Most loose motion after the Chennai rains is treated with fluid, not with a test and not with an antibiotic. Give 50–100 ml of ORS after every loose stool for a child under two years and 100–200 ml for a child of two or more, and throw away any made-up solution 24 hours after mixing it.
Those figures are from the ICMR and Ministry of Health and Family Welfare Standard Treatment Workflow for acute diarrhoea, which follows the WHO IMCI module, and the 24-hour rule is printed on every WHO-specification ORS packet. This article, written for patients at AJSMC in Egmore, Chennai, sets out how ORS is mixed and given, which home fluids the national toolkit itself endorses, the dehydration signs you can check at home, and the narrow situations in which a stool test changes anything.
One thing before anything else. AJSMC is an outpatient centre with no casualty unit, no emergency department, no inpatient beds and no intensive care, and it is closed outside Monday to Saturday, 10am to 9pm. Severe dehydration is treated with intravenous fluids in hospital. If someone, a small child especially — is drowsy or unconscious, is vomiting everything and cannot keep ORS down, is not able to drink or breastfeed, has convulsions, or is passing blood in the stool, do not wait for an outpatient clinic to open. Call 108 or go to the nearest hospital with a 24-hour emergency department, at any hour and on any day.
How long does loose motion normally take to settle?
Diarrhoea is defined as three or more loose or watery stools in a day, or more frequent stools than is normal for that person (WHO diarrhoeal disease fact sheet, 2024). The Indian national workflow calls it acute below 14 days, persistent at 14 days or more, and dysentery when there is blood in the stool (ICMR / MoHFW Standard Treatment Workflow, Acute Diarrhea).
The national material does not promise a number of days; it gives two review points instead. The ICMR / MoHFW workflow says to go back to the doctor if there is no improvement in 5 days, and diarrhoea continuing beyond 14 days is persistent diarrhoea and needs investigation rather than more home treatment. Zinc, in children, shortens things measurably — WHO (2024) puts the reduction at 25% of episode duration and 30% of stool volume.
What decides whether this is a home problem at all is not the number of stools. It is hydration, and whether the person can keep fluid down.
How do you make ORS correctly at home?
Read the packet first. This is the single most useful line in this article for a household in Chennai, because Indian ORS sachets are sold in both 200 ml and 1 litre sizes, and the ICMR / MoHFW workflow tells the reader in as many words: on the ORS packet, check whether 200 ml or 1 litre of clean water is needed. A one-litre sachet mixed the same way as a 200 ml one, or the reverse, gives a solution at the wrong strength.
| Step | What the national and WHO material says |
|---|---|
| Check the packet | Indian sachets come in 200 ml and 1 litre sizes — check which volume of water your packet needs (ICMR / MoHFW Standard Treatment Workflow) |
| Water | Clean, potable drinking water only, measured out — not estimated by eye |
| Mixing | Dissolve the entire contents of one packet in the stated volume. Never a part packet, never a part measure |
| What is in a 1-litre sachet | 20.5 g in total: glucose anhydrous 13.5 g, sodium chloride 2.6 g, trisodium citrate dihydrate 2.9 g, potassium chloride 1.5 g (WHO, 2006) |
| How long it keeps | Discard any solution remaining 24 hours after it was prepared. WHO requires this warning on every packet |
| Do not | Add sugar, salt, milk or flavouring to made-up ORS. Glucose powder is not ORS, and the belief that ORS and glucose are the same thing is a common and costly one |
The formulation itself changed in 2003, and the ORS sold today is lower in sodium and in glucose than the packet many households remember. WHO (2006) records that this reduced-osmolarity version cut the need for unscheduled intravenous fluids in children by 33%.
| Constituent | Current low-osmolarity ORS (WHO, 2006) |
|---|---|
| Sodium | 75 mmol/L |
| Glucose (anhydrous) | 75 mmol/L |
| Potassium | 20 mmol/L |
| Chloride | 65 mmol/L |
| Citrate | 10 mmol/L |
| Total osmolarity | 245 mOsm/L |
Do not make up a home-made sugar-and-salt drink from a remembered recipe in place of a sachet. None of the Indian national documents used here publishes one for home use, and a wrong ratio is not a harmless approximation.
