Oral Rehydration Salts

I have a couple of questions regarding Oral Rehydration Salts.

In the event there is limited water, should Oral Rehydration Salts be used since one of the benefits is a high absorption rate?

When we give blood, we are given juice and snacks to help our body replenish what we gave. In the event a person has a wound, now under control, should that person be given Oral Rehydration Salts to help their body replenish what they lost?

Jeanette Isabelle

I'm a bit confused ...
Do you mean give ORS by themselves? Ie, no water? How much blood loss are you talking?

I wouldn't give ORS, the volume is more important. I mean, the person still has the same concentration of ions in their body, just less overall total. The electrolyte abnormalities, if any, wouldn't be all that severe (blood loss would kill you first) in an acute event. Even in hospitals they give 0.9% sodium chloride, not for the salt, but because the osmolality is the same as the body.

The OJ and crackers just replace fluid and sugar, have nothing to do with the red cells (FYI).

Also, not sure what you mean by a "high absorption rate." Salts and water are absorbed in different parts of the intestinal tract.

Supposedly some studies showed electrolyte fluids containing a small amount of protein are absorbed faster than those without protein.

No. I have established that there is some water so the Oral Rehydration Salts would not be given without water. Since the packets of Oral Rehydration Salts say to mix with one liter of water, let's assume one liter per person for one day.


I did say the wound is now under control but you are right, this does not establish how much blood was lost. Let's assume 250ml to 500ml of blood was lost.


Now I am the one who is lost. Adding a few grams of Oral Rehydration Salts to one liter of water will not decrease the volume. Also, I am not sure which of my two questions this was supposed to address.


That IS the point of using Oral Rehydration Salts.


In other words, low osmolarity.

Jeanette Isabelle

For this reason, CeraLyte is supposed to be better than regular Oral Rehydration Salts. "CeraLyte not only replaces lost fluids, it reduces on-going fluid loss. The mechanism for this action is believed to be a protein inherent in rice. . . ." -- http://www.chinookmed.com/Why_CeraLyte_ORS.pdf

Jeanette Isabelle

OK, I wasn't super clear. The volume of blood lost is more important than the electrolytes lost, at least initially. Additionally, rate of loss is important. An adult can die from 30% blood loss quickly, but live if it's over several weeks to months. So replacing the volume (ie, pure water) is more important initially; same idea as IV fluids. Granted, saline doesn't carry oxygen, which is why blood products are typically given after 2 liters of fluid.

Ceralyte ... oh how I give that away. You ever try it? Tastes pretty foul. The "ongoing fluid loss" is probably diarrhea related. It won't stop blood loss. sentence 1 on the back of the package: "Ceralyte 70 - a rice-based oral electrolyte solution to help prevent dehydration from diarrhea." we order this stuff by the pallet at my aid station. It works well for the runs.

If you're planning on oral rehydration from non-traumatic losses, it's not a bad solution. It packs larger than straight ORS packs (ie, from REI or Chinook med), but actually has some calories to it as well.

If you're looking at blood loss, IV fluids and blood are probably best, and second would be water. I can't imagine why ORS to an oral solution in a trauma would make much of a difference.

As an aside, 250ml is the amount taken during a blood donation. The average American adult can tolerate that just fine. 500ml is a bit much, but they should be OK too, if rather dizzy for a day or two.

We now have the second question covered. Let's get back to the first question.


Does this mean that in the event of a limited supply of water, let's assume one liter of water per person per day, that Oral Rehydration Salts would help due to the level of osmolarity?

For clarification, I am asking about Oral Rehydration Salts, not CeraLyte. I mentioned CeraLyte to address another post.

Jeanette Isabelle

For #1, it can't hurt but considering the low total volume of water involved (1L over a day), I doubt it makes any significant difference for a healthy person. When the water volume is that small, and your body is thirsting for water, it will absorb all of it.

The one exception I would make is if the person's GI tract is compromised somehow, e.g. they're vomiting or have diarrhea or some stomach bug and the additional electrolytes will assist in fluid absorption. If I have diarrhea, drinking Vitalyte can significantly lessen its severity because the gut can absorb the water instead of letting it "run through you". For me, that works better and quicker than using, say, a binder like Kaopectate.

Also, some products are salty enough to make you thirsty, like Gatorade, which is probably the opposite effect you want. That's great for the company who wants to sell as many bottles of Gatorade as possible, but not good when you have a limited water supply to drink.

For #2, assuming you are making a "large" amount of water available to the wounded person at once, then it probably is more beneficial than straight water, although I'm not sure it makes much practical difference here either given that amount of blood loss.

It can be beneficial to increase the volume of fluid in the circulatory system after blood loss, and pure water would tend to dilute the blood, potentially causing other complications. Also, when giving a large volume of water to drink at once, the ORS can assist in increasing the rate of absorption of all that fluid.

Actually, I'm not sure if your body would want extra fluid to replace the blood volume loss. If your blood vessels constrict to keep up your blood pressure, then there's nowhere for that extra water to go except out through your kidneys. On the other hand, if the person is feeling lightheaded from low blood pressure, it could help.

