Trainer Attachment 5C: Suggestions for a lecturette on the hows and whys of ORS

RESOURCES

- Oral Rehydration Therapy (ORT) For ChIIdhood Diarrhea (ORT Resource Packet. pp. 43-44.
- Trainer Attachment 5 (The Scientific Basis for Oral Rehydration Therapy)

IMPORTANT INFORMATION:

1. Diarrhea upsets the body's chemical balance and its' ability to process and absorb eater and nutrients.

When the child is healthy, the lining of his or her intestines transforms food into a tore that can be absorbed and transported by the blood stream to all parts of the body. These nutrients provide energy and enable growth. The blood stream is also the source of the minerals and water needed by the intestine to transform the food into a useable form. The intestine "borrows" and returns water and minerals as it processes food. This chemical balance is upset during diarrhea.

Diarrheal diseases affect the functions of the intestines. During diarrhea, the small intestine loses its ability to absorb water and essential minerals called electrolytes (sodium chloride, potassium, and bicarbonate). Minerals and water needed to process food leave the body in the child's stools, depleting the body's store of these vital elements and the nutrients they help process.

2. Water and electrolye loss cause the physical signs and symptoms recorded on the WHO Treatment Chart.

Fluid and mineral loss of greater than five percent, but less than ten percent of body weight generally causes a weak rapid pulse, loss of skin elasticity, low blood pressure, severe thirst, and other signs noted in Column B of the WHO Diarrhea Treatment Chart.

A loss of more than ten percent of the body weight results in shock, stupor, disrupted kidney function, acids build up in the blood (acidosis), peripheral blood vessels collapse, and death follows (see Treatment Plan C on the WHO chart.

3. Infants and small children are nor- susceptible to dehydration from diarrhea.

Infants and young children are particularly susceptable to dehydration from diarrhea, because of their small body weight For example, it a child who weighs ten kilograms loses one kilogram of water, ho or she has lost ten percent of the body weight and is severely dehydrated.

4. Oral Rehydration Salts (ORS) restore the body's chemical balance, and replaces the water lost.

Oral Rehydration with ORS (Oral Rehydration Salts) replaces the blood's electrolytes nearly as quickly as they are lost in the stool. This is due in large measure to the special ability of glucose to increase the absorption rate of sodium through the intestinal lining.

ORS includes all the essential electrolytes. Sugar and salt solution only has one of the three. This is why it is necessary to give ORS to a mildly dehydrated child.

Summarized below is the formula for the new trisodium citrate ORS. The ingredients for the other solutions are stated in The Treatment of Diarrhoea, p.17 and 42.

ORAL REHYDRATION SALTS (ORS) FORMULATION CONTAINING TRISODIUM CITRATE

1. In 1982-1983 the WHO Diarrhoeal Diseases Control (CDD) Programme supported laboratory studies to identify a more stable ORS composition, particularly for use in tropical countries, where ORS has to be packed and stored under climatic conditions of high humidity and temperature. The results of these studies demonstrated that ORS containing 2.9 grams of trisodium citrate dihydrate in place of 2.5 grams of sodium bicarbonate (sodium hydrogen carbonate) was the best of the formulations evaluated¹. The formulae of the standard ORS (ORS-bicarbonate) and ORS containing trisodium citrate dihydrate (ORS-citrate) are shown below:

SUMMARIZE by stating that Oral Rehydration Therapy is used to:

· Replace fluids
· Restore the chemical balance of the body.

ANALOGIES THAT HELP LEARNERS UNDERSTAND THESE CONCEPTS:

To give participants a more concrete sense of what it means to lose chemical balance, ask someone to stand on one foot and hold objects of equal weight in each hand. Then ask them to remain on one foot but hold both objects in one hand. Ask thee to tell the others hoe that feels to go from a balanced to an unbalanced situation. How well can they function in this states This can provide the basis for discussion.

To convey the idea that children are particularly vulnerable to dehydration from diarrhea, put the sane amount of water in a large cup and in a small cup. Ask participants to compare the cups. Use this as a basis for discussion.