How much ORS should be given after each loose stool?
By age, after every single loose stool, and in addition to whatever the person normally drinks, not instead of it. These are the Plan A amounts in the ICMR / MoHFW workflow, which follow WHO IMCI (2014).
| Age | ORS after each loose stool | How to give it |
|---|---|---|
| Up to 2 years | 50–100 ml | One teaspoon every 1–2 minutes, by spoon |
| 2 years and above | 100–200 ml | One sip every 1–2 minutes, from a cup |
| Older children and adults | As much as they want | WHO's physician manual and the WHO ORS label both say to drink freely, as required |
Two practical points. If the child vomits, wait 10 minutes and then start again more slowly — vomiting once is not a reason to stop offering ORS (ICMR / MoHFW workflow). And a breastfed baby continues breastfeeding, more often and for longer, in between the ORS. Continue until the diarrhoea stops.
Which home fluids actually help, and which make it worse?
Home fluids are for preventing dehydration and for after rehydration is complete; ORS is what treats dehydration that has already set in. The national sequence is to rehydrate with ORS, reassess after about 4 hours, and once the child is no longer dehydrated, go back to home available fluids. The lists below are the ones the national and WHO documents actually name, and nothing has been added to them.
| Give | Named in |
|---|---|
| Breast milk, more often and for longer feeds | ICMR / MoHFW workflow; WHO |
| Rice water, salted | ICMR / MoHFW workflow; WHO |
| Yoghurt drink, salted | ICMR / MoHFW workflow; WHO |
| Vegetable or chicken soup, with salt | ICMR / MoHFW workflow; WHO |
| Unsweetened fresh fruit juice | ICMR / MoHFW workflow; WHO |
| Green coconut water | ICMR / MoHFW workflow; WHO |
| Clean water | ICMR / MoHFW workflow; WHO |
| Avoid | Named in |
|---|---|
| Carbonated beverages and soft drinks | ICMR / MoHFW workflow; WHO |
| Commercial and sweetened fruit juices | ICMR / MoHFW workflow; WHO |
| Sweetened tea and coffee | ICMR / MoHFW workflow; WHO |
| Local medicinal teas and infusions | ICMR / MoHFW workflow; WHO |
Extra home fluid goes in after each loose stool, and more if the child asks for it, but a very young baby with diarrhoea is not a home-treatment problem at all, and needs to be seen rather than managed with fluids at home.
Does a child with diarrhoea need zinc, and for how long?
Yes, and the length of the course is the part most households get wrong. Zinc is part of India's national treatment for childhood diarrhoea, it is started on the first day, and the course is meant to be completed in full even if the stools have settled long before it ends. Stopping the moment the child looks better is the common mistake.
The amount and the number of days are not something to work out at home from a tablet strip. Both are set by the treating doctor, who will match them to the child's age, and the pharmacist can confirm what the packet you have been given contains.
| Who | What applies | How it is given |
|---|---|---|
| A very young infant | Not a home-treatment situation — diarrhoea at this age is itself a reason to be seen | Referred, not treated at home |
| Older infants and children | Zinc as part of the national diarrhoea treatment, alongside ORS and continued feeding | Dissolved in expressed breast milk on a clean spoon, or in breast milk or clean water; an older child may chew the tablet |
Zinc replaces what was lost in the stools and supports appetite and weight gain during recovery. WHO (2024) is the source for the size of the benefit, a 25% reduction in how long the episode lasts and a 30% reduction in stool volume. Note that every verified figure here is paediatric: the national zinc programme is a children's programme, and none of this is evidence for zinc in an adult with loose motion.
Which signs of dehydration mean the person must be seen today?
