ORS B Plus

Sodium chloride, potassium chloride, trisodium citrate, anhydrous glucose.

A white and odourless, crystalline powder.
Each sachet contains the equivalent of: Sodium chloride 650 mg, Potassium chloride 375 mg, Trisodium citrate 725 mg, Anhydrous glucose 3.375 g.
Ionic concentration (mmol/litre): Na⁺ 75, K⁺ 20, Cl^- 65, Glucose 75 and Citrate 10.

Pharmacology: Pharmacodynamics: Sodium chloride is the principal salt involved in maintaining the osmotic tension of the blood and tissues; changes in osmotic tension influence the movement of fluids and diffusion of salts in cellular tissues.
Solutions containing sodium chloride are extensively used for the prevention or correction of fluid and electrolyte deficits or imbalance in a wide range of clinical situations.
Sodium citrate, after absorption, is metabolized and has actions similar to those of sodium bicarbonate. It neutralizes the acid secretion in the stomach with the liberation of carbon dioxide. After absorption, it is retained by kidneys to meet any deficit of bicarbonate in the plasma, e.g. in metabolic acidosis.
Potassium chloride is mainly used in the prevention and treatment of potassium deficiency. As it contains chloride ions, it is employed in the treatment of hypokalaemia associated with hypochloraemic alkalosis.
Glucose is given by mouth as a readily absorbed carbohydrate in conditions associated with insufficiency of carbohydrates: it provides rapidly with available source of energy. It also reduces the need for the metabolism of fats and thus prevents ketonaemia.
Pharmacokinetics: Sodium chloride is readily absorbed from the gastrointestinal tract. It is present in all body fluids but is mainly found in the extracellular fluid. The amount of sodium chloride normally lost in the sweat is small and the osmotic equilibrium is maintained by the excretion of surplus amounts in the urine.
Potassium salts other than the phosphate, sulphate, and tartrate are generally readily absorbed from the gastrointestinal tract. Potassium is excreted mainly by the distal tubules of the kidney; 5 to 10 mmol a day may be excreted in the faeces, and some in perspiration. The urinary excretion of potassium continues even when intake is low and faecal losses may be large in the presence of diarrhoea.
Glucose is absorbed from the gastrointestinal tract. Three pathways of metabolism are established: glycolysis leading to the formation of pyruvate (aerobic) or lactate (anaerobic), followed by the Krebs tricarboxylic acid cycle (citric acid cycle), leading to metabolism to carbon dioxide and water, a pentose phosphate pathway leads also to carbon dioxide and water. Energy is released in these processes. Glucose is also stored as glycogen in the liver and muscles. Blood-glucose concentrations are maintained on healthy persons within normal limits by the insulin, which facilitates the passage of glucose through cell membranes, and other homeostatic mechanisms. The body can metabolise about 800 mg per kg body weight hourly. Glucose facilitates the absorption of sodium from the intestinal tract.

Solutions of sodium chloride and glucose often with added potassium chloride is used for oral rehydration in acute diarrhoea and cholera.

Recommended Dosage: Dissolve contents in each sachet of 5.125 g in 250 mL of cool, boiled water.
Children under 2 years: 250 mL for the first two hours; 3 x 250 mL can be taken a day.
Children 2 -5 years: 3 x 250 mL for the first two hours; 6 x 250 mL can be taken a day.
Adults: 4 x 250 mL for the first two hours; 12 x 250 mL can be taken a day.
Infants and young children should be given in small, frequent and slowly administered amounts of oral rehydration fluid.
Route of Administration: Oral.

Overdose and Treatment: In the event of overdosage, hypernatraemia or hyperkalaemia could occur.
Hypernatraemia requires the use of sodium-free fluids and the cessation of excessive sodium intake. Very occasionally, dialysis has been needed in severe hypernatraemia.
Iso-osmotic overload is managed by sodium and water restrictions plus measures to increase renal sodium and water loss such as 'loop diuretics' (e.g. frusemide) or, in specific circumstances, antimineralcorticoid agents.
Mild hyperkalaemia may be treated with sodium polystyrene sulphonate, administered by mouth or as an enema. In severe hyperkalaemia, treatment with haemodialysis or peritoneal dialysis may become necessary.
Hyperkalaemia associated with hyponatraemia may respond to treatment with infusions of sodium salts.

Glucose is contraindicated in patients with the glucose-galactose malabsorption syndrome.

Sodium salts should be used cautiously in patients with cardiac failure, hypertension, impaired renal function, peripheral and pulmonary edema, and in toxaemia of pregnancy.
Potassium salts should be administered by mouth in well-diluted solutions. Intravenous injections should be given slowly as high blood concentrations may affect cardiac functions. Potassium salts should be given cautiously to patients with renal or adrenal insufficiency, acute dehydration or heat cramps. Care should be exercised if potassium salts are given concomitantly with potassium-sparing diuretics.
Glucose tolerance may be impaired in patients with renal failure and in the early post-traumatic state or in those with severe sepsis.

Hypernatraemia is characteristic of excessive (sodium) administration, including the overfeeding or inappropriate feeding of infants, in brain injury and acute water loss.
Symptoms of hypernatraemia may include restlessness, weakness, thirst, reduced salivation and lachrymation, swollen tongue, flushing of the skin, pyrexia, dizziness, headache, oliguria, hypotension, tachycardia, delirium, hyperpnoea and respiratory arrest.
Retention of sodium and water-isotonic retention or iso-osmotic, expansion because the plasma concentration is unchanged - leads to the accumulation of extracellular fluid (oedema). This may affect the cerebral, pulmonary or peripheral circulation.
The toxicity of potassium salts given by mouth in healthy individuals is slight, since potassium is rapidly excreted in the urine. With some salts such as potassium chloride, nausea, vomiting, diarrhoea and abdominal cramps may occur. Hyperkalaemia may occur after excessive intake (including the excessive transfusion of stored blood); after the use of potassium-sparing diuretics; in adrenal cortical insufficiency, renal failure and acidosis, and after tissue trauma. Symptoms include paraesthesia of the extremities, listlessness, mental confusion, weakness, paralysis, hypotension, cardiac arrhythmias, heart block and cardiac arrest.
Concentrated glucose solutions given by mouth may cause nausea and vomiting

Store below 25°C.
Protect from light.

Electrolytes

A07CA - Oral rehydration salt formulations ; Used in the treatment of diarrhea.

NP