ORS – iDRATA ORS

THE IMPORTANCE OF ELECTROLYTES

Electrolytes are minerals present in the blood and body fluids which influence the control of the amount of water present in the body, as well as blood acidity, muscle function and other important physiological processes. An adequate balance of electrolytes helps the body maintain fluids at the proper concentrations. Examples of electrolytes include chloride, potassium and sodium. Electrolyte levels may become too low or too high when the amount of water in the body changes (causing dehydration or over hydration). The imbalance in electrolytes can be caused by diarrhea, vomiting, sweating, kidney problems and certain medications.

One of the main problems related to the water that can arise directly in our organism is the dehydration, because in many cases, the ingested water is below the desirable. Unfortunately the thirst is not the best indicator when our body needs water. A more reliable indicator is the color of the urine, because when it appears dark yellow or amber usually indicates dehydration. If a person is well hydrated the urine is clear or light-colored. If physical examinations or laboratory data indicate a state of dehydration, an immediate response is required and the water does not have enough electrolytes to solve the problem. Thus, for a mild or moderate dehydration water is often not enough. For a proper hydration in cases of dehydration it is necessary to replace both fluids and electrolytes, and the best option in this situation is an Oral Rehydration Solution.

ORAL REHYDRATION THERAPY

Oral rehydration therapy (ORT) using a low solution recommended by the World Health Organization (WHO), has reduced the number of dehydration deaths caused by vomiting and diarrhea at approximately one million per year. Recent research suggests that the use of oral rehydration solutions has advantages over conventional therapy, and we should make an effort to encourage the use of ORT as first choice for rehydration.For practical purposes rehydration can be achieved using solutions with high sodium content, ie 75-90 mmol / L. These are called Oral Rehydration Solutions (ORS). Prophylaxis of dehydration and maintenance involves solutions with 45-60 mmol/L of sodium. They are called maintenance solutions. Fruit juices are ineffective due to their high carbohydrate concentration as well as poor osmolality and sodium concentration. The individualized dietary management of the patient during acute diarrhea is the key and should be emphasized.

HOW ORAL REHYDRATION SOLUTIONS WORK?

Scientific research in molecular biology has made it possible to make a qualified advance considered by many as the most important of the 20th century for the treatment of dehydration, mainly for infectious diarrhea due to viruses or enteropathogenic bacteria. This advance was the discovery of the molecular mechanism of co-transport sodium glucose (SGLT), a protein present in the membrane of the intestine cells and responsible for the incorporation of sodium associated with glucose, since the sodium is the most important ion in the osmotic balance for incorporate water.

The intestine is able to absorb electrolytes like sodium thanks to three molecular mechanisms. However, two of them are affected by gastrointestinal diseases being SGLT1 the only active, despite the gastrointestinal condition present. Oral rehydration therapy (ORT) is based precisely on this mechanism, capable of introducing into the enterocyte (intestinal epithelial cell) sodium and glucose in a ratio of 1: 1 which facilitates not only the absorption of the ion but also that of the Nutrient. Once in the enterocyte the sodium and glucose are separated from the transporter and pass into the bloodstream through the basement membrane creating an osmotic imbalance compensated by the incorporation of water into the body.

For an optimum absorption, the composition of the oral rehydration solution is essential, since the amount of liquid absorbed depends on three factors: sodium concentration, glucose concentration and osmolality of the liquid. The maximum water uptake occurs with a sodium concentration of 40 to 90 mmol / L, a glucose concentration of 110 to 140 mmol / L (2.0 to 2.5 g / 100 ml) and an osmolality of approximately 290 mOsm / L equal to the osmolality of body fluids. Increasing sodium beyond 90 mmol / L may produce hypernatremia; increasing the glucose concentration above 200 mOsm/L or increasing the osmolality of the solution can result in a net loss of water.

FORMULAS AND RECOMMENDATIONS

Gastrointestinal diseases with diarrheal complications are one of the main causes of morbidity and mortality in the world. Oral rehydration therapy and the formulation of oral rehydration salts were proposed in the late 1970s by WHO-UNICEF to combat the consequences of diarrheal diseases, and they agreed to promote a single solution with an osmolarity of 330 Mmol/l.During the 90’s great advances have been made using this type of solution, helping to avoid more than 1 million annual deaths in children under 5 years of age. Subsequently, the ESPGHAM (European Society of Gastroenterology, Hepatology and Pediatric Nutrition) recommended a new improved formula with an osmolarity of between 200 and 250 mmol / l, since the oral rehydration salts with reduced osmolarity produce an optimal absorption of water ensuring an adequate replacement of sodium, potassium and bicarbonate. In addition, they also contain chlorine, bases and the potassium necessary, since significant amounts of these elements are lost in diarrheal stools

The last study of this type of formulation was done in five developing countries, among children from one month to two years of age with diarrhea and dehydration. The results of this study suggest that the use of a solution with low sodium and glucose content reduces the need for intravenous fluids by 33%. The effects of this reduction could result in fewer children requiring hospitalization, fewer secondary infections, a decrease in the need to manage the potentially dangerous consequences of these situations, and fewer health care costs.

WHO, UNICEF, ESPGHAN RECOMMENDATIONS

Throughout the time and thanks to the scientific advances, the formulations of the ORS have been changing until the year 2002 when the last type of SRO denominated oral rehydration salts of low osmolality was proposed by the European Society of Pediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) which is a multi-professional organization whose goal is to promote children’s health through the creation of knowledge, dissemination of information based on science and promotion of best practices in the provision of services. This organization has focused its efforts on improving ORS compositions to allow better treatment for all children.
Today, ORS are the first-line products that meet the nutritional needs of infants, children and adults in cases of dehydration.