Sivaranjani Santosh: Sweet Fighter

ORAL REHYDRATION SOLUTION (ORS) is considered one of the most important pub­lic health inventions of the 20th century, es­timated to have saved over 50 million lives. It is especially a lifesaver for children with diarrhoea. The ailment might be mostly considered an inconvenience but the number of deaths from dehydration when children have it is huge. ORS has been the standard treatment since its discovery.

Around 10 years or so ago, Dr Sivaranjani Santosh, a Hyder­abad-based paediatrician, began to notice something—children under her care whom she expected to get better quickly from diarrhoea weren’t recovering. The numbers began to concern her. She started questioning parents about what exactly they were giving and realised it was something called ORSL, an off-the-shelf product they thought was the rehydration solution. Even she had inadvertently been a party to it.

“Rehydration is the cornerstone of management of diarrhoea. If you don’t rehydrate appropriately, the blood flow slows, the oxygen to the tissues will decrease and the child’s blood pressure starts falling. That’s what we call in medical terms as shock. And that can lead to multi-organ failure and death. In India, ev­ery year, more than a lakh children die because of diarrhoea. Invariably, when a child has diarrhoea, we recom­mend oral rehydration salts and oral rehydration solution prepared in the right way. So one day, a parent asked me, ‘Doctor, is ORSL the same as ORS?’ Without even thinking, I said it must be the same. Because I never knew that such a thing existed,” she says.

When she eventually read the ingredients in a pack, it contained sugar that was eight times the level of the World Health Organization (WHO)-approved formula. “It should have 13.5 grammes of glucose per litre. This formula had 110 grammes of sugar per litre,” she says.ORS works on the principle of having a balanced amount of glucose and so­dium in such a way that they are used by proteins called sodium-glucose cotransporters to pull water from the intestines into the body. But if sugar or glucose is in excess, it will do the opposite, pushing water into the gut and worsening the diarrhoea.

The company which owned the brand ORSL was Johnson & Johnson, now with Kenvue after it was spun-off as a separate company. But they weren’t the only ones. There were other com­panies too selling such drinks by marketing it as ORS. Even peo­ple with diabetes were taking it despite the high sugar content. “One parent told me she used to buy a carton of it and give it to her diabetic father,” says Sivaranjani. “Ideally, they should have got permission from CDSCO [Central Drugs Standard Control Organisation, which regulates medicines].They took permission from FSSAI [Food Safety and Standards Authority of India, the authority that regulates food] to sell it as a beverage. Everywhere, hospitals, pharmacies, schools, only ORSL was available. Even experts thought that was the real ORS.”

She wasn’t the only paediatrician noticing this. Others had pointed it out. She however made it into a singular cause beginning with educating parents. For many years, she had been conducting free first-aid sessions for the public. She now took both the beverage packs and real ORS sachets to show them the difference. In 2018, she started doing social media posts but that was stillborn because she was too busy with her medical practice. During Covid, she revived her posting and became active again. In parallel, she started writ­ing to the CDSCO, informing them about what was happening. More brands had entered the market piggybacking on ORS. The CDSCO re­plied asking her for proof. She sent the Tetra Paks, data, etc. They replied that it was the FSSAI’s responsibility. “They passed the buck. But they also sent my letter to FSSAI. I started writing to the FSSAI, started sending proof to them. I even collected data in Hyderabad, from various pharmacies, showing that the maximum sale was for ORSL instead of the WHO-recommended ORS,” she says.

Meanwhile, in Delhi, a mother had filed a PIL in the high court because her child’s condition worsened after taking the beverage mistaking it for ORS. The court too referred it to FS­SAI, asking it to look into this matter. “But that also was just sitting. Nothing happened,” she says. Other doctors had also written to FSSAI by then. In the Indian Pediatrics journal, there was an article about it. No one persisted in the way she did.

“I kept telling people, kept posting on various forums. On WhatsApp groups, my friends started saying, ‘Don’t bore us with the same thing again and again.’ In April 2022, FSSAI issued an order saying these beverages cannot use ORS on their label because the public may confuse them with ORS, making it a health hazard. Once that order came, we were happy. But within two months, the order was reversed. They said you can use it, but with a disclaimer that this is not an ORS. It really boiled my blood. In India, first of all, literacy is less. Whoever is literate also don’t bother about disclaimers. Most paediatricians don’t know about this deception, leave alone other doctors. I got very upset and filed a public interest litigation in Telangana,” she says.

