Incorrect mixing ratio of ORS can easily cause poisoning.
Children who are dehydrated and lose electrolytes due to diarrhea, vomiting or fever need to be rehydrated as soon as possible to avoid unpredictable consequences, in which oral rehydration solution (ORS) is the first choice. However, if ORS is mixed in the wrong ratio (too concentrated), it can cause salt poisoning in children.
There are three types of fluids commonly used to compensate for children when necessary, which are ORS containing sodium, potassium, sugar and water; Ringer lactate solution containing sodium, potassium, sodium carbonate, H20 and sodium carbonate solution. Of these, ORS is the most popular type because it is mixed into a solution for children to drink, the other two types are solutions for intravenous infusion when absolutely necessary (as prescribed by the treating physician).
How to rehydrate and what type of fluid to use is determined by the examining doctor (if the child is examined for fever, diarrhea, severe vomiting, severe burns, etc.). In cases where the child is still drinking well, the doctor will usually prescribe ORS. However, to use it correctly, rehydrate the child in a timely manner.
Why can children get salt poisoning when drinking ORS?
Salt poisoning occurs when children drink too concentrated ORS solution. ORS mixed with water according to regulations when given to children will help to replace lost water, salt, and sugar.
But if mixed incorrectly, it will cause water and electrolyte imbalance, diarrhea, fever, or vomiting... will become more severe and the child may die from electrolyte loss or cardiovascular collapse.
When mixed too thick, adults find it salty and may spit it out immediately, but children can still drink it normally. Because it is salty, the more children drink, the thirstier they become, and the thirstier they become, the more they want to drink and are given more ORS solution, making children very susceptible to salt poisoning.
Due to the amount of salt entering the blood being more than normal, the osmotic pressure of the blood increases, more water goes out of the cells, so the cell membrane will shrink, leading to wrinkled skin, dry lips, sunken eyes, dry tongue mucosa, little urine, especially high fever of unknown cause, breathing disorders, accompanied by prominent neurological manifestations such as perceptual disorders (drowsiness alternating with bouts of agitation, convulsions, increased tendon reflexes...). The most dangerous is causing acute cerebral edema leading to coma.
What to do when suspecting salt poisoning in children?When using ORS solution to rehydrate and replenish salt for children with diarrhea or fever, if you see the signs as mentioned above (extreme thirst, dry lips, sunken eyes, drowsiness or fever, convulsions, etc.), you need to stop giving the child more ORS solution and quickly take the child to the nearest hospital for emergency treatment because the child may have salt poisoning from drinking an ORS solution that is too concentrated.
The child's family or caregiver should not continue giving the child ORS solution when the child is thirsty or asks to drink because the child's life can be threatened if the child continues to drink ORS that is too concentrated.
How to mix ORS solution correctly
It is necessary to carefully read the instructions on how to mix the medicine package regarding the appropriate amount of water. Specifically, if the ORS package instructs to mix with 200ml, you need to mix with 200ml of water; if it instructs to mix with 500ml, you must mix with 500ml of water or mix 1,000ml (1 liter) to have 1,000ml to achieve the appropriate osmotic concentration for children. Thus, to mix the correct ratio, you need a measuring tool (a 200ml glass cup with graduations or a 500ml glass cup, with graduations, preferably a 1,000ml cup, with graduations).
If diluted too much, the electrolyte supply will be reduced and will not be effective in rehydration and nutrition. If diluted too much with little water, it will cause salt poisoning in children, which is very dangerous to their lives.
It is important to note that the ORS packet should not be divided into multiple parts, as this will distort the ratio of substances in the ORS packet and when taken ORS will not have a therapeutic effect (replenish water and electrolytes).
Use boiled water to mix, stir until the ORS medicine is completely dissolved in the water before giving it to the child. Absolutely do not mix the medicine with milk, fruit juice, sugar or other medicines.
Do not mix ORS with mineral water, because mineral water already contains salt components that alter the concentration of the drug, reducing the effectiveness of the drug or increasing the risk of salt poisoning. Do not use electrolyte supplements instead of ORS.
