The Branding Battle for Rehydration: Why a Hyderabad Doctor is Taking on “Fake” ORS

HYDERABAD — In a move that has sent ripples through the Indian medical community and the pharmaceutical industry, Dr. Sivaranjani Santosh, a prominent senior paediatrician, launched a national online petition on April 20, 2026. The petition demands that the Food Safety and Standards Authority of India (FSSAI) and the Ministry of Health and Family Welfare (MoHFW) enforce stricter branding regulations on sugar-based electrolyte drinks that mimic the appearance and naming conventions of medical-grade Oral Rehydration Salts (ORS).

The initiative, titled “Clear Communication for Electrolyte Drinks: Protect Consumers in Pharmacies,” highlights a critical loophole in public health safety. Despite a landmark FSSAI ban in late 2025 on non-WHO compliant products using the “ORS” label, Dr. Santosh argues that “look-alike, sound-alike” brands continue to mislead parents, potentially leading to fatal consequences for children suffering from severe dehydration.

The Core of the Confusion: Marketing vs. Medicine

At the heart of the controversy is the distinction between a beverage and a medicine. True Oral Rehydration Salts (ORS) follow a precise formula established by the World Health Organization (WHO). This formula requires a specific balance of:

• Glucose: To facilitate the absorption of salt and water.

• Sodium and Potassium: To replace essential electrolytes lost during illness.

• Citrate: To correct acidosis caused by dehydration.

When a child suffers from diarrhea—a condition that claims over 500,000 young lives annually worldwide—the “osmolarity” of the fluid they drink is a matter of life and death.

“This issue is not about whether sugar-based drinks are safe in isolation. It is about how they are presented and perceived,” Dr. Santosh stated in her petition. She emphasizes that in the high-stress environment of a pharmacy, a parent whose child is vomiting often reaches for familiar-looking bottles with names like “ORSL” or similar phonetic variants, believing they are buying a life-saving medical treatment.

A Lone Fight Becomes a National Movement

Dr. Santosh’s campaign is the culmination of an eight-year crusade. Her persistent advocacy previously led to the FSSAI’s October 2025 directive, which revoked permissions for “ORS” trademarks on products that did not meet the WHO-UNICEF standards.

However, the “victory” was short-lived. Manufacturers pivoted to evocative branding that avoids the literal letters “ORS” but retains the same color schemes, shelf placement, and phonetic similarities. The frustration over the lack of systemic support led Dr. Santosh to resign from the Indian Academy of Paediatrics (IAP) recently, citing a need to speak more freely without the constraints of institutional diplomacy, particularly in the face of legal threats from pharmaceutical giants.

Evidence from the Frontlines

Reports from major Hyderabad institutions, including Gandhi Hospital and Osmania General Hospital, have documented cases where children were admitted to emergency wards with worsened dehydration or dangerous blood sugar spikes after being given sugary “electrolyte” drinks instead of actual ORS.

“Misleading branding exploits parental panic during child illness; a sugary ‘electrolyte’ drink won’t save a dehydrated kid like WHO-ORS does,” says Dr. Rajesh Kumar (name simulated), a Mumbai-based child health specialist. “We have seen cases in the ER where these products actually draw more water out of the body and into the gut because the sugar content is too high, making the diarrhea worse.”

The Industry Perspective and Regulatory Lag

From a regulatory standpoint, the FSSAI’s 2025 order was intended to curb deceptive marketing by mandating that “ORS” be reserved strictly for therapeutic formulations. However, industry representatives often argue that these drinks are intended as “lifestyle” products for hydration during sports or mild heat exhaustion.

The conflict arises when these lifestyle drinks are stocked in pharmacies alongside medicines. Paediatricians argue that the “pharmacy cue” gives the product an unearned medical endorsement. While some firms claim their products are safe for general hydration, the petition argues that the visual and nominal similarities are inherently deceptive under the duress of a medical emergency.

Public Health Stakes: Why Precision Matters

Diarrhea remains a leading cause of mortality for children under five in India. While India’s Universal Immunization Programme and improved sanitation have made strides, ORS remains the most cost-effective tool in the public health arsenal.

Statistics at a Glance

The “osmotic penalty” of sugary drinks is the primary concern for doctors. If a fluid has too much sugar and not enough sodium, it can cause osmotic diarrhea, where the drink itself pulls more water out of the child’s cells, accelerating dehydration rather than reversing it.

What Should Consumers Do?

For parents and caregivers, the advice from medical professionals is clear:

1. Check for the WHO Formula: Look for the specific wording “WHO-ORS Formula” or “WHO-Recommended” on the sachet or bottle.

2. Avoid Ready-to-Drink “Fruit” Electrolytes: For medical dehydration (diarrhea/vomiting), stick to powder sachets that require mixing with clean water, as these are most likely to be the regulated therapeutic versions.

3. Consult a Professional: If a child shows signs of lethargy, sunken eyes, or decreased urination, bypass the pharmacy shelf and seek immediate medical attention.

The petition on Change.org continues to gain momentum, with healthcare workers nationwide calling for a “total rebranding” of sugary drinks to ensure they cannot be confused with medical ORS. As heatwaves and monsoon seasons approach—periods where dehydration cases spike—the urgency for clear labeling has never been higher.

References

• https://medicaldialogues.in/news/health/doctors/hyderabad-paediatrician-launches-online-petition-against-ors-misbranding-169235

Medical Disclaimer: This article is for informational purposes only and should not be considered medical advice. Always consult with qualified healthcare professionals before making any health-related decisions or changes to your treatment plan. The information presented here is based on current research and expert opinions, which may evolve as new evidence emerges.