What is Super ORS?

ORS (oral rehydration salt or solution) is commonly used in treatment of mild (fluid loss of 5% to 7% of body weight) to moderate diarrhea (fluid loss of 7% to 10% of body weight). If mild and moderate diarrhea (which cause mild to moderate dehydration) is not treated adequately and early in the disease, it may lead to severe dehydration, which may ultimately cause death. Initiate treatment (replacement of lost fluid) of diarrhea as early as possible with ORS to reduce morbidity and mortality. There is no alternative to starting treatment early in diarrhea cases.

What is super ORS?

Super ORS is made by adding certain amino acids (such as alanine, glycine etc. which are actively transported or absorbed amino acids lumen of gastrointestinal tract and transport sodium along with them) which have some advantages over commonly used WHO-ORS (as recommended by World Health Organization). The advantages of super ORS (by adding amino acids) is said to be marginal and generally do not benefit much in non-cholera diarrhea.

What are the advantages of super ORS?

  • Super ORS can decrease purging rate in diarrhea (reduce frequency of stool, and stool volume). There is improved absorption and recovery is faster.
  • Supply additional calories (180 Kcal/liter), which is helpful for malnourished children.
  • Can prevent secondary disaccharide intolerance by causing gradual release of glucose.

What are the disadvantages of super ORS?

  • Super ORS is much more costly than WHO-ORS. Cost benefit ratio is not favorable. The benefits are marginal.
  • Self life of prepared super ORS is not more than 10 hours (simple ORS has self life of 24 hours and need to be prepared only once a day), which may be inconvenient for mothers preparing super ORS for their babies suffering from diarrhea.

How to improve ORS/super ORS?

As we know, super ORS few benefits but the cost is high. The cost to benefit ratio is not in favor of super ORS. To make ORS more effective and cheaper we can add complex substrates such as boiled rice powder to ORS instead of glucose, which is better than glucose, as rice contain proteins and amino acids. 40-50 grams of boiled rice powder can be added to make one liter of ORS.

There are certain distinct advantages of adding rice powder instead of glucose (and/or amino acids). Rice contains complex starch which is slowly broken down to glucose and absorbed. Addition of rice powder do not cause osmotic diarrhea even if large quantity is given, which may be seen if excess glucose is given (as seen with old formula ORS). Approximately 7% protein is present in rice which provides nutrition as well as helps in absorption of salt and water during diarrhea and help to control diarrhea rapidly. Rice is also very cheap and easily available.

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