Caution in preparing oral saline
The word 'saline' comes from another word 'salt'. Once upon a time,the 'salary' of a laborer was settled upon how much salt he could secrete through sweat. Now a days 'oral saline' refers to a typical solution that is usually used in rehydrating a person. Important thing is that you should be aware of that 'salt' fact in making oral saline.
Few months ago, a girl of three years of age was admitted at our pediatric ward. She had been passing watery loose stool for last two days, accompanied by frequent vomiting. Lastly she had seizure which made the anxious parents to bring her at hospital. On query mother stated that the girl was offered homemade oral rehydration saline after each purging. The problem was mother did not know the accurate preparation technique. She took around one glass of water and mixed the whole packet of saline within.We examined the girl thoroughly and found that she was severely dehydrated and one of the salts in the blood (sodium) was likely to be raised, which should be confirmed upon investigations.
Actually the problem was 'hypernatremia', i.e. excess in blood sodium concentration. We know our blood contains various types of salt in very specific range. Decrease or excess in salt concentration can result in grave condition. In case of diarrhea and vomiting our bodies lose some salt, particularly sodium, potassium and chloride. Again children contain more water proportion in the body in comparison to adult. So, salt concentrations change dramatically in their blood. The aim of oral rehydration is not to correct disease process, rather to prevent water and salt imbalance in the body.
In our particular case, the mother made concentrated saline, which when entered into the body made the girl thirstier. The girl then again demanded more saline. A vicious cycle was taking place, which made the blood sodium (and also chloride) rich. Excess sodium draws water from cell. Our brain cells get shrinked. Initially patients become dehydrated. In advanced stages seizure, unconsciousness and even death may occur.
Besides, there are few misconceptions exist among caregivers regarding rehydration saline. Some points should be noted.
1. Can I (mother herself) drink saline instead of my baby, who is breast fed? Answer is 'no'. Because your baby is losing water and salt, not you. So s/he must be treated.
2. I'm afraid of giving too much saline. Can it cause him/her cough and cold? No, preparing saline with appropriate warm water is not likely to cause respiratory symptoms. If concurrent respiratory infectious agent is present that may cause problem.
3. Giving watery substance results in more watery stool. This is another wrong conception. Passage of watery stool is due to infectious pathology. It will persist till pathology is present. Oral saline is aimed to correct water lose. It is lifesaving in conditions.
4. I'm giving saline but stool is not improving, rather it is worsening. Well, the oral saline helps to maintain normal water and salt concentration. It has no effect on disease length. Your doctor may give additional advices and drugs, if needed, to treat disease.
Finally, I must add that, amount and frequency of giving oral saline is very crucial in children. Doctor will guide you according to age, weight, dehydration status and other health conditions of the baby. More emphasis should be given in encouraging mothers to prepare 'safe' oral rehydration saline.