Oral Re-Hydration Therapy

By Dr. Leo Rebello

Oral rehydration therapy (ORT) consists of a solution of salt and sugar to be taken by mouth. It is used in dehydration due to diarrhea, gastroenteritis, cholera and in malnutrition. It was adopted in 1980 by the WHO and UNICEF. But the Oral Rehydration Solution sachets, instead of the simple home made solution, created more problems, like the antibiotics have created major diseases all over the world, as compared to home remedies. In fact, ORT was the original grandma solution for cholera.

The great Indian physician Sushruta, over 2500 years ago, treated acute diarrhea with rice water, coconut water, and carrot soup. ORT was revived in India, in the 1950s, and the events surrounding the Bangladesh War in 1971 convinced the world of its effectiveness when about half a million refugees were given ORT which saved their lives. Over 3,000 patients with cholera were treated with ORT and the death rate was 3.6%, compared to 30% seen in IV fluid therapy. The fact that ORT was delivered primarily by family members instead of trained staff, across such a large population in an emergency situation demonstrated the utility of ORT, beyond an iota of doubt.

ORT is prepared by adding salt and sugar to water. 1 level teaspoon of salt, 8 level teaspoons of sugar, and (optionally) 4 ounces of orange juice; mixed into 1 litre of clean water. Instead of orange juice, I squeeze sour lime juice which is readily available in most Indian kitchens. One small sour lime to one litre of water is enough. This home prepared ORS should be spoon fed to small children, throughout, at regular intervals till the sunken fontanels (indication of danger) pop up to normalcy, and diarrhea stops, and the crying child sleeps to recover fully. Salt replenishes hypo-natremia (low body salt) due to loss of body salt because of watery stools of cholera in particular, and sugar (and vitamin C of the sour lime or orange) absorbed by the parched intestine gives instant boost to sagging vital force.

Other home prepared decoctions of ORT in India include salted rice water, salted whey (yogurt water) and clear vegetable or chicken soup with salt.

WHO through UNICEF distributed 500 million sachets of ORS to over 60 developing nations in 1996. This commercially produced ORS is not only costly, but unsafe, because the electrolyte overdose can be harmful, leading to kidney damage, unwittingly. For the same reason soft drinks are contra indicated in intestinal disorders.

Why salt is essential to the body? A healthy individual will secrete 20-30 grams of sodium per day via intestinal secretions. Nearly all of this is reabsorbed by the intestine, helping to maintain constant sodium levels in the body (homeostasis). Hence, in Hindu homes in India, salt and sour lime is applied to the tongue before eating. This activates saliva that helps maintain sodium balance in the body and helps in digestion. Next time listen carefully to what the Christian priest says at baptism. He puts a tiny granule of salt in the child's mouth and says: this is the 'Salt of Life'. This ritual itself conveys 'while in danger salt will be the savior'.