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03/20/2007 Archived Entry: "You need this in your bug-out bag"

ITíS 1:30 AM. SILVER HAS BEEN AWAKENED from a sound sleep by cries of agony. A family member lies on the floor of the bathroom. He is barely coherent, writhing in pain. Heís pale; his skin is cold and clammy, pulse rapid and weak. Eventually he talks clearly enough to tell you that heís had 2 bouts of diarrhea with cramps, and feel like more is on the way. The pain is from strong tingling and cramp sensations in his muscles. He isnít nauseous and hasnít vomited, and doesnít hurt in any particular place. Heís lying on the floor because he feels so dizzy and weak heís afraid of fainting if he sits or stands.

He slips back into semi-consciousness, awake but not very responsive, moaning in pain. Frantically you review what you know of the day. You both ate pasta for dinner, so food poisoning doesnít seem likely. You know from dinner conversation that he worked hard all afternoon, saw the time was late, and jumped in the car to come pick you up. He mentioned a light, late breakfast. There was no mention of feeling poorly earlier, and none during dinner.

The cramps are getting worse, the writhing now bordering on convulsions. What is wrong? What do you do?

This happened to me recently, and it was scary and sobering. Before I reveal the cause of the malady, I want to note that this is likely in any kind of scenario that involves a bug-out bag. Whether youíre young and fit, or fifty and fat, this could happen to you. Whatís more, I couldnít find any list of bug-out bag ingredients that mentioned the necessary response:

Oral Rehydration Therapy. I opened one of the bottles of Pedialyte that I keep around in case of diarrhea. I gave about half a cup to my patient, who sipped it down in a few minutes.

Almost immediately he started feeling better. After a few minutes he felt well enough to let me get him off the floor and into bed. There, I gave him another 12-oz glass, and he drank it all down. (Had he been vomiting, I would have given small sips every 5 minutes. Even if he threw it back up, the salts and sugars would have entered his system.) He felt almost normal in 10 minutes. Twenty minutes later, I gave him another 12-oz glass. All told, he drank nearly a liter in less than an hour. He fell into a normal sleep, and awoke feeling fine.

Hereís what happened: a light, late breakfast of toast with coffee, no lunch, and 4 hours of heavy exertion in the winter cold. He had lost a lot of fluids and salt via sweating. The pasta dinner provided complex carbs but not much salt and not much sugar for quick energy. The wine, while taken in moderation, only increased the dehydration, as metabolizing alcohol uses water. A few hours later, my patientís sodium and/or potassium levels had slipped outside the narrow range the body requires, and the diarrhea and cramping began. The classic signs of serious dehydration are:

* sunken eyes or, for infants, sunken fontanel ("soft spot" at the top of the head)
* loss of skin turgor, rapid pulse with low blood pressure, cold clammy extremities
* excessive thirst or dry mouth
* decreased urine or no urine or dark urine (it should be pale in color)
* very ill appearance, listless or fainting

Oral Rehydration Therapy (ORT) has been heavily promoted in developing countries, and is credited with reducing the deaths from infant diarrhea from 5 million to 2 million per year. It works by restoring both fluid and electrolyte balance in the patient. Whatís particularly amazing is that it helps in cases where the patientís sodium levels are too low as well as when they are too high. It also corrects potassium imbalances.

The secret is the correct ratio of salt and sugar. The initial version approved by the World Health Organization (WHO) is pretty salty, 90 mg equivalent sodium per liter. Theyíve since developed a reduced osmolarity version. Pedialyte is 45 mg equivalent sodium.

Sports drinks and soft drinks are NOT acceptable substitutes. They tend to have far too much sugar, and can cause even further fluid loss in a patient with diarrhea and/or electrolyte imbalance. Sports drinks are for healthy athletes, not sick people.

Plain water is better than nothing, but by the time a patient is exhibiting symptoms of electrolyte imbalance, such as the diarrhea and cramping in my patient, plain water may not fix the problem. Even if it does, it will take a lot longer than the near-miraculous cure I witnessed.