Two or more signs in a column classify that category. This is the WHO IMCI (2014) assessment reproduced in the ICMR / MoHFW workflow.
| Sign | No dehydration | Some dehydration | Severe dehydration |
|---|---|---|---|
| Alertness | Normal | Restless, irritable | Lethargic or unconscious |
| Eyes | Normal | Sunken | Sunken |
| Drinking | Normal | Drinks eagerly, thirsty | Not able to drink, or drinking poorly |
| Skin pinch on the abdomen | Goes back immediately | Goes back slowly | Goes back very slowly, over 2 seconds |
| What it means | Treat at home with ORS, zinc for children, and continued feeding | Supervised ORS over about 4 hours with reassessment — the volume is worked out by weight, by the treating doctor | Intravenous fluids in hospital — not an outpatient problem |
The skin pinch has a technique, and done wrongly it reads falsely reassuring. The ICMR / MoHFW workflow describes it precisely: use the abdomen, halfway between the navel and the side; use the thumb and first finger rather than the fingertips; make the fold run up and down the body; pick up all the layers of skin and the tissue underneath; hold for one second, release, and watch. Longer than two seconds to flatten is very slow, and that is severe.
Read the bottom row honestly. Some dehydration means supervised rehydration and reassessment, which an outpatient visit can arrange. Severe dehydration means intravenous fluids under observation, and that belongs in a hospital with beds. AJSMC has none, and cannot be the destination for it.
When is a stool test actually worth doing?
For most people in Chennai with watery loose motion and no fever, no blood and no severe pain, it changes nothing, the treatment is ORS, zinc in children, continued feeding and review if it worsens, whatever the report says. The Indian national workflow orders no stool test at all for uncomplicated acute watery diarrhoea. That is a narrower claim than "stool tests are useless", and the difference matters, because there are a handful of situations where the test genuinely directs treatment.
| Situation | Is a stool test indicated? | Source |
|---|---|---|
| Acute watery diarrhoea, no fever, no blood, otherwise healthy person | No — it does not change management | IDSA 2017 guidelines; the ICMR / MoHFW workflow orders none |
| Fever along with the diarrhoea | Yes | IDSA 2017 guidelines |
| Blood or mucus in the stool | Yes | IDSA 2017 guidelines |
| Severe abdominal cramping or tenderness | Yes | IDSA 2017 guidelines |
| Signs of sepsis | Yes — and this is a hospital problem, not a clinic one | IDSA 2017 guidelines |
| Immunocompromised person | Yes — culture, viral studies and parasite examination | IDSA 2017 guidelines |
| Dysentery not improving after 2 days of treatment | Yes — stool culture and routine examination for amoebic trophozoites | ICMR / MoHFW workflow |
| Diarrhoea lasting 14 days or more | Yes — stool routine microscopy, urine routine and culture | ICMR / MoHFW workflow |
| Suspected cholera, with large-volume rice-water stools | Yes — hanging drop and culture | ICMR / MoHFW workflow; IDSA 2017 guidelines |
| Uncomplicated traveller's diarrhoea | No, unless treatment is indicated | IDSA 2017 guidelines |
The blood tests the workflow does ask for are different: electrolytes are preferred where there is some dehydration, and a complete blood count with electrolytes is essential in severe dehydration. AJSMC has an in-house laboratory in Egmore, Chennai handling blood and urine samples. Before travelling for any test asked for in this article, call 044 2532 2021 and check where the sample is to be given, a sample taken to the wrong place is a wasted trip on a day you are already unwell.
Which medicines should you not take for this?
Antibiotics, in almost every case. The national material is blunt about it: antibiotics are not effective in treating most diarrhoea, they rarely help, they make some children sicker, and unnecessary use increases resistance. They are restricted to a short list of situations — dysentery, cholera with severe dehydration, diarrhoea in a very low birth weight or severely malnourished child, diarrhoea alongside another systemic infection such as pneumonia, and diarrhoea with danger signs, and the plain version for parents is this: if your child has not been given one, your child does not need one. The 2017 IDSA guidelines say the same for adults — in most people with acute watery diarrhoea and no recent international travel, empiric antibiotic treatment is not recommended.
