An understanding of fluid and electrolyte losses from diarrhea and mechanisms of solute co transport led to development of oral rehydration solution (ORS), representing a watershed in efforts to reduce diarrheal disease morbidity and mortality.

A recent study published in Current Gastroenterology Reports reviewed the scientific rationale and modifications of ORS and barriers to universal application.

The findings revealed that solutions with osmolality and electrolyte composition different from original ORS for routine and unique pathophysiology, such as in malnutrition have met with varying success. Following the conceptual rationale of sodium-glucose co-transportation to facilitate water absorption, other co transporters and formulations have been explored with the aim to improve ORS efficacy and acceptance.

This article summarized that ORS remains the anchor of acute watery diarrhea and dehydration management worldwide. Despite development of different formulations, the current standard solution is the mainstay of treatment for nearly all situations. Efforts to improve oral hydration solution and to increase acceptance and usage are ongoing. Coordinated global initiatives have helped sensitize policy makers to ORS and zinc as key interventions for child health which facilitated national governments and local partners to implement large-scale programs that have effectively helped to reduced local barriers to access. The ORS usage rates increased from 35% before 2000 to 45% post-2000; still, fewer than 50% of children received correct treatment.

The authors stated that if scaled to full coverage, ORS has the potential to prevent more than 90% of diarrhea deaths and zinc to reduce duration of illness by 23%. A better understanding and means to change health care seeking behavior by caregivers and case management practices of health care providers to increase ORS usage rates are seemingly intractable challenges and remain priority research areas. Owing to its simplicity, ease of use and relevance in different clinical, healthcare and community settings, ORS will continue to have substantial impact and save the lives of millions annually.

Source: Current Gastroenterology Reports. 2019; 21: 67. doi: 10.1007/s11894-019-0734-1