How to prepare an oral rehydration solution with 2L water, KCl, and sugar?

How to Prepare Oral Rehydration Solution (ReSoMal) from 2L Water, KCl, and Sugar

To prepare ReSoMal (Rehydration Solution for Malnutrition) from 2L water, KCl, and sugar, you need additional ingredients beyond what you have listed—specifically sodium chloride (NaCl) and a bicarbonate source—as ReSoMal requires a specific electrolyte composition that cannot be achieved with only KCl and sugar.

Standard WHO-ORS Preparation (If ReSoMal Components Unavailable)

If you cannot obtain all ReSoMal components, prepare standard WHO oral rehydration solution instead by mixing per liter of clean water 1:

• 3.5 g NaCl (sodium chloride)
• 2.5 g NaHCO₃ (sodium bicarbonate) or 2.9 g sodium citrate
• 1.5 g KCl (potassium chloride)
• 20 g glucose OR 40 g sucrose (table sugar) OR 4 tablespoons sugar OR 50-60 g cooked cereal flour 1

For 2 liters, double all quantities above 1.

This produces approximately: Na 90 mM, K 20 mM, Cl 80 mM, HCO₃ 30 mM, and glucose 111 mM 1.

Critical Differences: ReSoMal vs. Standard ORS

ReSoMal is specifically designed for severely malnourished children and differs substantially from standard WHO-ORS 2:

• Lower sodium content to prevent fluid overload in malnourished patients
• Higher potassium content to address severe potassium depletion common in malnutrition
• Additional minerals (magnesium, zinc, copper) not present in standard ORS

Research demonstrates that ReSoMal allows less sodium and more potassium absorption compared to WHO-ORS, which is critical for malnourished patients 2.

Why You Cannot Make ReSoMal with Only Water, KCl, and Sugar

Attempting to prepare rehydration solution with only these three ingredients will fail because 1:

• No sodium source: Sodium is essential for glucose-coupled water absorption in the intestine—the fundamental mechanism by which ORS works 1
• No bicarbonate/citrate: Required to correct metabolic acidosis that accompanies severe diarrhea 1
• Incorrect electrolyte ratios: KCl alone without sodium creates dangerous electrolyte imbalances

Administration Guidelines for Standard ORS

For Mild Dehydration (3-5% fluid deficit):

• Administer 50 mL/kg over 2-4 hours 1
• Start with small volumes (one teaspoon) using a syringe or medicine dropper, gradually increasing as tolerated 1

For Moderate Dehydration (6-9% fluid deficit):

• Administer 100 mL/kg over 2-4 hours 1

Ongoing Losses:

• Replace with 10 mL/kg for each watery stool 1
• Replace with 2 mL/kg for each vomiting episode 1

Critical Safety Warnings

Do not use plain water, tea, or sugar water alone for rehydration 1:

• Hypotonic fluids (water, tea, coffee) worsen fluid losses in patients with high-output diarrhea or jejunostomy 1
• These fluids cause net secretion rather than absorption in the small intestine 1

Severe dehydration (≥10% fluid deficit) requires immediate IV rehydration with Ringer's lactate or normal saline at 20 mL/kg boluses until perfusion normalizes 1.

Proper Preparation Steps for Standard WHO-ORS

1. Use clean water: Boiled and cooled, or from safe source 1
2. Measure ingredients accurately: Incorrect mixing creates hypertonic solutions that worsen diarrhea 1
3. Mix thoroughly until all ingredients dissolve 1
4. Prepare fresh daily: Discard unused solution after 24 hours 1
5. Store in clean, covered container 1

Common Pitfalls to Avoid

• Never use only sugar and water: This lacks essential electrolytes and will not correct dehydration 1
• Never use only salt and water: Without glucose, sodium-coupled water absorption cannot occur 1
• Never prepare concentrated solutions: Hypertonic solutions cause osmotic diarrhea and worsen dehydration 1
• Never add extra ingredients beyond the standard recipe without medical guidance 1