ORS: The Simple Cup That Has Saved Millions of Children — and the Fake Versions That Have Not

In 1978, the Lancet called Oral Rehydration Therapy (ORT) "potentially the most important medical advance of the 20th century." Before ORS, diarrhoeal disease killed millions of children globally every year — most dying not from the diarrhoea itself but from the dehydration it caused. A simple solution of salt, sugar, and water, given by mouth, changed this entirely — and it is estimated that ORS has saved over 50 million lives since its introduction.

Why ORS Works

The intestine has a sodium-glucose co-transporter — a protein that actively pulls sodium and glucose together across the gut wall into the bloodstream. By including both sodium and glucose in the exact right ratio, ORS exploits this transporter to pull water from the gut into the blood even when the gut is inflamed from diarrhoea. Plain water, sugar water, or fruit juice does not work as well because they lack the correct sodium-glucose ratio.

WHO-Standard ORS Composition

Each litre of ORS contains: Sodium 75 mmol/L, Glucose 75 mmol/L, Chloride 65 mmol/L, Potassium 20 mmol/L, Citrate 10 mmol/L. Osmolarity: 245 mOsm/L. This specific formulation is available in every pharmacy in India as commercially prepared ORS packets — Electral, WHO ORS, Pedialyte, and generics.

The Fake ORS Problem

Commercial sports drinks, energy drinks, flavoured electrolyte drinks, and home-made solutions of lime juice with salt are NOT ORS. They do not contain the correct composition for treating childhood dehydration. Sports drinks typically have too much sugar and too little sodium. Some are also given as "ORS" for diarrhoea — but their high osmolarity can actually worsen diarrhoea in children.

The only correct product is WHO-standard ORS from a pharmacy. Home-made ORS (6 level teaspoons sugar + ½ teaspoon salt in 1 litre clean water) is acceptable when pharmacy ORS is unavailable.

When to Use ORS

Any episode of vomiting or diarrhoea in a child should prompt early ORS use — do not wait until the child appears dehydrated. Give small sips every 1–2 minutes continuously. If a child cannot keep ORS down, continue offering small sips — even 5 ml every 2 minutes adds up. If the child is unable to drink at all or shows signs of severe dehydration (sunken eyes, very dry mouth, no urine for 8+ hours, drowsy or limp) — go to hospital for IV rehydration.

Paediatric emergencies and dehydration management: Dr. Sushma B at Sri Anand CNC, Chanda Nagar, Hyderabad. Call +91 90633 66983.