preventing dehydration
http://www.flutrackers.com/forum/showthread.php?t=16760
(SNIP) ... preventing dehydration will be the most important way to avoid a preventable death of a loved one or friend.
As Sally stated,
the basic formula is 1 quart of water, 1 tsp of salt and 3 tbsp of sugar. What this amounts to is a physiologic solution that is very rapidly absorbed by the gut.
However,
when I took my own medicine (the above recipe) it tasted too salty and was sweeter than I liked. If sick and given this to drink, well being stubborn I just might refuse. If you doubt me, mix this up and try it for yourself. If you do, it would be interesting to hear what you think.
Given my real world experience with ORS as prescribed by the WHO and others including me,
I have modified my opinion.
First, the recommended ORS basically is an attempt to provide a physiologic salt and sugar solution orally in a proportion somewhat similar that that provided to patients with dehydration intravenously.
It is certain that when sugar is given in addition to water and salt orally that there is improved absorption of all three and this is the essence of the prescriptions components.
What is important to understand about medicine is there are often many ways to successfully treat a serious condition like dehydration. For instance, it is perfectly OK the lower the salt and sugar content of the solution and still obtain excellent results. In fact if the ORS is more palatable to the patient then they are much more likely to take it.
When a patient is really sick with flu there are many ways you can enhance the ORS to make it more palatable to them. First is the temperature of the fluid. If they have a very sore throat, a heated fluid will help relieve the pain. If they have a high fever a cold fluid may prove to be more comforting. In some cases drinking room temperature fluid is preferred. The point is to kowtow to the patient's preferences to the extent possible since their life may depend on them drinking down as much fluid as possible.
Second,
don't get hung up on the formula. It is too strong IMO. Way too salty and sweet. It is fine to reduce the salt and sugar content. It will still work great. What is important is they drink the stuff because if they don't they could die.
Caffeinated tea, coffee, or soda helps increase the fluid transfer through the lung, increases the function of the heart, kidneys, and colon and increases awareness. It is a time honored treatment for flu and other infectious diseases.
So, simply add a pinch of salt to these beverages, sweeten then with sugar (no diet coke!) and enjoy.
A very good ORS recipe is using juice as the flavor and sugar source added to water and a bit of salt. For instance, 2 cups water, 2 cups juice, and 1/4 tsp salt. This ORS provides plenty of water and sugar but also potassium and sodium. The potassium can substitute for sodium with regards to enhancing water absorption in the presence of sugar. This is my preferred ORS because it tastes so much better to me.
In essence, what is important is not the quantity of salt and sugar but the amount of water given. Yes, to improve the absorption of water from the gut both salt and sugar need to be present but in fact there is a large range of acceptable concentrations of these two that still result in a good clinical recovery. So, don't get locked into a single mantra. There are many variations that also work quite well.
I wish to elaborate a bit on one point Sally made
regarding the use of sodium bicarbonate. If the patient is dehydrated from fever then it is fine to use this source of sodium instead of table salt (sodium chloride) if this is all you have available. When doing so, use the flexible guidelines above because like salt, sodium bicarbonate is very salty.
The caveat relates to the cause of the dehydration. If it is due to vomiting, sodium bicarbonate administrate will harm the patient because this cause of dehydration results in an excess of bicarbonate in the blood due to loss of chloride in the vomitus. So if your patient is vomiting, the best ORS has plain table salt as the sodium source since it provides both sodium and chloride.
OTOH, if the patient has diarrhea as the cause of dehydration they loose more bicarbonate than chloride. So when diarrhea is playing an important role, using sodium bicarbonate is preferred.
As you can see, it is a little complicated but not all that difficult to manage. I have spelled all this out in a pamphlet entitled Good Home Influenza Care which is widely available.
What is important is not to wait until your child, spouse, or friend comes down with severe flu and the medical establishment is unable to respond due to its being overwhelmed. You need to get the information for how to do this on your own within your own home now. What's more you need to stock up on the simple things like salt, sugar, sodium bicarb, aspirin, acetaminophen, Benadryl etc that you will need to care for people at home.
Recently I had the privilege of advising a mother of a 14 y/o with A (novel H1N1) on how to care for her at home. While sick, she was not ill enough to require hospitalization thank goodness and she recovered quite rapidly (Tamiflu worked wonders). The point in sharing this vignette with you is how totally distraught and disorganized her mother was when she called me for help. Why was this a surprise? Because her mother is someone who works in the medical field and has significantly more knowledge about pandemic influenza than 99% of the population. What she did not have was a plan. She was not prepared to deal with pandemic influenza occurring within her own household and affecting her only child.
The lesson here is the need for everyone, irrespective of how much you "know" about influenza, pandemics, etc to be ready, really ready to handle it if it shows up in your own home. When this happens, it will not be of any value to understand how just-in-time inventory management by industry has broken down or that there is no true surge capacity within the advanced nation's health care system. What will matter most is the lethargic febrile being lying totally defenseless in the bed in front of you. Their life may well depend on what steps you take right now. So, what are you going to do?
Don't wait until then to answer that question. That is all that I am saying.
Grattan Woodson, MD