There are many recipes on the net for making ORT solution at home, but beware. Some are clearly far off the mark, with way too much sugar. Few provide potassium, those that do will call for "no salt" salt substitute, which is potassium chloride. I want some premixed bottles of sterile solution to keep around the house; you can't boil ORT after it is mixed, and it has just enough sugar to make it a good growth medium for nasty things. Keep opened bottles refrigerated, and discard after 24 hours.

Pedialyte is expensive, about $6 for a 1 liter bottle, but it is convenient to keep at home. Walgreenís sells a store brand for $4 a liter. The WHO distributes packets of ORT in developing nations at a reported cost of $0.03 each. It sounds cheap unless youíre living on $0.20 a day and three of your kids are sick.

I found it amazingly hard to find ORT packets for sale in the US.
There was plentiful information on foreign firms making the packets, but no way to buy them. Eventually I found two US suppliers.

Jianis Brothers
2533 Southwest Boulevard
Kansa City, MO 64108-2395 U.S.A.

[816] 421-2880 - Fax [816] 421-2883
They donít appear to have a website. I found the following information at
rehydrate.org:


Oral Rehydration Salts manufactured by Jianas Brothers in Kansas City, MO, U.S.A.

Each packet of ORS contains the equivalent of:

Sodium Cloride 3.5 g
Potassium Cloride 1.5 g
Trisodium Citrate, Dihydrate 2.9 g
Glucose Anyhydrous 20 g

The 27.9 gram dose is intended for dissolution into one liter of drinking water.

Packets are packed as follows:

Carton 125 packets 9 lbs. 0.3 cu. ft.
Case 625 packets
5 cartons 45 lbs. 1.6 cu. ft.

The minimum order is one carton [125 packets]. NSN: 6505-01-197-8809.

The F.O.B plant prices are as follows:

Quantity Price per
packet carton
1-4 cartons $0.55 $68.75
5-99 cartons $0.50 $62.50
100 or more cartons $0.30 $37.50

Please include $7.00 per carton and/or $24.00 per case for shipping and handling. VISA and MasterCard are accepted

Make checks payable to Jianas Brothers Packaging Co.

For C.O.D. orders please add $5.00 and indicate that order is C.O.D.

Usage:
For replacement of water and electrolytes lost during moderate to severe diarrhea.

Features:
World Health Organization formula

The second US source is Cera Products online store.

Cera sells three version of the ORT packets, 50, 70, and 90 ml/Eqm sodium.
What was this? According to the CERA website:


CeraLyte 50 is for mild Dehydration or for maintaining fluid balance and volume, and is available in packets and ready-to-drink liquid.
CeraLyte 70 is for mild to moderate diarrhea, to prevent and correct dehydration. Ideal for travelers.
CeraLyte 90 is for severe diarrhea and dehydration--where fluid losses are high--such as in cholera or with short bowel or ileostomy.

Some more research found this article:
New formulation of Oral Rehydration Salts (ORS) with reduced osmolarity.

It seems that the WHO found that the original solution, while effective at saving lives of infants, did nothing to reduce the duration of diarrhea. They developed a reduced sodium and sugar that was less concentrated (reduced osmolarity) than the original formula. The amount of sodium in a packet to be mixed to make 1 liter of ORT has been reduced from 3.5 to 2.6 grams.
The Cera 50 formula is similar in concentration to Pedialyte, although all the Cera formulas provide carbohydrates in place of glucose. Glucose is fuel and requires no digestion, while carbs will need some time to digest.
I found individual packets of the Jianas Brothers WHO formulation available online for $1.25 each at
Tactical Response Gear. Jianas Brothers sells 125 packets for $68.75.
I found half-sized (30 g versus 50 g for a full liter) packets of CeraLyte 70 Rice-Based Electrolyte Drink Mix Packets, Lemon Flavor, 24 packets for $51 on Amazon. Cera sells the full-sized packets for $245 per 100.

This experience was sobering. Iím very glad I didnít panic and take my patient to the emergency room, although it was a near thing. Had I done so, there is a near certain chance of extended waiting, and a high probability of misdiagnosis and excessive, invasive treatment. The Cera website has testimonials from people who were confined to hospital beds before being cured by Cera offered by family members.

I bought 100 packets of the Ceralyte 70 lemon flavor. At $245, it isnít cheap, but this could literally save lives.

Posted by Silver @ 06:13 AM CST
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