Dehydration: a new solution.
The World Health Organization's (WHO's) improved way to counter the dehydrating effect of diarrhea is a mix of salts and sugars, much the same as oral rehydration salts (ORS) solution already widely used, but is earier and cheaper to package, has a longer shelf life, and will be more effective against the disease itself. In developing countries diarrhea is the biggest killer of children under 5, and most of the deaths are caused by the rapid loss of essential salts and water. Increasing emphasis has been placed on the early prevention of dehydration at home using drinks such as tea and rice water, but the message has not always got through. Many millions of children reach a stage of moderate or severe dehydration when they need treatment with oral rehydration salts. The ORS solution recommended by WHO for over a decade is made up of 20 grams of glucose and 3 salts -- sodium chloride (3.5 g), sodium bicarbonate (2.5 g) and potassium chloride (1.5 g ) -- mixed in 1 liter of water. The children's program UN International Childrens Emergency Fund (UNICEF) supplied some 42 million packets of this ORS worldwide in 1982-83. By the end of 1983, the mixture was being produced in 38 developing countries. Its greatest appeal is that it is simple, inexpensive, and can be used at home. ORS is usable in place of intravenous therapy in 80-90% of clinically dehydrated patients, which has reduced significantly the number of child deaths due to diarrhea in many developing countries. The new improved formula will now make it even more useful. This replaces the sodium bicarbonate of the original formula with trisodium citrate dihydrate, resulting in a more stable product. Clinical trials show that the new formula corrects acidosis at a similar rate to the sodium bicarbonate formula and is considerably more effective in reducing the amount of diarrhea. This is most likely due to the increased intestinal absorption of sodium and water that is facilitated by the citrate. Packets of the new ORS-citrate supplied by UNICEF will look the same as the original bicarbonate. Research continues into other improved ORS formulae.