Oral rehydration salts (ORS) powder must be reconstituted accurately with water before consumption to avoid incorrect concentration (recommended osmolality: 245 mOsmol/kg). A consumer behavior study was conducted to understand the process of preparing ORS solution by respondents/caregivers; thereafter, the prepared solutions were tested for osmolarity. Respondents/caregivers (n = 120) from Bengaluru and Pune, who were prescribed ORS from three different brands, either in small (4.2–4.4 g in 200 ml water) or large sachets (21–21.8 g in 1,000 ml water) in the past 3 weeks, were enrolled. The quantity of water and powder, type of water, size of the ORS sachet, and preparation method were recorded. Prepared ORS solutions were tested for osmolality using the United States Pharmacopeia method . Recorded osmolality showed wide variability, ranging from 30 to 1,331 mOsmol/kg. The majority of prepared ORS solutions (52/120, 43%) were >310 mOsmol/kg; 35/120 (29.16%) were in the range of 200–310 mOsmol/kg, and only 17/120 (14.16%) were in the reduced osmolality range of 210–268 mOsmol/kg. The volume of water and quantity of powder used ranged between 100–1,000 ml and 1.38–23 g, respectively. Respondents/caregivers reconstituted the powdered ORS as per their own preferences, regardless of labeled instructions. Reconstitution variations led to a deviation in the resulting osmolality of the ORS solution from the recommended value of 245 mOsmol/kg. Respondents/caregivers should be counseled on the correct method of reconstituting ORS powder and the potential adverse effect of incorrect concentration of ORS, if not prepared as per the labeled instructions.
Key words: Oral rehydration salts; osmolality; hyper-osmolar, hypo-osmolar; diarrhea; risk factors; consumer behavior
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