low-Osmolarity ORS: Why New Research Favors It for Kids’ Diarrhoea

What do you give a child suffering from diarrhoea? They are bound to get dehydrated and refuse to eat anything healthy. Anything they like eating may not be suitable for their delicate stomachs. How else can you ensure your child is hydrated and recovers well? WHO recommends giving children LORS.

Why is Diarrhoea Dangerous?

Diarrhoea is one of the leading causes of morbidity and mortality in children. Children tend to lose a lot of fluid, leading to severe dehydration, an imbalance in their electrolytes, shock, and, in very severe cases, if left unattended, it can even lead to death. 

The number of deaths in children due to acute diarrhoea in developed nations has decreased over the last few years due to the introduction and increase in use of WHO-ORS.

The Need for LORS

So, why did WHO go on to alter its ORS when it was effectively reducing the number of deaths in children caused by diarrhoea? While the ORS was helping with rehydration, it did not reduce stool volume or the duration of diarrhoea. So, WHO started altering compositions to develop LORS, which is more effective than the original ORS in treating diarrhoea in children.

What is Low Osmolar ORS?

ORS stands for Oral Rehydration Solution. Low-osmolar oral rehydration solution is a unique formulation with sugar and sodium content that are lower compared to regular ORS. It is recommended by the WHO and UNICEF for treating dehydration in children resulting from diarrhoea. 

LORS reduces stool output and vomiting, thus reducing the need for IV fluids when a child is suffering from diarrhoea. It enhances the absorption of sodium and water in the gut, and recovery is faster than with older ORS formulas. 

What Does LORS Contain?

LORS contains sodium chlorides, glucose, potassium chloride, citric acid, and osmolarity.  These components work together to help the body absorb and retain more fluids, as diarrhoea can cause severe fluid loss and dehydration. 

Advantages of Low Osmolarity ORS

Low Osmolarity Oral Rehydration Solution offers the following advantages when given to children suffering from acute dehydration or diarrhoea – 

  1. Reduces Stool Output – Diarrhoea increases stool output, leading to fluid loss. LORS reduces stool frequency and volume in children. 
  2. Reduces Duration – LORS can also effectively reduce the duration of a diarrhoea episode.
  3. Lesser Vomit – Compared with the standard WHO-ORS, which has higher sugar content, LORS reduces vomiting.
  4. Fewer IV Drips – Severe dehydration and loss of essential body fluids require replenishment through IV drips. LORS reduces this need by decreasing the loss of body salts during diarrhoea. 
  5. Safe Sodium Levels – The sodium level in LORS is lower than in standard ORS. This reduces the risk of hypernatremia.
  6. Improves Absorption – The specific combination of sodium and glucose in LORS facilitates faster absorption of water and electrolytes than the original ORS.
  7. Easy to Use – LORS can be used for diarrhoea in children as well as cholera in children and adults. It is easy to get, mix, and administer, making it a convenient and effective solution. 

Why is Low Osmolarity ORS Recommended for Diarrhoea?

According to ongoing studies, LORS is more effective not only in reducing the stool output but also in reducing vomiting. So, the two main causes of dehydration are decreased, and this in turn reduces the need for IV fluids to help replenish lost fluids in the child’s body. The low sodium content helps in preventing hypernatremia – a rare side effect of diarrhoea which can be caused by high sodium levels in the blood. 

How to Give Low Osmolarity ORS to Children?

The instructions on the package are very clear and easy to follow.

  • Ensure you use only clean drinking water to avoid any form of water contamination. 
  • Let your child have small sips at frequent intervals rather than gulping it down.
  • If your child vomits after drinking the solution, give them a break of about 10 minutes and offer the solution again.
  • Store the mixed solution in a clean container. Discard the solution after 24 hours and mix another fresh packet if necessary.

Can You Give Low Osmolarity ORS to Children Regularly?

No, LORS is not an everyday beverage and should never be given unless the child is sick and requires such intense hydration. Remember, LORS is not just water. It contains certain body salts in a concentrated formulation, designed to replenish them faster than regular water or food. Giving this to children regularly, especially when there is no need, can disrupt their natural electrolyte balance, leading to unnecessary side effects.

Although LORS and ORS are over-the-counter solutions readily available worldwide, they are not recommended for regular consumption. If your child is severely dehydrated due to diarrhoea or even the heat, you can give them ORS after consulting your doctor. They will advise you on the quantity and frequency of administering the liquid, based on your child’s age, weight, requirement, etc. 

Book an online appointment with Dr. Jayesh P Yadav for Paediatric related issues.

Can LORS Cause Side Effects?

In general, low-osmolality ORS (LORS) does not cause side effects when mixed and administered as directed by a doctor. However, in some cases, it can cause side effects.

  • If mixed improperly, it can cause an imbalance in electrolyte levels, leading to electrolyte toxicity. Ensure you use the right amount of water for mixing.
  • When used in severe sodium-loss conditions, it cannot correct the imbalance because it contains less sodium than the standard ORS solution.
  • Some individuals may experience mild bloating or nausea after consuming the solution. 
  • It may not be effective in settings where children have different electrolyte needs.

Conclusion

Low Osmolarity ORS is a new WHO formulation. It is an alteration to its existing ORS, designed to address severe diarrhoea and promote quicker recovery in children. This solution may not yet be available in all regions. When instructions and recommendations are closely followed, LORS can be more beneficial for children than standard ORS in cases of severe diarrhoea or even cholera. 

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Frequently Asked Questions

How is low-osmolarity ORS different from standard ORS?

Low osmolarity ORS contains less sodium and glucose than the standard ORS solution.

Is low-osmolarity ORS safe for infants?

Yes, it is considered safe for infants and children of all ages when prepared and administered as directed.

Can low-osmolarity ORS be used for severe diarrhoea?

Yes, low osmolarity ORS is specifically formulated to treat severe diarrhoea in children. It is a modification of the standard ORS solution to help children with diarrhoea recover faster.

Can parents prepare low-osmolarity ORS at home?

Yes, the instructions on the package are very simple and easy to follow. Parents should ensure they use only clean drinking water and mix the solution at the recommended water-to-LORS powder ratio to maximise benefit.

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