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ORS History & Research

Oral Rehydration Solutions (ORS) are a scientific breakthrough that treat and prevent dehydration for millions of people worldwide.

ORS are a balanced glucose-electrolyte mixture first used in 1969 and approved, recommended, and distributed by UNICEF (United Nations International Children’s Emergency Fund) and WHO (World Health Organization) as a treatment for clinical dehydration throughout the world.

Containing a precise ratio of electrolytes including sodium, potassium, and magnesium, ORS continues to be one of the most successful medical breakthroughs in the world.

For instance, diarrhea, and resulting dehydration, is the #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%, 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.

Discovering the key to fast absorption

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

When glucose is present in the small intestine, sodium is absorbed more quickly, which draws additional water into the bloodstream. The right ratio of glucose and sodium in a solution accelerates 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% 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%; once ORS was distributed, the mortality rate dropped to just 3%.[iii]

Refining the ratio of ORS

To be effective, an ORS must contain a precise ratio of electrolytes. If the solution's balance is off, the solution’s hydrating potential is drastically limited.

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 2-3x.[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]

Perfecting ORS for great taste

The standard formula established by WHO has drawbacks. The higher relative electrolyte levels (primarily sodium) in ORS have historically resulted in poor taste that impede broader use.

DripDrop ORS’s patented formula provides medically relevant electrolyte levels consistent with WHO's ORS standards, but also tastes great! (Notably, sports drinks only contain about 1/3 the electrolytes of DripDrop ORS, and most contain too much sugar.)

By solving the taste problem, DripDrop ORS has made the most highly effective oral hydration solution known to medical science practical for use by anyone who finds themselves with a hydration need where water and sports drinks just aren’t enough.

[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 Lancet, 292(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 investigation, 47(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 Rev, 4.

DripDrop's patented formula for efficacy and great taste is supported by over 50 years of ORS science and research

These studies, articles, and further readings about the effectiveness of ORS in various clinical settings and the importance of ORS palatability are engaging opportunities to feed a curious mind.

Further Reading

1. Fonseca BK, Holdgate A, et al. Enteral versus intravenous rehydration therapy for children with gastroenteritis: a meta analysis of randomized controlled trials. Arch Pediatr Adolesc Med 2004; 158:483

2. Victoria CG, Bryce J, et al. Reducing deaths from diarrhea through oral rehydration therapy. Bull World Health Organ 2000; 78;1246

3. Kosek M, Bern C, Guerrant RL. The global burden of diarrheal disease as estimated from studies published between1992 and 2000. Bull World Health Organ 81:197,2003

4. Santosham M,Chandran A, et al. Progress and barriers for the control of diarrheal disease. Lancet 376:63, 2010

5. Vesikari T, Isolauri E, et al. A comparative trial of rapid oral and intravenous rehydration in acute diarrhea. Acta Paediatr Scand 1987; 76:300

6. Hartling L, Bellemare S, et al. Oral versus intravenous rehydration for treating dehydration due to gastroenteritis in children. Cochrane Database syst rev 2006; CD004390

7. Hahn S, Kim S, Garner P. Reduced osmolarity oral rehydration solution for treating dehydration caused by acute diarrhea in children. Cochrane Database Syst Rev. 2002 ; CD002847

8. Rautanen T, Kurki S, Vesicari T. Randomized double blind study of hypotonic oral rehydration solution in diarrhea. Arch Dis Child 1997; 76:272

9. Spandorfer PR, Alassandrini EA, et al. Oral versus intravenous rehydration of moderately dehydrated children: a randomized, controlled trial. Pediatrics 2005; 115:295

10. Suh JS, Hahn WH,Cho BS Recent advances in oral rehydration therapy (ort). Electrolyte blood Press 2010 ; 8:82

11. Atherly-John YC, Cunningham SJ, Crain EF. A randomized trial of oral versus intravenous rehydration in a pediatric emergency department. Arch Pediatric Adolesc Med. 2002; 156:1240

12. Cohen MB, Mezoff AG, et al. Use of a single solution for oral rehydration and maintenance therapy of infants with diarrhea and mild to moderate dehydration. Pediatrics 1995; 95;639

13. Duggan C, Lasche J, et al. Oral rehydration solution for acute diarrhea prevents subsequent unscheduled follow up visits. Pediatrics 1999; 29;104

14. Atia AN, Buchman AL. Oral rehydration solutions in non-cholera diarrhea: a Review. Am J Gastroenterol 2009; 104:2596

15. Munos MK, Fisher Walker CL, Black RE. The effect of oral rehydration solution and recommended home fluids on diarrhea mortality. International J of Epidemiology 2010; 39:175

16. Kahn AM, Sarker SA, et al, Low osmolar oral rehydration salts solution in the treatment of acute watery diarrhea in neonates and young infants; a randomized controlled clinical trial. J Health Popul Nutr 2005; 23:52

17. International Study Group on Reduced Osmolarity ORS solutions. Multicenter evaluation of reduced osmolarity oral rehydration salts. Lancet 1995; 345:282

18. Snyder JD. Use and misuse of oral therapy for diarrhea: comparison of US practices with American Academy of Pediatrics recommendations. Pediatrics 1991; 7:28-33

19. Lavizzo-Mourey R, Johnson J, Stolley P. Risk factors for dehydration among elderly nursing home residents. J AM Geriatr Soc 1988; 36: 213-18

20. Warren JL, Bacon E, Harris T. et al. The burden and outcomes associated with dehydration among the US elderly 1991 Am J Public Health 1994: 84:1265-69

21. Ellsbury, D., George C. (2006) Dehydration, American Academy of Pediatrics. Retrieved June 5 2002

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