Oral Rehydration: A Medical Breakthrough That Has Saved Millions

Salt, sugar, water. These three household ingredients comprise one of the world’s most effective cures for dehydration. When mixed together, along with other electrolytes, they create an oral rehydration solution (ORS). It’s simple, easy-to-administer, and has been credited with reversing millions of life-threatening cases of dehydration.

Oral rehydration might not sound familiar, but it’s well-known by relief workers throughout the world.  Doctors Without Borders once called it “the most important medical advance since penicillin.” And since the 1980s, the World Health Organization and UNICEF have distributed millions of doses in relief situations. ORS remains to be one of the most successful medical interventions in the world.

For instance, diarrhea, and resulting dehydration, is the No. 2 cause of preventable death globally for children under 5. Thanks in a large part to ORS, the number of diarrhea-related deaths in the last decade has dropped by 54 percent, from 1.3 million in 2000 to 600,000 in 2013.[i]

Yet, for such an effective and low-cost treatment, ORS remains under-utilized in the West. Most consumers have never heard of it, and physicians here haven’t embraced it fully.

The Sodium-Glucose Cotransport: An Important Medical Advance

In 1960, American chemist Dr. Robert K. Crane discovered the sodium-glucose co-transport system. Crane noticed that the body’s absorption of glucose was dependent on sodium.

Thus, when glucose is present in the small intestine, sodium is absorbed more quickly. In turn, the sodium draws additional water into the bloodstream. The right ratio of glucose and sodium in a solution can accelerate the rate at which water is absorbed by the body.

Crane’s discovery was put to use in 1968 by a research team in Bangladesh led by David Nalin. Nalin’s group fashioned a crude version of ORS, mixing electrolytes, sugars and water that proved effective in treating cholera-induced dehydration. The small field test found that an “oral solution containing glucose and electrolytes helped reduce the intravenous fluid needs for 80 percent of adult cholera patients.[ii]” It was a breakthrough discovery.

ORS was put into wide application, during the 1971 Bangladeshi refugee crisis. Thousands of refugees were succumbing to severe dehydration caused by cholera. Unfortunately, the doctors at the camp were undersupplied with field IVs, and they turned to ORS. At the time, the mortality rate at the camp was 30 percent; once ORS was distributed, the mortality rate dropped to just 3 percent.[iii]

Perfecting the Science of Oral Hydration

To be effective, an ORS must contain a precise ratio of electrolytes. Too much or too little salt or sugar limits the solution’s hydrating potential. For instance, an ORS with too much salt can lead to an electrolyte imbalance, spiking blood sodium levels and exacerbating dehydration. On the other hand, a solution with too little sugar or salt, limits how quickly water is absorbed.

Conversely, if the correct ratio is met, water absorption is maximized. In fact, one early test following Crane’s discovery suggested that an ORS with the right ratio of sugar and sodium could increase water absorption 2-3 times.[iv]

Since the discovery of ORS, the recommended ratio of electrolytes and sugar have been updated. Standard WHO-UNICEF ORS in early years contained more sodium, which was thought to maximize hydration. But more recently, the amount of electrolytes and glucose in the formula has been reduced.[v] Essentially, WHO found that a “reduced-osmolarity” ORS – which means there is less sodium and glucose – achieved the same outcomes, while reducing the severity of diarrhea and vomiting.[vi]

DripDrop: An Advance in ORS

Many “rehydration drinks” don’t contain the right ratio of electrolytes for medical-grade hydration. Sports drinks are the perfect example. Many of them contain an inconsequential amount of salt. Why? The amount of salt is minimized to improve taste, and instead, these beverages are loaded with sugar. The ratio is flawed. Many ORS, on the other hand, contain more sodium, but due to this, their taste is very salty. This makes it more challenging to get children to drink them when sick.

DripDrop ORS represents an evolution in the standard oral rehydration formula. Our doctor-developed rehydration powder contains a medically relevant level of sodium, while tasting great enough to drink every day.

[i] UNICEF. (2014). Committing to Child Survival: A Promise Renewed. Progress Report 2014. UNICEF. New York.

[ii] Nalin, D., Cash, R., Islam, R., Molla, M., & Phillips, R. (1968). Oral maintenance therapy for cholera in adults. The Lancet292(7564), 370-372.

[iii] Gerlin, A. (2006, October 16). A Simple Solution. TIME Europe, 168(17), pp. 40-47.

[iv] Fordtran, J. S., Rector Jr, F. C., & Carter, N. W. (1968). The mechanisms of sodium absorption in the human small intestine. Journal of clinical investigation47(4), 884.

[v] Unicef. (2001). New formulation of Oral Rehydration Salts (ORS) with reduced osmolarity. UNICEF technical bulletin, (9).

[vi] Murphy, C., Hahn, S., & Volmink, J. (2004). Reduced osmolarity oral rehydration solution for treating cholera. Cochrane Database Syst Rev4.