Oral rehydration solutions (ORS) utilise the electrochemical gradient for sodium to drive electrogenic sodium coupled glucose and water absorption across the small intestinal epithelium. These solutions have proven to be a lifesaving therapy worldwide in acute diarrhoeal diseases. The precise composition of these solutions varies depending upon clinical indication with higher sodium solutions being used where secretory diarrhoeas, such as cholera, are prevalent and hypo-osmolar lower sodium solutions being used in developed countries where other forms of diarrhoea are prevalent.

In the UK, Dioralyte is the most common ORS used in paediatrics. It is a hypo-osmolar solution with an illustrative composition of sodium (Na) 60mmol/L, potassium 20mmol/L, glucose 111mmol/L, chloride 40mmol/L and citrate 10mmol/L with an osmolality of 240 mosm/Kg. The composition of this solution is optimised for rehydration rather than electrolyte replacement, where other solutions are more appropriate.

There is a current national shortage of Dioralyte expected to last until the end of 2022. This has prompted us to review current use of Dioralyte in clinical practice and consider alternative solutions.

We undertook a point prevalence audit of the use of ORS (Dioralyte) in a tertiary paediatric referral hospital. We evaluated the most recent prescriptions of Dioralyte in 50 patients across the Trust (August-September 2022).

Only 6% (3/50) patients were being treated by the Gastroenterology Department. 90% (45/50) required feeding support via nasogastric tube, nasojejunal tube, gastrostomy, jejunostomy and/or parenteral nutrition. Only 18% (9/50) patients had acute diarrhoea. 34% (17/50) received Dioralyte whilst fasting for a procedural anaesthetic. Dioralyte was used to build up feed volume over time in 16% (8/50) and to meet fluid target requirement in 8% (4/50). Dioralyte was also prescribed for constipation, dystonia, hypokalaemia, high nasogastric tube losses and as part of bowel prep for colonoscopy. No intravenous access was stated as the rationale for starting Dioralyte in 14% (7/50). In 3 patients the ORS was being used to replace secretions with high Na content (typical Na content of losses was 120–150 mmol/L).

Overall we found 82% of ORS prescriptions were for non-diarrhoeal illnesses and thus widespread overuse of ORS.

Clinicians need to be educated about the indications for ORS and the choice of appropriate ORS for each clinical situation. This point prevalence audit has highlighted the potential substantial cost savings that could be made within the NHS and acknowledges the significant risks of a “one glove fits all” strategy for the use of ORS in healthcare settings.