Pharmacy Practical for MBBS/BDS

1. Oral Rehydration Salts
(ORS) powder

2.  Too frequent, often too precipitate passage of poorly formed stools
 WHO defined:- 3 or more loose or watery stools in a 24 hrs. period
 Occurs due to passage of excess water & Electrolytes in faces
Cause:-
 Decrease electrolyte and water absorption
 Increase secretion by intestinal mucosa
 Increase luminal osmotic load
 Inflammation of mucosa and exudation into lumen

5. Types
1.Acute Diarrhoea
-infectious agents
• Bacterial
• Viral
• Parasitic
Mild-
Moderate-
2.Chronic diarrhoea- persist
for more than 2 weeks

6. Types of Dehydration Fluid deficit as % of body
weight
Clinical Finding
Mild dehydration <5% Thirst in some cases
Moderate Dehydration 5%-10% Thirst, postural hypotension,
weakness, tachycardia,
decreased skin turgor, dry
mouth/tongue, no tears
Severe dehydration >10% Unconsciousness, lethargy, or
"floppiness"; weak or absent
pulse; inability to drink; sunken
eyes

8.  Inhibition of Na+K+ ATPase and structural damage to mucosal cell by Rota virus causes diarrhoea by reducing
absorption
 Excess of bile acids also cause diarrhoea by activating adenylyl cyclase
 Prostaglandins also stimulate secretory process
 Cholera toxin, Enterotoxigenic E. coli(ETEC) , Staph aureus, Salmonella stimulate adenylyl cyclase- increasing
secretion
:Pathophysiology:-

11.  ORS therapy is the core of management of acute diarrhoea (mild-5-7% BW/moderate-7.5-10%
BW)
 A mixture of salts and water
 Purpose:-
 To correct water electrolyte deficient
 To prevent dehydration
 Reduce mortality
 Advantages:-
Simplest, safest, least expensive life saving method
Introduction

12. Aim
 To prepare and dispense oral rehydration salt powder for 1000 ml solution
ORT:- It is a type of fluid replacement used to prevent and treat dehydration especially that
due to diarrhea due to any cause
Apparatus:-
Tiles
Spatula
Mortar & pestle
wax paper-preferable
White paper,Fractional weight box,scissors,rulers

13.  Glucose when given orally enhances the intestinal absorption of salt and water
 Thus it can correct water and electrolyte & water deficit
 ORS should be isotonic or hypotonic to plasma
Principles

14. Sodium chloride(NaCl)-
3.5g
Potassium chloride(Kcl)1.5g
Trisodium citrate- 2.9 g
Anhydrous Glucose-20g
Water-1000 ml
Ingredients of ORS
Na+- 90mM
K+-20 mM
Cl- 80mM
Citrate- 10 mM
Anhydrous Glucose-111
mM
Osmolality- 311 mOsm/L
‘’Diarrhoea due to cholera’’

15. Sodium chloride(NaCl)-2.6
g
Potassium chloride(Kcl)-1.5
g
Trisodium citrate- 2.9 g
Anhydrous Glucose-13.5g
Water-1000 ml
New formula WHO-ORS
Na+- 75mM
K+-20 mM
Cl- 65 mM
Citrate- 10 mM
Anhydrous Glucose-75
mM
Osmolality- 245 mOsm/L
Based on stool composition of ETEC diarrhoea

16. Reason for modification in ingredients:-
1.Na+ has decrease from (90 mM to 75mM)
Cause:- produce periorbital edema due to excess Na+
2.Glucose reduce from (110mM to 75mM)
Cause:- Increase in stool volume due to osmotic activity of glucose in
colon

17. Functions of each ingredients:-
 Anhydrous Glucose –it included in the solution principally to help the
absorption of sodium
 Nacl-Role of sodium chloride is to replace sodium losses and to promote water
absorption in the small intestine
 KCl-to correct electrolyte disturbances and to maintain nerve muscle activity.
 Trisodium citrate :- corrects acidosis and enhances the absorption of water and
electrolytes

