water and salts lost \\ilh each diarrhea episode. some henlth centers in the,;llagcs or "barangays· supply patients "ith prepacked oral rehydration sa Jts. Each pac:kel is dissolved in one liler of the cleanest drinking "·ater available,,~ith iustructions to disc:ird the solution if not taken within 24 hours after mi:-. ing. If the oral rehydration packets are not available. home-made ORS can be prepared. lfased on the Reduced Osmol. iritv Formula (WHO/UNICEF, 2004) of 13. 5 Gm/L Glucose and 75 m Eq/L Sodium, home-made ORS c:m he rnixe<I using 3 level huusehold teaspoons (15 grams) of sugar and i/3 level lea!-poon of in<li1. ed salt dissolve<l in 1 liter of the clea11es1 drinking water nvailablc (prefcrnhly cooled boiled ,-,ater). 1f rock salt is used. 1/., level of hous<Chold tca$poon will give approximately the same amount of sodium. The reduced·osmolanty OR. S addressed the concern for occasional hypematremia from the standard ORS formula. Howf. 'Vcr, the new ORS showed increased risk of hyponatremi;i (odds ratio 2. 1) (AJam & ot J1cr. :. 1999). Sbou Jd there be early clinical indicabon of hyponatremia, such as lethargy or wcakne.,;s, the child must be brou):\ht immediately to tbc nearest health facility. ln the interim. the child should be given foo<l sources of sodium. Juice from citms fmits such as orange and ca\aman si can be added to each cup or serving of ORS to improve its taste. These fniits arc rich sources of potassium, an important sa Jt needed by t11c body. Another liquid source of_potassium is coconut· warer. Wboever mixes and gives the ORS must ta... <:te it before making the sick child drink it. It must not taste more salty Lhan tears. Too much sall cnn result in hypematraemia (high ]eve] of sodium in the blood) which can cause fits and brain damage. W11en the solution js very sweet the diarrhea may continue longer and the child may lose more wate. r. The ORS must not be contaminated "ith dirty hands, teaspoons, cup and storage vessel. Once mixed the ORS must not be used after 24 hours. The ORS must be given frequently and in smnll drinks. Following the guidelines on the amount to be given, the fluids must not be given more tha. n 1 teaspoonful (s ml. ) every minute. If ORS is given too fast. the child mnyvomitor refuse to take ony more. If vomiting occurs, give drinks of about 5-10 ml. (1-2 teaspoonfuls ) every 5-10 minutes. Tlris allows more time for the fluid i. n the stomach to pas. s into the intestines to be absorbed before the next drink is given. Milk and so Hds comprise the second part of the oral therapy for diarrhea. Mothers need not stop breast-feedi ng their children suffering from diarrhea. Infants and toddlers taking solids can go back to norma J diet after 4 or 6 hours of oral rehydration. Mothers or other care takers can give easily digestible food such as soft-cooked rice with protein powders and stewed, mashed vegetables. Ripe bananas ("latundan") can provide additional potassium. Fats or oil can be added to the diet only when the child has recovered from diarrhea. Solids can make the child pass larger stools but that does not matter. Uthe child vomits food, give ORS for a few more hours and tty to give food again later. [fa baby vomits breast milk, let the mother express her milk for one or two feedings. Start food again as soon as possible. Food is a very important par1 of oral treabnent. After the diarrhea bas stopped, the child can be given one extra meal each day for one week. This will help him make up what has been Jost. Diarrhea due to infection can be prevented by making sure that the food and water taken by-the. child are clean. The things used for eating and drinking mu!it, lik C\\ise, be clean. Hygiene and sanitation are important aspects to be emphasized to prevent diarrhea and parasitism, two diseases highly :related with malnutrition. 353 