Oral Rehydration Salts (ORS) — Recipe and Dehydration Treatment

Assess severity before treating:

Mild dehydration: Thirst, dry mouth, dark urine, reduced urination.

Moderate dehydration: Weakness, dizziness when standing, sunken eyes, skin turgor (pinched skin returns slowly).

Severe dehydration: Confusion, no tears when crying, sunken fontanelle (in infants), rapid weak pulse, cold extremities.

Children and elderly dehydrate faster. Monitor continuously—dehydration worsens quickly without fluid replacement.

Severe dehydration can cause shock and organ failure. If patient is unconscious, has seizures, or fails to improve after 4 hours of ORS, escalation is critical.

Measure precisely for correct osmolarity:

Ingredients per 1 litre:

• 1 litre of clean water (boiled and cooled, or treated water if boiling unavailable)
• 6 level teaspoons of sugar (approximately 30 grams)
• 0.5 teaspoon of salt (approximately 2.6 grams sodium chloride)

Mixing steps:

1. Pour water into a clean container.
2. Add sugar first; stir until fully dissolved.
3. Add salt; stir until fully dissolved.
4. Taste—it should taste like tears (salty-sweet, not fruit juice).
5. Use immediately or store in cool place for up to 24 hours.

Ratios matter: Too much salt causes osmotic diarrhea; too little provides insufficient sodium. Use a scale or standard spoons—estimate introduces error.

Never substitute honey for sugar in children under 1 year (botulism risk). Do not use salt substitutes containing potassium chloride unless specified by medical personnel.

Frequent small sips prevent vomiting:

For adults: 50–100 mL every 5–10 minutes (drink continuously, not in bulk gulps).

For children: 5–10 mL every few minutes using a spoon, cup, or syringe.

For infants: 2–5 mL every 2–3 minutes; breastfeed if possible between ORS doses.

Replace ongoing losses: For every stool (diarrhea) or vomiting episode, drink 10 mL/kg ORS (e.g., 30-year-old losing 500 mL fluid needs 500 mL additional ORS).

If vomiting occurs, wait 10 minutes then resume at smaller volumes. Vomiting often stops once stomach tolerates small amounts.

If patient vomits persistently or cannot keep ORS down after 30 minutes of attempted rehydration, IV fluids are necessary—seek advanced care immediately.

Assess response every 1–2 hours:

Signs of successful rehydration:

• Thirst subsides
• Mucous membranes moist (saliva present)
• Eyes return to normal appearance
• Skin turgor normalizes (pinched skin bounces back)
• Urine output increases and lightens in colour
• Energy improves; child becomes playful again

Continue ORS: Even after rehydration appears complete, maintain fluid intake equal to ongoing losses (diarrhea, sweat, urine) to prevent relapse.

Nutrition: Introduce bland foods as soon as patient tolerates (crackers, rice, banana, soup broth). Food actually improves intestinal recovery—do not fast.

Some conditions require IV therapy or advanced care:

ORS failure indicators:

• Severe dehydration with lethargy or confusion
• Inability to drink (unconsciousness, seizures, persistent vomiting)
• Bloody diarrhea with fever ≥39°C (indicate bacterial infection, not simple dehydration)
• Abdominal distension or severe pain (possible obstruction or acute abdomen)
• Signs of shock: rapid weak pulse (>120 bpm), cold skin, low blood pressure
• No urination for 6+ hours despite ORS intake
• Dehydration in newborns (risk of hyponatremia)

Supportive actions while awaiting care: Continue ORS if tolerated, keep patient cool, elevate legs if in shock position, comfort and reassure.

Do not delay seeking advanced care while administering ORS alone in severe dehydration. ORS is lifesaving for mild-to-moderate dehydration but cannot replace IV fluids in shock or severe electrolyte loss.