18. Procedure to dispensed ORS
1. The above ingredients are measure and taken on the tiles
3.Inner packing of butter paper measuring 3’’-5’’
2.Mixing is done with pestle

19. 5.Labelling is done on the outer packet
4.Outer packing of white paper measuring 5’’-7’’
Administered:-
 one packet of ORS to be dissolve in freshly prepared boiled & cool 1liter of
water.
 Patient is instructed to drink as much as he can after every stool(2-3 L/day )

20.  Label:-
Name:- Anil kumar Age/ Sex:- 21M
Address:-14B,Chandani chowk, Delhi Date:-24/02/2021
Directions:- To be dissolved in freshly boiled and cooled 1lit of water which should be used
within 24 hrs. To be taken after every stool.
Signature of pharmacist & Reg No.
ITS PHARMACY
THE POWDER
DO NOT ADD EXTRA WATER

21. Prescription:-
Particulars of Doctors:-
Name-
Address- mobile no:-
Qualification-
Date-
Particulars of patient:-
Name- Age:-
sex- weight-
Address- Mobile no-
occupation -
Sodium chloride – 2.6 g
Potassium chloride- 1.5 g
Trisodium citrate- 2.9 g
Glucose- 13.5 g
Diarrhoea
Rx-
Mix and send 2 such packets
Dissolve 1 packet in 1000 ml of water and drink as a much as possible after every
stool.
Signature & registration no

22.  Improved form of ORS with addition of certain actively transported
amino acids like alanine, glycine
 Glucose is replace with boiled rice powder
 Advantages:-
enhanced absorption
decrease frequency of diarrhoea
less chance of osmotic diarrhoea in high dose also
# it has been found to reduce stool volume compared to WHO-ORS in cholera

23. Zinc supplementation-
-Reason for Zn supplement ?
- ↓ the length and severity of the diarrhoea.
-Zinc is important for the child’s immune system and
will help the child fight off new episodes of diarrhoea
in the 2-3 months following treatment.
-Zinc improves appetite and growth
-it is now recommended that zinc (10-20 mg/day) be given for 10 to 14 days to
all children with diarrhoea.

24. Indication:-
1.Diarrhoea-Acute (Mild to moderate)
Non-diarrhoeal uses of ORS:-
1. Maintenance of hydration and nutrition after
surgery,
burn
trauma
dengue
2. Heat stroke
(Any cause of dehydration)

25. Home made ORS solution:-
To make 1lit of home made ORS-take 1lit of boiled and cooled water
and add 6 tea-spoons of sugar. Now add half level tea-spoon of salt
and squeeze half lemon. Stirr the mixture and taste it.

26.  The recommended composition of i.v. fluid
Composition:-
Nacl-5gm (85mM)
Kcl-1gm (13mM) in 1L of water or 5%
NaHCO3-4gm (48mM) glucose solution.
Volume equivalent to 10% BW should be infused over
2-4 hours
Dhaka water:-

27. -:Questions:-
1.What is the composition of ORS ?
2. What is the concentration of constituents in mmols?
3.In which condition it is used ?
4.Why is not given in severe diarrhoea ?
Ans:- quick improvement of hydration is required which is not possible
with ORS. IV-fluids are given first

28. 5. The composition of ORS prepared by you is based on which
diarrhoea?
ans:- It is based on the composition of stool of “Diarrhoea due to
cholera ”
6. What is new formula ‘’WHO-ORS’’ ?
7. what is the reason for this modification in WHO-ORS ?
8. What are the non-diarrhoeal uses of ORS ?

29. 9.what are the functions of each ingredients ?
10.Adverse effect of overtreatment with ORS.?
1.Hypernatremia is manifested as raised BP, irritability, muscle twitching, swelling.
2.Osmotic diarrhea due to glucose presence may take place in few.