. Further, it is said that children and elders can utilise commercial rehydration salts like Dioralyte and Rehidrat. The formulation of ORS was revised in 2003 by the World Health Organisation. The earlier formulation of ORS contained high amount of sodium and so it was called hypertonic. The new formulation of WHO which is used in the United Kingdom comprises of low level of sodium and so it is called hypotonic. Research has shown that water absorption into the body is high if hypotonic ORS solution is administered. Certain studies show that the use of rice based ORT solutions is more effective in adults when compared to glucose solutions. (Goodyear & Goodyear, L.I., (2004). P.32)

Oral Rehydration Solutions are the most effective and cheap way to control diarrhoeal dehydration

An effective and easy salt solution to rehydrate a child can be prepared by mixing salt, sugar, and water. White sugar can be replaced by other types of raw sugar or molasses since they have more potassium. Gruels made by diluting mixtures of boiled cereals and water, boiled rice water, carrot juice, green coconut water, boiled and cooled water, carrot juice, and breast milk are other solutions to rehydrate a child. Usually, children die of diarrhea when they are dehydrated with the loss of essential fluids and salts from the child’s body. So it is essential to substitute the liquid content of the body and maintain the balance by giving additional drinks.

ORT is the method of providing fluid through the mouth to prevent or control dehydration that happens as a result of diarrhea. Soon after the diarrhoea starts in a person, medication should be given from home to prevent dehydration. This can be prepared from ingredients available in the house and other liquid forms.

Oral Rehydration Salts can also be used to control dehydration. ORS should be prepared with clean water and the drink includes major elements that are lost due to diarrhoea. ORS is effective in controlling dehydration that arises from all forms of severe diarrhoeal disease. The essential fluid or ORS should be given to the patient after every watery stool is released. If diarrhea persists, the patient should continue to drink the solution. Fluid intake will not increase diarrhoea. While treating for dehydration, the patient can undergo treatment for diarrhea, vomiting ,or similar sickness.

The distribution and promotion of ORT is yet to reach all corners of the world. Though many countries have adopted programs to control diarrhoea, ORT is now widely used. Diarrhoea can be prevented with the supply of clean drinking water, hygiene and sanitation. However, the number of death caused due to diarrhoeal dehydration can be prevented using the cheap medication called ORT.

How does ORT work?

Severe diarrhoea stops after a few days. ORT is not a treatment for diarrhoea but it substitutes the fluid and salts lost during the sickness and protect the body from dehydration, thus saving the patient from danger. The glucose content in ORS solution assists better absorption of the fluid and salts into the body.

Oral Rehydration Therapy is effective in 90-95 percent patient with severe watery diarrhoea irrespective of the cause of the disease. Hence intravenous drip treatment is not required except in the most acute case.

A ten point recommendation on rehydrating a child is as follows; 1. Use clean hands (wash with soap and water before preparing the fluid). 2. Prepare the fluid in a clean vessel by combining eight teaspoons of sugar with one teaspoon salt in one litre boiled and cooled water. (Alternatively 1 sachet of ORS can be mixed with one litre boiled and cooled water). The contents should thoroughly dissolve in the water before consumption.3. Clean the feeders hand and the child’s hand before feeding the solution. 4. Children should be given ample fluid in small quantity frequently. 5. Other fluids like breast milk and juices should alsofeeder's be given. 6. Continue with solid food if the patient is above four months of age 7. If a child requires ORS after 24 hours a fresh solution may be prepared and fed. 8. ORS stops the body from dehydrating and the diarrhea will stop by itself. 9. If a child vomits provide ORS after ten minutes 10. If diarrhea or vomiting continues for a long time after assisting ORS, the child should be taken to a health clinic. (Anon, Rehydration Project)

Gastroenteritis is a condition that involves severe diarrhea combined with or without nausea, abdominal pain, fever, and vomiting caused by different forms of infections. Comparative systematic research with randomized controlled trials (RCT), ORT, and intravenous therapy on treating dehydration which is secondary to severe gastroenteritis revealed that there was only one failure with the use of ORT and so the primary course of therapy in children with dehydration secondary to severe gastroenteritis should be Oral Rehydration Therapy.

Diarrhea leads to dehydration which in turn results in the death of the patients. Acute dehydration is usually found among infants who are less than one year old. Oral rehydration salt solution was widely used in the 1970s to effectively overcome the problem of dehydration at a lesser cost. Even after recommendations from various institutions, oral rehydration therapy is not fully employed by physicians in economically advanced nations.

A recent report shows that ORT is feasible only for 20 percent of children around the world which if extensively used can stop 15 percent death of children aged below five. The reasons that hinder the widespread use of ORT are presumed to be the fear of stimulating iatrogenic hypernatremia, inadequate time, questions on the efficiency of the therapy in moderate dehydration, and the preference of parents. Though Intravenous therapy is often used because it reverses hypovolemic shock, the therapy is bound by certain disadvantages. IVT cannot be easily accessed or administered. The patient should be treated with a qualified staff in a hospital and the treatment is expensive in terms of medicine and human resource. Due to these factors, ORT has an edge over IVT though it should not be used in patients with paralytic ileus however it is safe for children in the case of hyponatremic or hypernatremic dehydration and acidosis. ORT causes fewer traumas to the child at the time of consumption, easstaysy to use and even parents can administer the solution in any setting. Research has indicated that ORT is cheaper than IVT with lesser expenses related to short stay at the hospital.

A meta-analysis by Gavin et al has found that there has been no report of failure of ORT and that it is related to favorable results in treatment. This was supported by the NHS Centre for Reviews and Dissemination which applauded the report to be reliable. (Bellemare et al, 2004)