ORS saves millions of lives every year, and yet, some companies thought it was okay to sell sugary drinks labelled as “ORS,” misleading thousands of parents into thinking they were giving their children a life-saving solution for diarrrhoea. Until one hyderabad based pediatrician, Dr Sivaranjani Santosh relentlessly battled for eight long years to ban the sales of fake ORS. However, after the ban imposed by FSSAI, Delhi high court allowed the sales of Rs 180 crore stock of ORSL.
How Was ORS Made?
Before the 1970s, diarrhoea was among the leading causes of death in Indian children. In cholera outbreaks across Bengal, children often died within hours of symptom onset. IV fluids were limited, dehydration was rapid, and there was little that doctors could do once severe shock set in.
During the 1971 Bangladesh war, millions of refugees flooded camps across West Bengal. Cholera and acute watery diarrhoea spread like wildfire. Thousands of children were dying every week, not because treatment was impossible, but because it was inaccessible.
It was in these camps that Dr. Dilip Mahalanabis, a physician working with the WHO Cholera Research Unit in Calcutta, decided to try something revolutionary. He gave patients an oral solution of glucose and electrolytes — sodium, chloride, potassium, and bicarbonate — mixed in clean water.
The science was simple. Glucose helps sodium absorption in the intestine via the sodium–glucose cotransport mechanism, and water follows sodium into the bloodstream. Even in severe diarrhoea, this pathway remains intact.
The results were nothing short of life-changing. Mortality in refugee camps dropped from over 30% to under 5%. For the first time, lives could be saved without IV lines or hospital beds just by giving the right mix of salts and sugar in water.
This became the foundation of Oral Rehydration Therapy (ORT) — hailed as one of the greatest public-health breakthroughs of the 20th century.
Over time, WHO and UNICEF standardized the formula into the ORS packets we know today — a low-osmolarity solution with a total osmolarity near 245 mOsm/L and a precise balance of sodium and glucose at 75 each, along with potassium and citrate. That exact ratio is what keeps water moving into the bloodstream, not back into the gut. So, changing it, even slightly, breaks the science that makes ORS work.
Marketing Sugary Drinks As “ORS”
Decades later, brightly coloured drinks began appearing on supermarket shelves; each proudly carrying the word “ORS” on the label. But these weren’t medical formulations. Many contained too much sugar and too little sodium, packaged and sold as refreshing “electrolyte drinks.”
Anyone who has treated a child with diarrhoea knows why that matters. Excess sugar increases the solution’s osmolarity, pulling more water into the gut instead of back into the bloodstream. This leads to worsened dehydration, more stools, and is potentially life-threatening.
That is exactly why every pediatric guideline, from the Indian Academy of Pediatrics to the American Academy of Pediatrics — tells parents not to use juices, sodas, sports drinks, or sweet teas for rehydration during diarrhoea. Yet, parents in India were unknowingly buying these look-alike tetra packs labelled “ORS,” thinking they were helping their child, when in reality, they were doing the opposite.
Why Fake ORS Can Be Life-Threatening
At first glance, a tetra pack labelled “ORS” may look harmless, like just another flavoured rehydration drink. But in medical terms, it can be dangerous, even fatal, especially for children or elderly patients battling dehydration.
True ORS works because of a specific physiological mechanism inside the small intestine:
- When glucose and sodium are present in a 1:1 ratio, they get absorbed together through a transporter called SGLT-1 (Sodium–Glucose Co-Transporter 1).
- Water follows this movement through osmosis, effectively pulling fluid back into the bloodstream, thus, rehydrating the body efficiently.
- This pathway stays functional even during severe diarrhoea, which is why ORS saves lives when IV fluids aren’t available.
However, when the solution has too much sugar and too little sodium, which is the case with many so-called “ORS drinks” in the market, this mechanism breaks down.
This is what happens instead:
- High sugar concentration increases osmolarity inside the intestine. Instead of drawing water into the bloodstream, it starts pulling water into the gut.
- This leads to osmotic diarrhoea — worsening fluid loss and dehydration.
