Annals of Community Health (ISSN 2347-5455, eISSN 2347-5714), Peer Reviewed, Indexed Journal focusing exclusively on Community Medicine and Public Health

Types of ORS

  • Low osmolarity ORS
  • Citrate based ORS
  • Rice based ORS
  • Home available ORS
  • ORS with nutrients- Zinc, Magnesium, selenium, Vitamin A.

Advantages of ORS

  • More physiological.
  • Easy to administer.
  • Cost effective.
  • Home equivalents available.
  • Free of cost at PHC, sub-centres.
  • Readily available and needs no sterilizations.

Ineffective when

  • Stool purge is high (> 5 ml kg/ hr)
  • Persistent vomiting
  • Incorrect preparation
  • Abdominal distension and ileus.
  • Glucose malabsorption cases.

Low osmolarity ORS

  • Decrease in stool output by 25%
  • Decrease vomiting by 30%
  • Decrease need for iv fluids.
  • Decrease both sodium and glucose results in decrease in osmalarity.

Trisodium citrate based ORS

  • The inclusion of trisodium citrate in place of sodium bicarbonate has made the product more stable, no discoloration and shelf life 2-3 years.
  • Less stool output especially in high output diarrhea (cholera) probably because of a direct effect of trisodium citrate in increasing intestinal absorption of sodium and water.
  • The WHO and UNICEF now recommend that countries use ORS citrate where feasible.

Rice based ORS

  • Tastes better and provide more calories than the glucose based.
  • Culturally acceptable, reduces stool volume (by about 40%) shortens the duration of diarrhea in both cholera and other diarrheal diseases.
  • Starches other than rice, including wheat flour and maize have also been shown to decrease stool volume in patients with cholera.
  • Decrease diarrhea by adding more substrate to the gut lumen without increasing osmolality. Thus providing additional glucose molecules for glucose mediated absorption.

Home based ORS

  • Home prepared solutions are recommended for use by parents to give to their child immediately after an attack of diarrhea starts and before any signs of dehydration occur.
  • Basically the idea is to prevent dehydration and preserve good nutritional status by maintaining fluid and food intake.

· (Less hospitalization, less disrupt of breast feeding, less cost.)

Super ORS

  • These are special types of ors which instead of monosugars contain more complex sugars. They may be food based(as rice based) or otherwise be starch free (glycine/ alanine based or glucose polymer based).


  • Provides rehydration
  • Reduce stool output, frequency of stools and duration
  • Furnishes increase amount of calories(180 kcal/litre)
  • With gradual release of glucose, prevents secondary disaccharide intolerance.
  • Contributes to weight gain, as it provides additional nutritional ( especially malnourished).

Disadvantages of Super ORS:

  • Short self life (not exceeding 10 hours).
  • Should be frequently prepared 2-3 times a day.

Super super ORS:

· Addition of Zinc to super ORS.

  • Improved absorption of water and electrolytes by the intestine.
  • Faster regeneration of gut epithelium.
  • Increase levels of enterocyte brush border enzymes.
  • Enhanced immune response leading to increased clearance of the pathogens.

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