From the Guidelines
D5 should not be the first-line treatment for diarrhea, as oral rehydration solutions (ORS) are recommended for mild to moderate dehydration in infants, children, and adults with acute diarrhea from any cause 1.
Key Points to Consider
- The 2017 Infectious Diseases Society of America (IDSA) guidelines recommend reduced ORS as the first-line therapy for mild to moderate dehydration in patients with acute diarrhea 1.
- D5 can be considered in specific situations, such as severe dehydration, where intravenous isotonic crystalloid boluses are administered until pulse, perfusion, and mental status return to normal, and then D5 solutions can be added if needed 1.
- The use of D5 in normal saline or half-normal saline can provide glucose, which helps with sodium absorption in the intestines and offers some caloric support during illness, but this should be guided by the patient's clinical condition and laboratory values 1.
Administration and Monitoring
- For patients requiring intravenous fluids, the administration rate of D5 solutions depends on the severity of dehydration and the patient's overall condition, but it is often used after initial rehydration with isotonic crystalloids 1.
- It is crucial to monitor patients closely for signs of dehydration, electrolyte imbalances, and glucose levels when administering D5 solutions, especially in severe cases of diarrhea 1.
Prioritizing Oral Rehydration
- Oral rehydration therapy with balanced electrolyte solutions remains the preferred treatment for most uncomplicated diarrhea cases, given its effectiveness in replenishing lost fluids and electrolytes 1.
- The World Health Organization (WHO) and other advisory bodies recommend hypotonic ORS as the first-line therapy for mild to moderate dehydration caused by diarrhea of all causes, highlighting the importance of oral rehydration in managing diarrhea 1.
From the Research
Oral Rehydration Solutions in Diarrhea
- The use of oral rehydration solutions (ORS) has been shown to be effective in managing acute diarrhea, particularly in children 2.
- ORS can help improve hydration status, reduce morbidity and mortality, and decrease the need for intravenous fluids 2, 3.
- Various modifications to the standard ORS have been developed, including hypo-osmolar or hyperosmolar solutions, rice-based ORS, and the addition of zinc or amino acids 2.
Use of D5 in Diarrhea
- There is no direct evidence in the provided studies to support the use of D5 (5% dextrose solution) in the treatment of diarrhea.
- However, the use of oral rehydration solutions that contain glucose, such as the World Health Organization-recommended solution, has been shown to be effective in managing diarrhea 2, 4.
- It is worth noting that the use of glucose-based ORS may not appreciably reduce diarrheal stool volume, and alternative formulations may be needed to address this issue 4.
Rehydration Therapy in Diarrhea
- Rehydration therapy, either with oral rehydration solutions or intravenous fluids, is a crucial component of diarrhea management 2, 3.
- The choice of rehydration fluid, such as Normal Saline (NS) or Ringer Lactate (RL), may not significantly impact serum sodium levels in children with acute diarrhea and severe dehydration 3.
- The addition of other agents, such as loperamide, to rehydration therapy may not provide additional benefits in certain cases 5.