Earlier, government bodies would respond at least when she wrote to them about the issue. Once the PIL was filed, she stopped getting any replies to her letters. Meanwhile, the medical association she belonged to, Indian Academy of Pediatrics (IAP), not only didn’t assist her but were taking sponsorships for their confer­ences from companies selling these products. She began to speak against them too on social media. “It was like going against my own fraternity, I agree, but I had to call them out,” she says.

Something else had also happened as a result of her long-running crusade. She was steadily gaining popularity on social media. Today, she has close to a million fol­lowers on Instagram, making her one of the biggest public health in­fluencers in India. Her posts were being picked up and reported on by mainstream media. She also reached out to other professional bodies like the Endocrine Society of India and Women Pediatricians Forum and included them in the petition. More evidence was being gathered.

“I sent people to the pharmacies where they asked for ORS but were given ORSL. In some places, we gath­ered video evidence. All these I again sent to the health minister,” she said. “The case was going very slowly. I felt rejected many times. But not at any point did I think I’ll step back; I had to do this for the children.” Her posts were frequently going viral, as when she made a large file with all the letters, videos, and evidence and shared it on social media asking her followers to tag and forward it to the health ministry and the FSSAI.

SOON AFTER THAT, in October 2025, FSSAI issued an order stating that ORS could not be used for branding the products. Somebody messaged her saying, “Congratula­tions, your hard work paid off.” She checked a news outlet but the report said the opposite, that even the disclaimer was now not needed. It was however erroneous news. When she went to the FSSAI website, she realised that the order was in her favour. Her feed on Instagram of that day shows her crying. There were still twists. The Delhi High Court granted a stay on the order but a bigger bench, after a few weeks, refused it and the com­pany withdrew the case. They first restickered existing stocks as eRZL instead of ORSL. Later, they made eRZL into a low-sugar electrolyte drink. Sivaranjani says that the work is not over be­cause eRZL still has the same packaging and design, leading to confusion even now. She has filed a trademark objection and expects it to go to court.

“It’s highly likely to be misused again. They started marketing it as the new form of ORS. I raised that point [in social media], and they got upset and sent me a legal notice,” she says.

The notice from Kenvue asks her to remove her posts related to eRZL and also to refrain from making any future posts on it. Sivaranjani has refused. She says, “I am not the type to just bow down to pressure. They thought to silence me but I went on social media and said how dare you send me a notice when you are the one who needs to answer to people.”

Kenvue, when contacted by Open, responded stating that in January 2026, the company launched two distinct brands—ORSL is now their WHO ORS drug portfolio for the treatment of diar­rhoeal dehydration while eRZL is for electrolyte drinks for the hydration of general consumers. The product packs, it said, include statutory dec­larations which are in compliance with regulatory requirements. “For example, our ORSL WHO ORS prod­uct range clearly mentions ‘WHO recommended formula’ and ‘Restores Fluids and Electrolytes lost during Dehydration Due to Diarrhoea’ while the eRZL range explicitly declares ‘Ready to Serve Fruit Beverage’ on the front of pack’,” it said.

Sivaranjani wrote to Indian Acad­emy of Pediatrics too for support when she received the notice but says she did not get any. She resigned from the body.

When contacted by Open, IAP said that the resignation was her personal choice and that it rejected the “assertion that institutional support was withheld to protect corporate interests.” On not sup­porting Sivaranjani when she received a legal notice, it said that “as a scientific and academic body, the IAP does not have the jurisdic­tion to intervene in private civil legal disputes or notices exchanged between individual practitioners and corporate entities.” And to the claim that they accepted sponsorship from Kenvue for its events, it said “Like most large professional medical organisations world­wide, IAP conferences have historically received educational grants and exhibition support from multiple healthcare companies under established guidelines and applicable regulations. Such support does not determine the Academy’s scientific positions, recommen­dations, or decision-making processes and is completely decoupled from scientific agenda.”

While the result of her long-running campaign has been de­cisive, Sivaranjani feels there is more to be done. “We are getting information that when people are asking for ORS, they are getting eRZL in tier-two cities and towns. So the battle is not over,” she says. It has been a decade since she started on the campaign and along the way she became a public figure and an influencer who now uses her reach to speak on a wide variety of public health issues. She recently created an Instagram channel where ethical doctors can come together and communicate with the public. And all this while maintaining a busy paediatric practice in Hy­derabad. How does she manage to do everything together? She says, “I wish the day has 48 hours.”