- As sodium levels drop (a condition called hyponatremia), cells in the brain can swell, causing confusion, seizures, or even coma in severe cases.
- In young children, whose fluid reserves are smaller, this decline can happen within hours.
That’s why every standard ORS packet — the kind approved by WHO and ICMR, contains precisely:
- Sodium 75 mEq/L
- Glucose 75 mmol/L
- Potassium 20 mEq/L
- Citrate 10 mmol/L
- Total osmolarity 245 mOsm/L
Any deviation from this balance can make the solution ineffective or harmful.
To put it simply:
ORS is not a “hydration drink.” It’s a scientifically balanced medical therapy. A sugary beverage that imitates it can turn a manageable diarrhoea into a medical emergency in no time.
A Long Fight Against Misleading ORS Labels
When hospitals began seeing children arriving more dehydrated after being given these so-called ORS drinks, Dr. Sivaranjani Santosh, a senior pediatrician from Hyderabad decided she had to do something to stop this.
She started filing formal complaints, sharing the physiological evidence, and petitioning regulators to act. For eight long years, she wrote to authorities, attended hearings, and urged that ORS, in India, be recognized for what it truly is: a drug, defined under the Drugs and Cosmetics Rules, not a sugary beverage. As she often said, “You can’t call something ORS just because it sounds scientific. The science behind ORS is very specific and changing that balance makes it dangerous.”
The Regulatory Battle: FSSAI, Court Orders, and the Turning Point
After years of advocacy, the Food Safety and Standards Authority of India (FSSAI) finally issued warnings in 2022, clarifying that the term “ORS” must not be used on fruit-based or ready-to-drink beverages. Only products that match the WHO formula could carry the name.
In October 2025, FSSAI ordered a ban on such misleading products, a move widely hailed by doctors and public health experts. However, one major manufacturer, JNTL Consumer Health (makers of ORSL), approached the Delhi High Court, which temporarily stayed the ban, allowing the company to continue selling its “ORSL” drink until further hearings. While the legal process continues, the scientific and ethical clarity remains clear: ORS is not a marketing term. It’s a life-saving medicine.
A simple sachet of ORS has saved millions of lives across the world. Yet, imagine the plight of a mother giving her child a costly, sugary drink mislabeled as “ORS,” believing it would help treat diarrhoea, not realising it could make the dehydration worse. Thankfully, there are doctors like Dr. Sivaranjani Santosh who refused to look away and took up the fight to protect that trust.
Frequently Asked Questions (FAQs)
Q: What exactly is ORS?
ORS (Oral Rehydration Solution) is a precise combination of sodium, glucose, potassium, and citrate in water, designed to replace fluids lost during diarrhoea or vomiting.
Q: Why can’t I give fruit juice, soda, or sports drinks instead?
They have too much sugar and not enough electrolytes. This increases stool output and worsens dehydration.
Q: What is the correct ORS formula?
The WHO-recommended formula contains sodium 75 mEq/L, glucose 75 mmol/L, potassium 20 mEq/L, citrate 10 mmol/L, and total osmolarity around 245 mOsm/L.
Q: Are tetra packs “ORS drinks” safe?
Most of them are not true ORS unless they meet the above formula. Always read the label, if the sodium content is below 75 mEq/L or sugar is high, avoid it.
Q: What should parents use for diarrhoea?
Stick to WHO-approved ORS sachets. If the child cannot drink or shows signs of severe dehydration (sunken eyes, poor urine output, lethargy), seek medical help immediately.
How HealthPil Can Help
At HealthPil, we stand for clarity in healthcare. Our pediatricians are available for online consultations to guide you through what to do when your child has diarrhoea, vomiting, or dehydration.
We help parents understand:
- When to use ORS and how to prepare it correctly.
- What warning signs mean your child needs medical attention.
- How to avoid misleading products and unsafe “hydration” alternatives.
We also provide trusted second opinions from qualified pediatricians so you can make informed choices.
Disclaimer
This article is meant for public awareness only. It does not replace medical advice, diagnosis, or treatment. Always consult a qualified healthcare professional if your child is dehydrated, vomiting, or has persistent diarrhoea.
