APPROPRIATE HEALTH CARE Primarily outpatient. Designed to be administered by family members.
GENERAL MEASURES
β’ In developed countries, most diarrheal losses are low sodium. Consequently, maintenance ORS can be used
for rehydration.
β’ Estimate replacement at 60 mL/kg for mild- and 80-100 mL/kg for moderate dehydration over the fi rst 4-8 hours. Very important to replace any ongoing losses and add maintenance fluids.
β’ Replace ongoing stool losses with ORS. In infant, estimate 5-10 mL/kg per stool or weigh diapers.
β’ Add maintenance requirements to replacement estimate
Estimated fluid maintenance
Weight Fluid
(kg) (mL/kg/hr)
-----------------------------------------------
<10 4
10-20 6
>20 7
β’ Traditional clear fluids (e.g., fruit juice, soda) are inappropriate for oral rehydration therapy.
β’ If the patient has hypertonic dehydration, oral rehydration should be planned for 12-24 hours
β’ If vomiting occurs, small amounts of ORS given frequently is usually effective
β’ If patient is not vomiting and is alert, patientβs thirst is excellent indicator of fluid needs
β’ ORS is not to be diluted
β’ Maintenance oral rehydration therapy begins when the deficit is replaced and provides for ongoing losses.
Maintenance ORS or a combination of ORS and water or other clear liquids can be used.
β’ Effective at all ages. If child refuses because of taste, flavor with a commercial artificially sweetened flavoring, such as Nutrasweet flavored Kool-Aid; use approximately 1/4 teaspoon to 4 oz ORS.
β’ If necessary, rehydration by nasogastric tube is appropriate
β’ Effective at all ages: prepackaged ORS fl avored freeze pops (often well accepted)
β’ Begin feeding as soon as rehydration achieved
DIET
β’ For breast feeding infants - mother should continue nursing
β’ For bottle fed babies - early institution of formulas. Lactose-free formulas rarely are required.
β’ Age appropriate - complex carbohydrate rich (eg, rice, bread, potato, cereal), low fat foods should be offered
as soon as the dehydration defi cit is replaced. Cowβs milk can be added to diet after several days.
PATIENT EDUCATION
β’ Awareness and availability of ORS markedly diminishes morbidity from gastroenteritis
β’ Travelers concerned with severe diarrhea should carry ORS packets on trips
DRUG(S) OF CHOICE
. The prototype ORS for dehydration due to cholera is the World Health Organization solution. When GE is
unlikely to be caused by cholera, a lower sodium solution is advisable, especially in children.
. WHO ORS: (90 mEq Na/liter)
- 1 liter of clean water
- 1/2 tsp sodium chloride (salt)
- 1/2 tsp trisodium citrate [can substitute sodium bicarbonate (baking soda)]
- 1/4 tsp potassium chloride (salt substitute)
- 2 Tbsp glucose [can substitute sucrose (table sugar) or rice powder. Rice starch-based ORS decreases stool volume in cholera.]
PATIENT MONITORING The patient needs to be frequently evaluated to ensure establishment of an improving clinical status and an adequate urine output
POSSIBLE COMPLICATIONS Change to IV hydration if the patient has increasing weight loss (fluid deficit), clinical deterioration, or intractable vomiting.
EXPECTED COURSE/PROGNOSIS
β’ Rapid clinical improvement despite continuing diarrhea is the usual course
β’ The overall complication rate for oral rehydration is the same as that for parenteral rehydration in cases of mild and moderate dehydration.