How to Use Oral Rehydration Salts (ORS) Correctly
Oral Rehydration Salts (ORS) is one of the most important medicines you can keep at home. Recommended by WHO and used worldwide since 1980, it has reduced diarrhoea-related deaths in children by over two-thirds. Yet in Ghana, many people still mix ORS wrongly — using too much or too little water, adding it to Coke or juice, or keeping it for days.
When prepared and used correctly, ORS replaces water, salt, potassium, and sugar lost through diarrhoea, vomiting, sweating in this heat, and fever. The glucose in ORS helps your small intestine absorb sodium and water faster.
At Citi Pharmacy, we sell both sachet powder (to mix with 500ml or 1 litre) and tablet forms. Here’s how to use them right.
Step 1: Read Your ORS Type First
In Ghana you will find:
– 1 litre sachet — Most common WHO formula. Dissolve in 1 LITRE.
– 500ml sachet — Small sachet. Dissolve in 500ml (one Voltic bottle).
– Tablets — Usually 2 tablets in 200ml of water.
Always check the label. Never guess the amount of water.
Step 2: How to Prepare ORS Correctly (WHO Method)
For 1-litre sachet:
1. Wash your hands with soap and clean the cup/jug.
2. Boil drinking water (bottled or sachet water is ideal) and allow to cool until lukewarm — do not use very hot water.
3. Measure exactly 1 litre (2 x 500ml Voltic bottles or 4 x 250ml cups).
4. Pour the whole sachet into the water and stir until fully dissolved.
5. Taste should be no saltier than tears — not very salty or very sweet.
For homemade when ORS is not available (temporary only):
Boil 1 litre of water, let it cool, add 6 level teaspoons of sugar + ½ level teaspoon of salt. Mix well. Use within 12 hours. Go and buy standard ORS as soon as possible — homemade is not as accurate.
Step 3: Dosage — How Much to Drink
ORS is not taken like a regular medicine “morning and evening”. You drink it after each loose stool or vomiting episode.
According to WHO & MSF Guidelines:
A. To PREVENT dehydration (when you have diarrhoea but not yet dehydrated):
– Child under 2 years: 50-100ml (¼ to ½ cup) after each watery stool, up to 500ml per day
– Child 2-10 years: 100-200ml (½ to 1 cup) after each watery stool, up to 1000ml per day
– Child over 10 years and adults: 200-400ml after each stool, up to 2000ml per day
B. To TREAT moderate dehydration (dry mouth, thirsty, sunken eyes, little urine) — First 4 hours:
– Under 4 months (<5kg): 200-400ml
– 4-11 months (5-7.9kg): 400-600ml
– 12-23 months (8-10.9kg): 600-800ml
– 2-4 years (11-15.9kg): 800-1200ml
– 5-14 years (16-29.9kg): 1200-2200ml
– 15 years and over (30kg+): 2200-4000ml
Give small sips every 1-2 minutes using a spoon or cup. If vomiting, pause 5-10 minutes then continue slower. Breastfed babies should continue breastfeeding.
If after 4 hours you still have signs of dehydration, repeat Treatment B. If no dehydration, switch to Plan A. If severe (cannot drink, very sleepy, no urine, rapid pulse), go to hospital for IV fluids — continue giving ORS 5ml/kg/hour on the way if conscious.
Step 4: Storage and Critical Mistakes to Avoid
DO:
– Make fresh daily. Discard after 24 hours (12 hours if not refrigerated). Bacteria grow in it.
– Keep mixed ORS in a clean covered jug. Refrigerate if possible.
– Continue eating — plain rice, banana, hausa koko, light soup. ORS does not replace food.
DON’T:
– Don’t use less water to make it “stronger” — too much salt causes salt toxicity (hypernatremia), brain swelling, especially in babies. Symptoms: excessive thirst, confusion, weakness.
– Don’t use more water to make it last — it won’t work.
– Don’t mix with juice, Coke, Fanta, Milo, or milk. Sugar in those drinks worsens diarrhoea.
– Don’t boil the solution after adding ORS.
– Don’t keep for >24 hours.
When NOT to Use ORS Alone?
ORS treats dehydration, not the cause. Go to hospital immediately if:
– Blood in stool or black tarry stool
– High fever, severe stomach pain
– Vomiting that won’t stop for >12 hours
– No improvement after 4 hours of correct ORS
– You have kidney disease, heart failure, or are on low-salt diet — seek advice first
– Baby under 6 months with diarrhoea — breastfeed and see doctor, do not give adult doses
At Citi Pharmacy, our pharmacists will show you exactly how much water to use for the ORS brand you buy. We stock 1L sachets, 500ml sachets, and ORS + Zinc co-packs for children.
FAQs
1. Can I mix ORS with 1.5 litres of Voltic or a small cup?
No. You must follow the sachet instruction exactly. 1-litre sachet = 1 litre of clean water (2 x 500ml bottles). Using more or less water makes it either ineffective or dangerous and can cause salt poisoning in children.
2. How long can mixed ORS stay? Can I keep it for 2-3 days?
No. Use within 24 hours if refrigerated, or within 8-12 hours if at room temperature in Ghana’s heat. After that, bacteria can grow and worsen diarrhoea. Always make fresh daily and throw away leftover.
3. Can babies drink ORS?
Yes, but dosage is smaller. Under 2 years: 50-100ml (10-20 spoonfuls) after each loose stool, using a spoon or syringe, small sips every minute. Continue breastfeeding. For babies under 6 months, seek medical advice quickly — do not give large volumes. Ask your Citi Pharmacy pharmacist for child dosing by weight.
4. Can I use coconut water or Coke instead of ORS?
Coconut water can help mild dehydration from heat because it has natural electrolytes, but it is NOT a replacement for ORS during diarrhoea/vomiting — it doesn’t have the right salt-sugar ratio. Never use soft drinks, energy drinks, or undiluted juice — the high sugar pulls more water into the gut and worsens diarrhoea.
References:
1. MSF Medical Guidelines — Oral Rehydration Salts (ORS) Indications, Forms and Dosage (WHO Plans A, B, C) — Updated Oct 2024
2. WHO — How to prepare oral rehydration sugar and salt solution (8 level teaspoons sugar + ½ teaspoon salt per litre)
3. Steroplast / http://Chemist.net — How to use ORS tablets: 2 tablets to 200ml, max 24 tablets/24h, storage <8h at room temp, 24h if refrigerated
4. Hello Doctor — ORS dosage by age: no dehydration and some dehydration protocols
5. Global Treatment Services — Dehydration and ORS: Dosage by weight and risks of salt toxicity
Unsure about ORS dosage for your child? Visit any Citi Pharmacy branch or chat with our pharmacist on WhatsApp now. We will show you how to mix it correctly and provide ORS + Zinc kits for children.
