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Oral Solutions

Oral Rehydration Solution


:Rx
NaCl 0.3g
KCl 0.2g
Sodiumbicarbonate 0.3g
Glucose 2g

The pharmacokinetics and therapeutic values of the substance are as


:follows
Glucose facilitates the absorption of sodium ( and hence water–
) on a 1:1 molar basis in the small intestine, although cereal-
.based formulations may also be used
Sodium and potassium are needed to replace the body losses–
.of these essential ions during diarrhea and vomiting
Citrate or bicarbonate correct the acidosis that occurs as a–
result of diarrhea and dehydration. They also enhance the
.sodium absorption in the small intestine

1
Sometimes, another additive added to the formula such as flavoring
and coloring agent, but the ingredients used for flavouring ORS must
be among those listed as “Generally Recognized as Safe” for their
intended use by the US Food and Drug Administration (FDA) or by the
US Flavour Extract Manufacturer’s Association (FEMA). The
responsibility for demonstrating the clinical efficacy, safety and
.chemical stability of such products remains with the manufacturer

:Degredation of ORS-bicarbonate
The formulation should be stored in a sealed aluminium laminate,
2

under temperature less than 40˚C, the shelf-life of ORS-bicarbonate


.can easily extend to 2-3 years
If this mixture is exposed to heat and high humidity, an accelerated
chemical interaction between the sodium bicarbonate and the glucose
may lead to their decomposition, which result in the discoloration of
the product from white to yellow and later to brow. This discoloration

.Oral rehydration Salts (ORS) A joint UNICEF/WHO update July 1996 Revised March 20021

ORAL REHYDRATION SALTS Planning, establishment and operation WHO, unicef. Reprinted in 19982
closely parallels the degree of decomposition of the two chemical and
thus provides an easy way of checking the stability of the product for
consumption. Whereas a light yellow color indicates a slight
decomposition of glucose and sodium bicarbonate, which still allows
consumption, the appearance of a dark brown color means that an
advanced state of decomposition ( up to 40% or more) has been
.reached
.It's preferable to discard a product in this case
Another way to avoid the decomposition of ORS-bicarbonate in
tropical countries is to use chemically treated sodium hydrogen
carbonate (encapsulated). However, its use may increase the price
and make the country dependent for its purchases on a very limited
.number of manufactures in the world

:Pharmaceutical Forms
They are most commonly available as oral powders (oral rehydration
salts) that are reconstituted with water before use, but effervescent
.tablets and ready-to-use oral solutions are also available

:3Precautions
Oral rehydration salts or effervescent tablets should be reconstituted
only with water and at the volume stated. Fresh drinking water is
generally appropriate, but freshly boiled and cooled water is preferred
when the solution is for infants or when drinking water is not
available. The solution should not be boiled after it is prepared. Other
ingredients such as sugar should not be added. Unused solution
should be stored in a refrigerator and discarded within 24 hours of
.preparation

Oral rehydration solutions are not appropriate for patients with


gastrointestinal obstruction, oliguric4 or anuric5 renal failure, or when
parenteral rehydration therapy is indicated as in severe dehydration
.or intractable vomiting

.Martindale3

.(Scarcity of urine secretion in relation to the intake of fluids into the body (Medicine4

Inability to form urine: inability of the kidneys to form urine, so that toxic waste builds up in the5
.blood
:Uses and Administration
Oral rehydration solutions are used for oral replacement of
electrolytes and fluids in patients with dehydration, particularly that
.associated with acute diarrhoea of various aetiologies
The dosage of oral rehydration solutions should be tailored to the
individual based on body-weight and the stage and severity of the
condition. The initial aim of treatment is to rehydrate the patient, and,
subsequently, to maintain hydration by replacing any further losses
due to continuing diarrhoea and vomiting and normal losses from
respiration, sweating, and urination. Initial rehydration should be
rapid, over 3 to 4 hours, unless the patient is hypernatraemic, in
.which case rehydration over 12 hours is appropriate

For adults, a usual dose of 200 to 400 mL of oral rehydration solution


for every loose motion has been suggested. The dosage for children is
200 mL for every loose motion, and for infants is 1 to 1.5 times their
usual feed volume. Normal feeding can continue after the initial fluid
deficit has been corrected. Breast feeding should continue between
.administrations of oral rehydration solution

:Notes to remember
ORS first used and proved 1969 recommended and distribute–
.by UNICEF and WHO
Using Trisodium citrate dihydrate instead of NaHCO3, to–
.improve the stability of ORS in heat and humid country
ORS-citrate results in less stool-out especially in the high–
output diarrhea (cholera), and the direct effect of the
trisodium citrate is increasing the Intestinal absorption of Na
and H2O. But the best choose (ORS-carbonate or ORS-citrate)
is based on the stability to be maintained, and the weather or
.the country
The loss of potassium ions in the body hasn't effect on the–
nerves but actually it will affect the heart pressure before the
.nerves
.Acidosis could affects the brain cells and the kidneys–
The pH decreases because of the destruction of the glucose–
.into ketones
,Momer Hakky

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