Hyderabad doctor quits paediatrics panel after ORS drink row sparks nationwide debate

“First, putting up a stall at a conference does not mean presenting it; it just means that the company funded it. After this, I reached out to the IAP asking them to condemn this statement as well as the notice against me by Kenvue. Instead, the IAP leadership asked other members to not speak about it until they looked into it and later issued a confusing position statement.”

Dr Santosh went on to explain that the IAP statement on ORS was redundant, considering all paediatricians know about the topic already. The second part of the statement spoke about the electrolyte drinks containing sucralose. “The statement did not talk about all non-nutritive sweeteners (artificial sweeteners such as aspartame, saccharine, stevia). It specifically talked about sucralose used by Kenvue in its new product and the one that I had been urging people not to consume on a daily basis. This position paper can now be used by the company if they file a defamation suit against me,” she said.

Dr Sivaranjini Santhosh’s resignation email to the Indian Academy of Paediatrics.

Calls to Dr Neelam Mohan, the current IAP president, went unanswered. Dr Santhosh has been fighting against the use of the term ORS by these sweetened beverages because they did not adhere to the salt- sugar ratios recommended by the WHO. The problem? Excess sugar pulls more water to the gut and can lead to severe dehydration and diarrhoea in already sick children — something that could turn fatal in the absence of timely medical care.

The controversy so far

After companies were asked to stop the sale of products that are not the WHO-approved ORS formulation with brand names containing the term ORS, one of the companies selling such a product Kenvue rebranded it as everyday hydration solution eRZL. Dr Santosh then raised the issue that the new packaging bore so much similarity to the old one that it could confuse consumers and retailers. She said the brand uses a four-letter name visually similar to the previous brand name, uses similar font style, the same colour and layout, as well as the same photograph of a fruit resulting in people still confusing the two. She filed a trademark opposition in late February based on these findings. “No child should end up in a coma after a bout of diarrhoea because the parents mistook a product to be genuine ORS. Other than the WHO recommended formulation that the company is selling as ORSL — which is absolutely okay — it has in the market currently two types of eRZL. Their remaining stock has been re-stickered with the new name. And, another product that has 87% less sugar. This product contains sucralose,” she said.

The challenge with sucralose is that it can also draw water to the gut and worsen diarrhoea in a sick child. In a healthy child also, she said, regular consumption of these non-nutritive sweeteners should not be encouraged.

A WHO report said that ‘Non-Sugar Sweeteners’ were associated with a 23% increase in the risk of type-2 diabetes when consumed in the form of beverages, and 34% increase when added to foods. The higher intake of these sweeteners was also linked to a 32% increase in the risk of cardiovascular disease.

Kenvue, which was formerly the consumer health division of Johnson and Johnson, in a statement previously said: “In January 2026, we launched our dual brand strategy … ORSL is now the exclusive brand name of our WHO ORS drug portfolio … whereas eRZL is our new and improved electrolyte drink portfolio designed for everyday hydration to address exhaustion and tiredness among general consumers…As a responsible company, we always recommend our WHO ORS recommended ORSL portfolio for addressing diarrheal dehydration, and have always been transparent in our communication and product packaging, while engaging with healthcare professionals, chemists and related stakeholders through various educational initiatives.”

ORS and diarrhoeal diseases

The oral rehydration solution — a simple glucose-electrolyte mixture — can reduce deaths and hospitalisations due to acute diarrhoeal diseases, especially in children under the age of five years in whom diarrhoea continues to be a big killer. The impact of this simple solution has been so profound that it has been hailed as “the most important medical advancements of the 20th century.”

A medicinal product, the ORS — or Oral Rehydration Solution — is able to save lives by effectively replenishing the water and electrolytes lost by people due to diarrhoea. There is a fixed formula for how much glucose, sodium chloride, and potassium chloride has to be there in the ORS solution. This formula is such that the sugar and salt actually pull water with them into the body and rehydrate a person. Any excess sugar will actually pull the water back into the gut and worsen the diarrhoea.

How to choose genuine ORS

Any genuine ORS will state on the packaging WHO recommended formulation. Importantly, it will not carry the logo of food regulator FSSAI as it is a medicinal product approved by the drug regulator CDSCO. Most of the genuine ORS products are sold as a salt that needs to be mixed in either 1 litre of water or one glass of water to make the solution. There are some tetra-pack products such as ORSL and Prolyte ORS also available — these would state that it is the WHO recommended formulation. ORS sachets are also cheaper, usually costing less than Rs 22 as the price of the ORS in India is capped at R1.11 per gram of salt and a packet usually contains over 20 grams of powder.