Curriculum · Pediatric / Nutrition & Growth / EPI / Routine Child Examination
Oral rehydration therapy in children
What it is
Diarrheal illnesses are common in family practice and most of them are viral, and patients sometimes have misconceptions about the preferred fluid and feeding recommendations during these illnesses. The World Health Organization recommends oral rehydration with low osmolarity drinks (oral rehydration solution) and early refeeding.
How it is treated
Low osmolarity solutions contain glucose and water, which decrease stool frequency, emesis, and the need for intravenous fluids compared to higher osmolarity solutions like soda and most sports drinks. Half-strength apple juice has been shown to be effective and it approximates an oral rehydration solution; its use prevents patient measurement errors and the purchase of beverages with an inappropriate osmolarity. Early refeeding has been shown to decrease the duration of illness. Oral rehydration is not enough for every child. A 20-month-old girl with 36 hours of nausea, nonbloody, non-bilious emesis and non-bloody diarrhea, unable to tolerate both liquids and solids for the past 24 hours, who had urinated 2 times in the last 24 hours and was drowsy with dry mucous membranes and a capillary refill time of 3 sec, is answered with parenteral hydration rather than a banana/rice/applesauce/toast (BRAT) diet, enteral rehydration with a lactose-containing product, or enteral rehydration with oral rehydration solution. For a severely dehydrated child the best solution is NS at 20ml/kg: a child whose weight is 15 kg is given 300 ml NS, not 80 ml NS, 500 ml NS or 500 ml Ringer lactate.