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Name another essentially free remedy that saves the lives of over a million children annually.

If you believe the TV, magazine and billboard commercials you’d think products like Gatorade have it all figured out when it comes to rehydration and prevention of dehydration.  Actually they have figured out how to sell a sugary drink that people like to ingest to make themselves feel like they are doing something healthy for themselves.

In fact, in the gut there is a special process called co-transport of glucose molecules and sodium molecules, which occurs when salt (sodium) and glucose solutions of the proper proportions are ingested, so that the absorption of glucose is coupled to the absorption of sodium across the cell membranes of the gut wall, which in turn passively pulls water along with them into the bloodstream.  This is nicely described on the rehydrate.org website.  In 1975, Lancet called the discovery and utilization of this mechanism of co-transport (which became known as oral rehydration formula or ORF) “potentially the most important medical advance in this century (1900’s).”

Diarrhea is the second leading cause of death worldwide in children under 5 years old (behind pneumonia), killing an estimated 2.2 million children annually, and an estimated 1 million are saved by the use of oral rehydration formula.  In 45 countries, UNICEF has partnered with other organizations to achieve an 80% rate of treating children, using ORF, for symptoms of diarrhea.

In 1992, the World Health Organization (WHO) modified the formula to a hypoosmolar (less concentrated than normal body fluids) solution, using 50 mEq concentration of sodium, down from the previously recommended 90 mEq concentration, after finding that there was less hypernatremia (elevated serum sodium concentration) associated with this formulation and similar success with preventing and reversing dehydration.

In the US, several commercial formulations of oral rehydration formula are available in the baby food section of most supermarkets and pharmacies.  Essentially all of these are effective, and most are fairly close to the ORF used by the WHO, though most are higher in sugar content than is ideal, likely to make them more palatable for children.  It is very possible to make your own oral rehydration formula.  Many recipes are listed on the rehydration.org web site, but probably the simplest recipe using common household materials in the US is:
1 liter of water
¼ tsp salt
¼ tsp baking soda (if unavailable add an extra ¼ tsp of salt)
2 tablespoons of sugar (or honey may be used if child is > 1 year old)

Stir the mixture until the salt and sugar dissolve.  Adding too much salt can make the solution unpalatable to the child and too little makes it less effective.  Too much sugar also makes it less effective.  Take special care to wash your hands carefully prior to preparing the solution.  It should taste no saltier than tears.  For children less than two years, give between a quarter-cup and a half-cup of the solution after each loose bowel movement.  For older children, you should give between a half-cup and a full cup.  For children or adults that are already dehydrated, give sips of the solution every 5 minutes until urination is normal (4-5 times daily). I often describe giving  this as a teaspoon every 2-5 minutes in young children.  Done carefully, this formula can save a good deal of money, as typical rehydration formulas at the supermarket can cost about three dollars per liter.  It is recommended that adults and larger children ingest 3 liters daily of ORF when they have diarrhea.

Once vomiting has resolved, it is OK to also start small frequent feedings with simple, absorbent solid foods, like bananas, bread, crackers and cereal.