Transcript LOW OSMOLARITY ORS: the advantage

LOW OSMOLARITY
ORS: the advantage
Dr Arati Deka
Associate Professor
Dept of Pediatrics, GMCH
Introduction
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Formost killer disease globally
In 1970 nearly 5 million deaths
--Only solution IV
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In 2004 1.5 billion episodes/yr
1.5-2.5 deaths /yr
8000 children/day
Reduction in mortality is possible by
proper
management of
dehydration by ORS
BMJ,The Lancet described ORS
MOST MEDICAL ADVANCE OF CENTUARY
Background/ history
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In 1968 researchers in Bangladesh
and India discovered addition of
glucose helps in sodium absorption
In 1971 large scale field application
of ORS in 1971 war
out of 3600 victims in refugees,
96% survived
Since then ORS mainstay of
treatment
Electrolyte loss in acute diarrhoea
Stool electrolytes (mmoles/Litre)
Etiology
Na
K
Cl
Cholera
88-101
27-30
86-92
Rota virus 37
38
22
ETEC
53
37
24
Others
56
25
55
Coupled Transport of Sodium and Glucose
in Intestinal Epithelial Cells
Standard ORS
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Composites mmole/L
It is the glucose
Na
based solution
90
Cl
80
K
20
Citrate
10
Glucose
111
Total osmo
311
Conditions required for optimal
absorption of ORS
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Osmolarity similar to or <
plasma(275-295 mosm/L)
Glucose conc should not exceed
20gm/L (111mosm/L)
Sod conc sufficient to correct deficit
and replace ongoing loss
Molar ratio of gluc to sod 1:1
Potassium conc 20 osm/L
Citrate conc 10 mosm/L
Limitations of standard ORS
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Does not decrease stool volume
Does not decrease frequency
Does not decrease severity
Does not stop diarrhoea
Potential risk of hypernatremia in
children with noncholera diarrhoea
May provide too much Sod to
edematous children
Two approaches to improve ORS
1) By modifying the amount and type
of organic carriers used in ORS
-rice based
-aminoacid fortified
- maltodextrin ORS
2) By reducing the osmolarity of ORS
Composition of standard and reduced
osmolarity ORS
standard
reduced osmo ORS
Glucose
111
111
75-90
75
Sod
90
50
60-70
75
Chloride
80
40
60-70
65
Pot
20
20
20
20
Citrate
10
30*
10
10
osmolarity
311
251
210-260 245
Advantage of low osmolarity ORS
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Reduction in need for unscheduled IV
therapy ( 35% in metaanalysis)
Significant red in vomiting (30%)
Reduction in stool output (20%)
Reduction in duration of diarrhoea
No risk of hyponatremia
• 0.05%/yr in Dhaka and 0.03% /yr in
Matlab, Bangladesh
Clinical relevance - low osmolarity ORS
Reduction in need of IV therapy results in
reduced hospitalisatin and in turn results:
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Reduced risk of hospital acquired infections.
Reduced disruption of breastfeeding.
Reduced use of needles and interventions
Reduced risk of transmission of nosocomial and
iatrogenic infections like HIV, Hepatitis
B in already immunosupressed children.
Reduced therapy cost.
Reduced risk diarrheal deaths in areas where IV
therapy is not readily available.
Clinical relevance - low osmolarity ORS
By a reduction in the sodium
concentration to 75 mmol/l, the
glucose concentration to 75 mmol/l
and the total osmolarity to 245
mmol/l the risks of the original
solution can be reduced such as:
1) Hypernatremia (high plasma sodium
concentration)
2) Increased stool output especially in
infants and young children.
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conclusion
With the advantages of
low osmolarity ORS over
standard ORS,
it is recommended to use low
osmolarity ORS irrespective of
the age.
Thank you
Thank you