ORS Rehydration Calculator
India · WHO & IAP Guidelines · Pediatric & Adult Diarrhea Treatment
ORS Dose Guidelines — Pediatric & Adult (WHO Plan A & B)
Mild dehydration (WHO Plan A - Home Treatment): Give 50ml/kg of ORS solution over 3–4 hours at home. Continue breastfeeding for infants. Offer extra ORS after each loose stool (50–100ml for children under 2 years, 100–200ml for older children and adults).
Moderate dehydration (WHO Plan B): Give 100ml/kg of ORS over 3–4 hours, preferably supervised at a health facility or clinic. Reassess the patient's hydration status after the 4-hour mark.
Severe dehydration (WHO Plan C): Requires immediate IV rehydration with Ringer's Lactate in a hospital. ORS should be started as soon as the patient is conscious and can safely drink.
Zinc Supplementation for Pediatric Diarrhea
The Indian Academy of Pediatrics (IAP) and WHO recommend zinc supplementation alongside ORS for all children with acute diarrhea: 10mg/day for infants under 6 months and 20mg/day for children 6 months and above, for exactly 14 days. Zinc reduces the duration and severity of diarrhea and helps prevent future episodes by regenerating the gut lining.
Diarrhoea in India — Why ORS Saves Lives
Diarrhoeal disease remains one of the top five causes of under-5 mortality in India, responsible for approximately 100,000 child deaths annually — most of which are preventable with timely oral rehydration. The WHO estimates that ORS alone reduces diarrhoea-related mortality by up to 93% when correctly administered.
Despite this, homemade salt-sugar solutions remain dangerously common in India — with incorrect proportions leading to hypernatraemia, seizures, and worsened dehydration. The standard WHO low-osmolarity ORS (osmolarity 245 mOsm/L, sodium 75 mEq/L) has been shown to reduce stool output by 20–30% compared to the older high-osmolarity formula and significantly reduces the need for IV fluids.
The Three Dehydration Plans — Simplified
Plan A (Home): Mild dehydration — 50 mL/kg ORS over 3–4 hours at home, with extra ORS after each loose stool. Continue breastfeeding. Resume normal feeding early.
Plan B (Clinic-supervised): Moderate dehydration — 100 mL/kg over 3–4 hours, ideally at a health facility. Reassess hydration status after each hour. If child deteriorates or cannot drink, escalate to Plan C.
Plan C (Hospital IV): Severe dehydration — IV Ringer's Lactate. Infants: 100 mL/kg over 3 hours. Children: 100 mL/kg over 3 hours (30 mL/kg in the first 30 minutes). Start oral ORS as soon as the child can safely drink.
5 Common ORS Mistakes in India
1. Adding extra salt or sugar to ORS sachets
ORS sachets are precisely formulated. Adding extra salt or sugar — or dissolving in less than 1 litre of water — disrupts the sodium-glucose co-transport mechanism and can cause hypernatraemia. Always use exactly 1 litre of clean water per sachet.
2. Stopping food during diarrhoea
Withholding food ("resting the gut") delays mucosal recovery and prolongs diarrhoea. The WHO and IAP both recommend continuing age-appropriate feeding alongside ORS — including breastfeeding for infants. Khichdi, banana, rice, and curd are well tolerated.
Related Clinical Guides
3. Giving antidiarrhoeals (loperamide) to children
Loperamide (Imodium) is contraindicated in children under 12 years and should not be used in acute infectious diarrhoea regardless of age. It reduces stool output but traps fluid and pathogens in the bowel, risking toxic megacolon. It does not treat dehydration and can mask clinical deterioration.
4. Using antibiotics routinely for diarrhoea
The vast majority of acute diarrhoea is viral (rotavirus, norovirus) and self-limiting. Antibiotics are indicated only for confirmed bacterial causes — cholera, Shigella dysentery, typhoid, or specific parasitic infections. Routine antibiotic use for diarrhoea contributes to antimicrobial resistance and is discouraged by IAP and WHO.
5. Forgetting Zinc for 14 days
Zinc supplementation for 14 days is a standard of care alongside ORS, recommended by both IAP and WHO for all children with acute diarrhoea. It reduces diarrhoea duration by ~25%, severity by ~30%, and prevents recurrence for 2–3 months by rebuilding the intestinal lining. It is commonly forgotten in practice — yet costs less than ₹20 per full course.
Frequently Asked Questions
How much ORS should I give my child?
For mild dehydration (WHO Plan A): 50ml per kg of body weight over 3–4 hours. For moderate dehydration (WHO Plan B): 100ml per kg over 3–4 hours. Always give in small frequent sips to prevent vomiting.
Which ORS brand is best in India?
WHO-approved ORS formula sachets like Electral, Enerlyte, or standard ORS WHO packets are best. They contain the correct sodium concentration of 75 mEq/L. Avoid energy drinks or untested homemade salt-sugar solutions for treating clinical dehydration.
Can I give ORS to a newborn?
Newborns and infants under 6 months with diarrhea must be seen by a pediatrician immediately. Continue breastfeeding frequently. Do not give plain water to newborns as it can cause dangerous hyponatremia.
What is the Zinc dose for pediatric diarrhea in India?
Per IAP guidelines, give 10mg/day for infants under 6 months, and 20mg/day for children 6 months and older. Continue for 14 days to rebuild gut lining and prevent future diarrhea episodes.
Should I stop feeding during diarrhea?
No — continue normal feeding and diets alongside ORS. Breastfed babies should continue breastfeeding. Stopping food prolongs recovery. Soft, easily digestible foods like the BRAT diet (banana, rice, applesauce, toast) or khichdi are commonly recommended in India.
Common ORS Brands Available in India
| Brand | Sodium | Osmolarity | Notes |
|---|---|---|---|
| Electral (FDC) | 75 mEq/L | 245 mOsm/L | WHO formula — most widely used in India |
| Enerlyte (Abbott) | 75 mEq/L | 245 mOsm/L | WHO formula; available as powder and ready-to-drink |
| ORS-Zinc (WHO sachet) | 75 mEq/L | 245 mOsm/L | Government supply; includes zinc — ideal first choice |
| Glucon-D / Sports drinks | Variable | High (>300) | ⚠️ NOT recommended — high sugar worsens diarrhoea |