Dr Sivaranjani Santosh, a paediatrician from Hyderabad, for over eight years, has all her time and efforts to an important campaign against misleading labelling and marketing of oral rehydration salts (ORS) in India. After witnessing children fall seriously ill and even die from consuming high-sugar drinks deceptively marketed as ORS during diarrhoea, she launched a persistent social media and legal battle to confirm safety and clarity for consumers.
The Problem with Misleading ORS Products
Many popular ORS brands have been selling high-sugar liquids under the name “ORS” without adhering to the World Health Organization’s (WHO) strict formulation standards. These products often contain up to 120 grams of sugar per litre—almost 90% added sugar—far exceeding the recommended 13.5 grams per litre. Such preparations get worse dehydration by pulling more water into the intestines, make worse diarrhoea instead of easing it.
Children suffering from diarrhoea require a precise balance of sodium, chloride, and glucose for effective rehydration. As Dr Jaykishan Tripathi, consultant paediatrician at KIMS Hospitals, explains, “If the sugar content is too high, it worsens dehydration; if too low, absorption slows, and the solution won’t work.” This misuse of the ORS label poses a serious health risk, causing many children to suffer unnecessarily.
The Victory: FSSAI’s New Order
After eight years of legal support, including a Public Interest Lawsuit filed in 2022 at Telangana High Court, Dr Sivaranjani welcomed the revolutionary Food Safety and Standards Authority of India (FSSAI) order dated October 15, 2025. This order forbids any brand from using the term “Oral Rehydration Salts” except their product strictly follows the WHO’s recommended compotion.
WHO’s composition:
- 2.6 g sodium chloride
- 1.5 g potassium chloride
- 2.9 g sodium citrate
- 13.5 g dextrose per litre
- with a total osmolarity of 245 mOsm/L.
Dr Sivaranjani highlights the urgency of immediate execution: no sales of non-submissive ORS in pharmacies, hospitals, schools, supermarkets, or online platforms until labels and formulations meet WHO standards. The new instruction aim is to protect helpless children and stop companies from misleading consumers with harmful high-sugar drinks.
Challenges Ahead: Court Interventions and Enforcement
Despite the victory, Dr Sivaranjani strains the fight is far from over. JNTL (a Johnson & Johnson subsidiary) secured an interim stay from the Delhi High Court on October 17, questioning the FSSAI order’s enforcement. The court allowed JNTL one week to submit its representation to FSSAI, which remains unanswered as of October 25, 2025.
“The FSSAI must take responsibility for ensuring the removal of misleading ORS stocks from shelves immediately,” Dr Sivaranjani said. She highlights the continuing need for government watchfulness, public awareness operations, and enforcement of strict standards to prevent children from continued revelation to dangerous products labelled as ORS.
How Parents/guardians Can Shield Their Children
Parents and caregivers can avoid misleading or false ORS by following these practical tips:
- Buy ORS only from trustworthy pharmacies or recognized and documented brands.
- Check the labels carefully to ensure sodium and glucose values are clearly listed (WHO recommends about 75 mmol/L each).
- Avoid products that are unclearly labelled “low sugar” or “high sugar” without specific numbers.
- Ensure the packet provides clear, accurate dilution instructions (usually for one litre of water).
- Taste after all preparation should be slightly sweet, not like sugary sentimental sports drinks.
- Verify expiry date and packaging date honesty before use (giving to children).
- Seek immediate medical help if dehydration symptoms get more worse, especially in young children.
The Effect of Dr Sivaranjani’s Crusade
Dr Sivaranjani’s dedication has saved countless lives and raised awareness of a previously ignored but deadly problem. Parents now share genuine and deepest gratefulness for her persistence in standing up against huge-companies. Despite facing mockery, pressure, and isolation, she remained committed to children’s health above all the problems.
This step taken sends a strong message: Only WHO-recommended ORS and plain water should be used/consumed for rehydration during diarrhoea specially for children. The CDSCO and Ministry of Health and Family Welfare must take strict implementation measures to ensure no more harmful, high-sugar liquids are sold under the guise of ORS.