How to prepare oral rehydration solution (ORS) for children-Part 1

Preparing and administering oral rehydration
Preparing and administering oral rehydration

Introduction to hydration/dehydration
Dehydration occurs when you use or lose more fluid than you take in, and your body doesn’t have enough water and other fluids to carry out its normal functions. Anyone may become dehydrated, but the condition is especially dangerous for young children and older adults.

What is the normal level of hydration?
Water is the most abundant body constituent. It accounts for 75 – 80% of the birth weight in neonates (babies less than 30 days) and even higher in preterm babies, however this percentage decreases as the child grows such that by age one, water accounts for 60% of the total body weight – and this remains till adulthood. However, Total Body Water (TBW) decreases with increase in body fat, consequently obese children have reduced body water than slim children.

The simplest calculation for body water is to multiply 0.6 by the body weight (in kilograms) since water accounts for about 2/3rd of the body weight.

There are several methods for calculating the amount of water in the body ,the Watson and the Hume formular can be used, other methods specifically designed for children like the Mellits – Cheek formula are also very useful.

Hydration status can also be checked by comparing urine colour against a chart; normal urine is amber yellow in colour. Once a child’s hydration status reduces, urine becomes concentrated and the colour deepens to dark yellow or brown.

Specific gravity of urine and sweat analysis can also be used to determine hydration status.

What level of dehydration can warrant ORT (oral rehydration therapy)?
Dehydration can be classified into three;
· Mild dehydration
· Moderate dehydration
· Severe dehydration

These levels have their distinct features with the severe form being potentially fatal.

Mild dehydration can be managed at home, usually resolving with administration of Oral Rehydration Solution (ORS) and treatment of the cause.

However, moderate and severe forms of dehydration require hospital admission and monitoring as in these cases, dehydration might kill the child if care is not taken.

The following are tell tale signs of the degrees of dehydration;

CRITERIA MILD MODERATE SEVERE
Consciousness Alert Irritable Comatose
Eyes No change Sunken Very sunken
Tear No change Reduced Absent
Skin Normal Cold & pale Cold & muffled
Pulse Normal/high Weak&fast Very weak & fast
Urine Reduced Very little None
Breathing Normal Fast Very fast
Fontanelle No change Sunken Very sunken

NOTE: The fontanelle is the space between the bones of your baby’s skull. They are usually two soft and depressible spots. The fontanelle at the back of the baby’s head (posterior fontanelle) closes often by 6 weeks while the fontanelle at the front of your baby’s head (anterior fontanelle) closes by 18 months.

What could cause a child to be dehydrated
1. Diarrhoeal diseases are the commonest causes of dehydration in children especially in African countries.
2. Vomiting
3. Not drinking enough fluids
4. Too much sweating due to hot weather
5. Excessive urination probably due to undiagnosed or poorly treated diabetes mellitus or diabetes insipidus
6. Fever from bacteria, viral or parasitic infections
7. Burns
8. Conditions like cystic fibrosis
9. Cancers and their treatment.

How to prepare Oral Rehydration Solution (ORS) for children- Part2

Preparing Oral Rehydration Solution
Preparing Oral Rehydration Solution

Early recognition and prompt treatment of dehydration is key to halting the progression of dehydration to the severe form and preventing the fatalities associated with increased severity.

As stated before, oral rehydration solution is essential to managing a child with mild dehydration. Consequently, after you as a parent has recognised that your child is dehydrated from the signs highlighted earlier, the next step is administering oral rehydration solution to your child before taking him/her to the nearest health centre for diagnosis and treatment of the cause of dehydration.

You can prepare your own oral rehydration solution at home or buy already prepared form at a pharmaceutical store.

To make the solution at home,
· In one litre of water
· Add 6 level teaspoon of sugar and
· 1/2 level teaspoon of salt
· Wait for the particles of sugar and salt to dissolve completely
· The ORS solution is ready for drinking

You can get 1 litre of bottled water, be sure to use clean, recently boiled and cooled water. Too much salt or sugar may be harmful, make sure you use the right amounts.

Using Prepared ORS
Already prepared Oral Rehydration Hydration Salt is a special combination of dry salts that is mixed with safe water. It can help replace the fluids lost due to diarrhoea.
· Put the contents of the ORS packet in a clean container
· Check the packet for directions and add the correct amount of clean water.
· Add water only.
· Stir well, and feed it to the child from a clean cup.
· Do not add ORS to milk, soup, fruit juice or soft drinks.

Other alternatives to salt- sugar solution home remedy for dehydration are; breast milk, coconut water, rice water. However make sure, these sources are hygienic and properly prepared.