Anti-diarrhoeal and stool-binding medicines are the second thing to leave on the shelf. The instruction in the national material is absolute, never give anti-diarrhoeal drugs to children. They do not treat the fluid loss, which is what actually causes harm, and they carry real risk in a small child. No medicine of any class should be bought over the counter and started for a child with diarrhoea in place of ORS, zinc and food.
Should you stop food or milk until the diarrhoea settles?
No, and this is the correction with the most evidence behind it. Two beliefs come up again and again. That certain foods should be cut back during diarrhoea, and that feeding will make it worse. Both the ICMR / MoHFW workflow and WHO say to keep feeding.
- Continue breastfeeding, more frequently and for longer than usual.
- A non-breastfed infant continues the usual milk or formula, at least once every three hours. Do not dilute the feed.
- A child over six months gets age-appropriate food, based on what they were eating before the illness.
- Resting the gut, fasting and skipping milk are not part of any of this guidance. Nor is boiling the fluid out of the diet.
One more belief is worth naming for Chennai households: that ORS should not be given in cold or wet weather. It should. Season has nothing to do with it.
Who needs to be seen immediately rather than waiting it out?
These are the referral criteria in the ICMR / MoHFW workflow and the national diarrhoea control material. They are not a graded list — any single one of them means going now.
| Sign | Why it matters |
|---|---|
| Blood in the stool | Dysentery — needs assessment, and referral if the child is under 1 year or dehydrated |
| Vomiting everything, unable to keep ORS down | Oral rehydration has failed; intravenous fluids are needed |
| Drowsy, lethargic or unconscious | Severe dehydration |
| Not able to drink or breastfeed | Severe dehydration |
| Convulsions | Emergency |
| Sunken eyes with the skin pinch going back very slowly | Severe dehydration — intravenous fluids, in hospital |
| A young infant with diarrhoea | An automatic referral, whatever else is present — small babies are not treated for this at home |
| Fast or difficult breathing alongside the diarrhoea | Suggests an associated pneumonia or sepsis |
| Severe malnutrition | Referral, regardless of how the diarrhoea looks |
| Diarrhoea continuing beyond 14 days | Persistent diarrhoea — needs investigation |
To say it once more plainly: AJSMC in Egmore, Chennai has no casualty unit, no emergency department, no inpatient beds and no intensive care, and outpatient hours are Monday to Saturday, 10am to 9pm only. Anyone on that list, and anyone who needs round-the-clock intravenous fluids, belongs in a hospital with a 24-hour emergency department. Call 108 rather than waiting for us to open on a Sunday morning.
How do you reduce the risk during the Chennai rains?
WHO's diarrhoeal disease fact sheet (2024) puts safe drinking water, safe sanitation and handwashing with soap at the centre of prevention, along with exclusive breastfeeding for the first six months and rotavirus vaccination in children. During and after flooding in Chennai, supply lines are the weak point — be certain of the water you drink and the water you mix ORS with, wash hands before eating and after using the toilet, and be careful with cut fruit, ice and roadside water. Keep a couple of ORS sachets at home before the rains rather than looking for them at 2am with a vomiting child.
When should you see a doctor?
See a doctor if the diarrhoea has not improved in 5 days, if it has passed 14 days, if there is fever, blood or mucus in the stool or severe abdominal pain, if the person is immunocompromised, or if you are unable to keep enough fluid going in at home. Bring the number of stools in the last 24 hours, whether there has been vomiting, whether urine has reduced, and how much ORS has actually gone in. Those four answers decide more than any test does.
Outpatient consultations at AJSMC, Police Commissioner Office Road, Egmore, Chennai 600008, run Monday to Saturday, 10am to 9pm. Call 044 2532 2021 to book. And for a drowsy child, a person vomiting everything, blood in the stool or a skin pinch that stays up, call 108 or go straight to the nearest hospital with a 24-hour emergency department instead.
