Union Ministry of Health Family Welfare (MOHFW), FSSAI and Union Health Minister, J P Nadda. The FSSAI then allowed companies to use the ORS tag, provided a disclaimer was added. (Image: File)
Oral rehydration salt solution (ORS) is a simple but great medical advancement, that has revolutionised the treatment of dehydration caused by diarrheal diseases, thus saving millions of lives, particularly in populations living in poor hygienic conditions where diarrheal diseases like Cholera are the main cause of death among children. 60% of infant and child deaths in places like Pakistan are due to diarrhoeal infections. In India 13% of children under 5 years of age die due to diarrhoea. “The Lancet” identified oral rehydration therapy (ORT) as “the most important medical advance of the 20th century”. Dr. Dilip Mahalanabis, the Indian paediatrician who pioneered the widespread use of Oral Rehydration Solution (ORS), was unofficially nominated for the Nobel Prize in Medicine, but never formally received one. The rules of the Nobel Committee prevent the official confirmation of nominees, but Mahalanabis was elected as a foreign member of the Royal Swedish Academy of Sciences in 1994, an institution responsible for selecting Nobel laureates. Dr. Mahalanabis (1934-2022), an alumni of Medical College and Hospital, Kolkata, received several other prestigious awards for his pioneering work including the Padma Vibhushan posthumously in 2023.
HISTORY OF ORS: During the 1971 Bangladesh Liberation War, Dr. Mahalanabis was running a refugee camp where a cholera epidemic erupted. With intravenous fluids in dangerously short supply and thousands of new patients arriving daily, he made the bold decision to treat patients with a simple oral solution of glucose and salts. This unconventional approach caused the fatality rate in his camp to drop from a staggering 30% to just 3%. His endeavour was based on the earlier work and efforts of the 1960s when researchers, particularly from the Johns Hopkins Center for Medical Research and Training in Calcutta, discovered that the body could absorb fluids with the right mix of salts and glucose during severe diarrhea. Captain Phillips of the US Army in 1964, first successfully tried oral glucose saline on two cholera patients. Following this, scientists working at the Cholera Research Laboratory, Dhaka, and the Infectious Diseases Hospital, Calcutta, contributed to the development of modern oral rehydration salt (ORS) solution. Sircar et al in 1978 demonstrated the efficacy of ORS in a cholera epidemic in Manipur. The World Health Organization (WHO) in 1978 launched the global diarrheal diseases control program with ORS formula as the global standard for treating diarrheal diseases, a move that is estimated to have saved over 60 million lives. July 29th every year is World ORS Day.
THE OPTIMAL ORS: Optimal WHO-recommended salt and glucose content of ORS is a balanced mixture designed to enhance absorption, using 75 mmol/L each of sodium and glucose, resulting in a total osmolarity of 245 mOsm/L. This formula has been shown to reduce stool volume and duration of diarrhoea compared to the older standard. WHO guidelines specify ORS should contain 2.6 grams sodium chloride, 1.5 grams potassium chloride, 2.9 grams sodium citrate, and 13.5 grams dextrose per litre of water. The ingredients are often sold in pre-packaged sachets to ensure the correct ratio when mixed with water.
MISLEADING BEVERAGES MISLABELED AS ORS: Pharmacies have sold colourful attractively packaged sugary drinks containing more than 120 grams of sugar per litre and dangerously low electrolyte levels, with names like ORSL and Rebalance with ORS, etc., alongside legitimate medical rehydration solutions. Sports drinks, sodas, or juices, mislabelled ORS do not contain the correct sodium and carbohydrate balance and may worsen diarrhoea. Another Indian paediatrician, this time from Hyderabad, Dr Sivranjani, campaigned alone for eight-years on social media against these alleged deceptive marketing practices, and raised the issue with Central Drugs Standards Control Organisation (CDSCO), Union Ministry of Health Family Welfare (MOHFW), FSSAI and Union Health Minister, J P Nadda. The FSSAI then allowed companies to use the ORS tag, provided a disclaimer was added. Manufacturers began printing micro-mini disclaimers on their packaging, such as “Not recommended during diarrhoea” not to save lives, but to meet legal requirements. These labels could not be read or understood by even literate urban parents, leave alone poor illiterate villagers and slum dwellers. Dr Sivaranjani Santosh, finally filed a PIL in the Telangana High Court in September 2024. The Food Safety and Standards Authority (FSSAI) on October 14, 2025, prohibited food and beverage makers from using the term ‘ORS’ label on any product names, labels, or trademarks, even when used as a prefix or suffix. The decision may have been hastened or triggered by the death of many children due to contaminated cough syrups. The decision ensures only WHO-approved medical ORS can add ORS to their brand name, protecting children from harmful sugary drinks. “ORS tag must be reserved exclusively for WHO-compliant formula. The ORS labelled products, given to children, have high-sugar content, which worsens their diarrhoea. Such sugary products should not be given to children at the time of diarrhoea. You are simply replacing a life-saving solution with a sweetened beverage with ORS labels purchased from medical stores, during the time of crisis” says Dr Sivranjani. Her campaign was supported by the Endocrine Society of India, Women Paediatricians Forum, thousands of parents, journalists, and health professionals, who amplified her message. “Children like sweet drinks, and companies exploit that. They marketed them as rehydration drinks, used celebrities, and even placed them in hospitals and schools. That’s what angered me most," she says. Implementation and awareness will determine the success of this and other such health campaigns. Health campaigns for vaccination and against drugs, tobacco, alcohol, obesity, fitness, etc. should be nationwide in regional languages, on TV, social and print media, and sustained to serve public health.
Dr. P.S.Venkatesh Rao is a Consultant Surgeon, Former Faculty CMC (Vellore), AIIMS (New Delhi), and a polymath in Bengaluru.