Administering oral rehydration solution
– Before preparation or administration of ORS for your child, wash your hand properly with soap and water.

– When a child has three or more loose stools in a day, begin to give ORS.

– A child under the age of 2 years needs at least 1/4 to 1/2 of a large 250-millilitre cup of the ORS drink after each watery stool.

– A child aged 2 years or older needs at least 1/2 to 1 whole large 250-millilitre cup of the ORS drink after each watery stool.

– You can keep the ORS in a refrigerator but not for more than 24 hrs. If your child needs ORS after 24 hrs, prepare fresh one. Do not keep the ORS for more than 24 hrs.

– Continue to give the child his/ her normal food alongside ORS.

– In addition, for 10–14 days, give children over 6 months of age 20 milligrams of zinc per day (tablet or syrup), give children under 6 months of age 10 milligrams per day (tablet or syrup).

– The best treatment for diarrhoea is to drink lots of liquids and oral rehydration salts (ORS), properly mixed with clean water from a safe source, and take zinc tablets or syrup for 10–14 days.

Signs of improved hydration
You should see symptoms of dehydration disappearing within hours of administering ORS.
· Your child should start urinating more
· The urine will start to look light yellow or almost clear.
· Skin goes back normally when pinched
· Thirst subsides
· Urine has been passed
· Pulse is strong

Danger signs/ when to go to the hospital
Having noted that as a parent, you can manage only the mild form of dehydration, what are the signs that your care is not yielding result or that you need to go to the hospital?
· Presence of blood in diarrhoea or black, tarry stools
· Persistent vomiting
· High fever
· Very dehydrated (feeling dizzy, lethargic, sunken eyes, no urination in the past 12 hours)

A child with diarrhoea should not be given any tablets, antibiotics or other medicines unless prescribed by a trained health worker. Diarrhoea usually stops within three or four days. If diarrhoea persists, consult a trained health worker.

Hospitalization due to dehydration can be avoided if as a parent, you recognise early when your child is dehydrated and promptly begin administration of ORS. Fatalities due to dehydration can be prevented if parents and care givers are well informed about what to do.

No more fillings, this drug can repair holes in the teeth

No more fillings
No more fillings
The days of tooth chiseling, hammering and filling will soon be over as scientists at King’s College,London, discover a way of making the teeth repair itself.

The group of London scientists proved that a drug, tideglusib, could stimulate cells in the dental pulp to heal small holes in the teeth of mice.

A biodegradable sponge was soaked in the drug and then put inside the tooth cavity.

The research was published in Science Reports and revealed that the technique brought about a complete and effective natural repair.

Healing holes
The Teeth has very limited regenerative abilities. That is why tooth cavities especially larger holes do not close up spontaneously.

Usually, dentists repair tooth decay and dental caries with a mixture of metals or a blend of powdered glass and ceramic that are used to fill the cavities.

However, “tooth filling” with synthetic materials often wares off eventually and the procedure having to be repeated several times during a lifetime.

By contrast, this new discovery has found a way to boost the natural regenerative capacity of the teeth to fill larger holes by itself.

The study found that the drug,tideglusib, increased the activity of stem cells in the dental pulp and facilitate the repair of holes about 0.13mm large in mice teeth.

The new technique involved placing a drug-soaked sponge in the hole and applying a protective cover at the top such that as the sponge breaks down, it is replaced by dentine that repairs the tooth cavity.

One of the researchers, Prof. Paul Sharpe remarked that “The sponge is biodegradable, that is the key thing”.

He also added that the space occupied by the sponge becomes full of minerals as the dentine regenerates so you don’t have anything in there to fail in the future.

So much for regenerative medicine
The field of regenerative medicine is fast growing, it is about finding techniques to make cells divide and proliferate rapidly to repair damaged parts of the body and this has raised concerns about a possible increase in the number of cancer cases.

Tideglusib, the drug used to stimulate dental pulp cells, alters Wnt chemical signals in the cells; this has been implicated in the genesis of some tumours.

Tideglusib has also undergone trial in patients for the treatment of dementia.

Talking about the drug, Prof Sharpe remarked that “the safety work has been done and at much higher concentrations so hopefully we’re on to a winner”.

The new thereapy for cavity repair was projected to be available commercially in the next three to five years.

Meanwhile….
Another group at King’s College is working on how electricity and natural minerals like calcium and phosphate can be used to strengthen the teeth.

Normally minerals flow into the teeth with acid produced when bacteria acts on food in the mouth.

The group is using small electric current to drive minerals deep into the tooth, they believe that “Electrically Accelerated and Enhanced Remineralisation” can give strength to the teeth and help reduce occurrence of dental caries.