ORS & ZINC IN DIARRHOEA

DR. NEHA
KUMARI
JR,PSM DEPTT.
NMC,PATNA

D IARRH O EA

Diarrhoea is the passage of 3 or more loose or liquid

stools per day, or more frequently than is normal for
the individual.
Main Cause -Gastrointestinal Infection
Other causes are hyperthyroidism, lactose
intolerance,inflammatory bowel disease,irritable
bowel syndrome,etc.

EPID EM O LO GY
Diarrhoeal disease is the second leading cause of death in
children under five years old. It is both preventable and
treatable.
Globally, there are nearly 1.7 billion cases of diarrhoeal
disease every year.
Diarrhoea is a leading cause of malnutrition in children
under five years old
Each year diarrhoea kills around 7,60,000 children under
five.

Types ofD iarrhoea

acute watery diarrhoea lasts several hours
or days, and includes cholera;
acute bloody diarrhoea also called
dysentery; and
persistent diarrhoea lasts 14 days or
longer.

Problem m agnitude in India and Bihar

According tothe WHO, more than 3,34,000 children below

five years of age die from diarrhoea-related diseases in
India annually.
4.2% of total medically certified deaths reported in 2010
was caused by diarrhoea.
In Bihar around 10% children suffer from diarrhoea (4.5 %
Patna &Saran,19.9% Khagaria)
Percentage of Women who are aware of
HAF/ORS/ORT/ZINC in Bihar is 99.0%
Percentage of Children suffering from Diarrhoea who
received HAF/ORS/ORT/Zinc in Bihar is 83.3%(Munger
41.0%,Araria 96.9%)

O RS
Oral rehydration salt solution remain mainstay
treatment for diarrhoea.
ORT is less invasive than the other strategies for fluid
replacement e.g. intravenous fluid replacement
ORS maintains water and electrolytes balance which get
disturbed in diarrhoea.
ORS may lower the mortality rate of diarrhoea by as
much as 93% .

CO M PO SITIO N O F O RS
Old

W hy R educed osm olarity

O R S?
39% reduction in need for IVF
19% reduction in stool output
29% lower incidence of vomiting
Risk of hyponatremia not significant in

any type of diarrhea.

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

ReSoM al
ReSoMal (oral rehydration

salts or ORS for severely

malnourished children) is used
in in-patient centres for the
treatment of children with
severe acute malnutrition
(SAM).
ReSoMal contains a mixture of
salts and minerals specially
designed to correct
deficiencies of potassium,
magnesium, zinc and copper
and to address high levels of
sodium in children with SAM

H ow O RS w orks?
Na
+

BLOOD
VESSELS

H2O

GLUCOSE

H2O

Na
+

H2O

LUMEN

GLUCOSE
Na
+

GLUCOS
E
Na
+

H2O
GLUCOSE

ZIN C

Zinc is an essentialtrace elementfor human.

Zinc is found in nearly 100 specificenzymes
Source
Animal sourcesOysters, lobster,red meats,
especiallybeef,lambandliver.
Plant sources - wheat (germ and bran) and
various seeds
(sesame,poppy,alfalfa,celery,mustard),bea
, nuts,almonds,whole grains,pumpkin
seeds,sunflower seedsandblackcurrant.

Zinc deficiency is associated with

an increased risk of gastrointestinal
infections,
disruption of the intestinal mucosa,
reduction of brush border enzymes and
increase in mucosal permeability and the
intestinal secretion of water
and impaired immune function.

G lobalZinc D ef c
iiency

< 14.9%

< 15-24.9%

> 25%

Supplementary zinc benefits

children with diarrhoea because
it is
a vital micronutrient essential for
protein synthesis,
cell growth and differentiation,
immune function,
intestinal transport of water and
electrolytes

Types ofzinc salt

Zinc is usually given as
zinc sulfate
zinc acetate
zinc gluconate
These all are water-soluble
compounds.

D ose ofZinc in diarrhoea

10 mg <6months
20 mg > 6 months
days

per day
for 10 14

Zinc in acute diarrhea

Reduces duration of diarrhea episode by
up to 25%
Decrease by about 25% the proportion
of episodes lasting more than seven
days
It is associated with a 30% reduction in
stool volume
Conclusion: significant beneficial
impact on the clinical course of acute
diarrhoea: reduces both severity and
duration

Zinc in persistent diarrhoea

Zinc-supplemented children had:
24% lower probability of continuing

diarrhoea
42% lower rate of treatment failure or
death

Conclusion: zinc supplementation

reduces the duration and severity of

persistent diarrhoea

Zinc in bloody diarrhoea

Positive impact of the prevalence of

dysentery in the month following the

supplementation
Improves seroconversion to
shigellaciddal antibody response and
increases the proportions of circulating
B lymphocytes and plasma cells and the
IgA-specific immunoglobulin response
Conclusion: zinc supplementation
should be given as an adjunct to
antibiotic treatment of bloody diarrhoea

Adverse aff
ect ofzinc

vomiting
epigastric pain
lethargy
fatigue
copper deficiency
difficult iron absorption.

THANK YOU