ORS-from choir to solo

Oral Rehydration Therapy (ORT), hailed as potentially the most important medical advance of the 20th century by Lancet in 1978, has had to pass through a long and arduous validation process before achieving global acceptance as a safe, effective, affordable and scalable intervention for the prevention and treatment of diarrheal dehydration.Thirst being the earliest symptom of dehydration, offering water to a patient suffering from diarrhoea has been a time old concept, but in 1940s, administration of water with sodium chloride, potassium, and glucose was introduced as a definite mode of rehydration therapy, even though parenteral fluids were preferred in such cases. 1The intestinal transport mechanism, however, was still not understood, and glucose was added merely to provide calories.After World War II, Robert A. Phillips successfully rehydrated cholera patients with profound fluid losses, using the oral route adding credence to the already introduced concept. 2 A major scientific breakthrough in the development of ORS was achieved in the 1960s with the demonstration of coupled active transport of glucose and sodium in the small intestine, resulting in passive absorption of water and electrolytes even during copious diarrhea. 3This scientific revelation established a robust basis for oral rehydration and served as a road map for further research in this field.The other important advance in diarrhoea research, that strongly complemented the concept of oral rehydration, was the understanding of the pathogenesis of secretory diarrhoea.It was demonstrated that activation of Adenosine Triphosphatase (ATPase) and breaking down into cyclic adenosine monophosphate (cAMP) resulted in sodium pump failure leading to dehydrating diarrhoea with a high purge rate, like in cholera and infection with Enterotoxigenic Escherichia coli. 4