Note that if the wound may require surgery fairly soon, then drinking water is probably not a good idea due to the risk of vomiting under anesthesia. Increasing fluid volume through an IV would be preferable.

If you have limited water, you probably don't want to always use it with the ORS. Have 1L of pure, unmixed water has some advantages over the ORS.

I can site personal experience... I gave myself heat exhaustion from working in the lawn on a hot and humid day. I was drinking water while working, but probably not enough. Well, got dizzy, naseous, chilled... Drinking a electrolyte type drink didn't agree with me. Sipping pure water over a period of time brought my system back under control.

Yes, it is important to replace lost salt/sugars on some occasions. Sometimes pure water if preferred tho.

I would think that, at 1Liter/day, there's no pro or con to the ORS. Think about it - we developed to drink water, not salt water. ORS isn't some magical potion, it just replaces electrolytes.

Lets say you're sweating like crazy. sure, you're losing electrolytes, but also water, so you're probably increasing the concentration of electrolytes in your body. Adding extra doesn't help (hypernatremia, anyone?)

It's hard to over-drink water at 1L/day, so dilutional hyponatremia is pretty low risk.

Final answer from me? why bother with ORS - wasting money!

I found something interesting regarding dehydration in an article by Brent Blue, M.D. "[Electrolyte powder] is particularly good for fluid replacement for diarrhea, and for treating dehydration due to heat exhaustion or heatstroke. Plain water is next best choice." -- http://www.aeromedix.com/aeromedix_articles/medkit/index.html

After rereading it, I realized I took it out of context. Oral Rehydration Salts is for treating dehydration "due to heat exhaustion" not due to a limited supply of water.

Jeanette Isabelle

For limited H2O intake, it probably doesn't really matter much one way or the other. 1/2 strength Gatorade makes a good oral dehydration solution. Mix twice the volume of water or 1/2 the quantity of powder. Cheaper and tatters than most commercial ORS. Especially Ceralyte - yuck!

I carry a roll of Nuun in my bag. I like the form factor -- makes for easy storage.

I recall watching a video -- I think it was part of the Talks @ Google lecture series which covered heat exhaustion and dehydration and they talked about what to look for in a drink electrolyte supplement.

After that, I went out looked at different supplements and found Gookinaid Hydralyte (now Vitalyte) matched their requirements.

Lately I haven't found it in the stores and so have been getting Nuun which looks pretty close and is available at my local REI.

I really wish I could find that video. It had some real good coverage about heat exhaustion, heat stroke, dehydration, etc. It was sort of hiking medical oriented.

-john

As an aside.

If the interest is in quickly treating dehydration, I think plain water is preferable to a drink with ORS.
Referencing Cody Lundin's "When all Hell Breaks Loose"..

Plain water passes much more quickly to the large intestine where it is absorbed by the body. Water mixed with ORS causes the stomach to treat it as food, delaying the liquid from reaching the large intestine and rehydrating the body.

After I complete a vigorous MMA training session in our relatively warm DOJO, I find drinking water to help much better than a commercial ORS. I believe another poster indicated the same.

For years I have been cutting Gatorade fluid 50-50 with water, getting the electrolyte concentration roughly down to that of what was then Gookinaide. This was based on an article in Runner's World which stated that the relatively high concentration in Gatorade impeded absorption of fluids.


On a hike many years ago in Arizona, I drank water regularly, but acquired a pounding headache. At the end of the day, I ate some salted pretzels - manna from heaven! I reviewed my diet for that day and realize that, quite by random, it had been entirely salt free.

Running distances, I cannot tolerate full strength Gatorade, but either dilute Gatorade or Gookinade goes down very well.

When I am doing my ironman distance triathlons, (just did Vineman 140.6 last week in Sonoma County, CA), I usually cut the Gatorade they hand out run aid stations with 50% water or pour it over ice letting it melt.

YMMV, but for me but putting different types of sugar in my gut, digesting at different intervals, plus the constant movement, gives me some GI distress so I try to keep stuff light.

So it sounds like it is best to initially start with just water to allow for quicker absorbtion. Then follow up with some sugar/salt electrolyte type drink to replace what was lost.

The main use of ORS is for diarrhea. The pioneers of the 1800s certainly could have used it. It wasn't the cholera that killed them, the dehydration got them first. The disease caused people to have diarrhea in the quantities of two to five GALLONS a day.

Water and other fluids after heavy blood loss just keep your blood pressure up. It doesn't replace the need for whole blood, the red blood cells of which carry oxygen to the brain and other organs.

When I had heavy blood loss (5 units replaced), I think they were giving me fluids as well as blood.

Sue

Mike, only speaking for myself and probably doing a disservice to the ORS thread, I am not a medical professional or scientist. I'm a simple guy & endurance athlete. The rule of thumb, (heck it's probably science based) is to stick with water for the first hour of endurance activity, if longer than that switch to something that puts electrolytes back into your system AND water. Many of us also supplement with an electrolyte tablet, like endurolytes or sportslegs, when going for multi hour runs and rides.

When you're done with a run or ride over 60 minutes, immediately replenish with coldest beer possible.

Comms,

Great advice... Esp about the beer!

Mike