From the Guidelines
The first treatment for a patient with vomiting and diarrhea should be reduced osmolarity oral rehydration solution (ORS) as the first-line therapy for mild to moderate dehydration. This approach is recommended by the 2017 Infectious Diseases Society of America clinical practice guidelines for the diagnosis and management of infectious diarrhea 1. The guidelines suggest that ORS is suitable for infants, children, and adults with acute diarrhea from any cause, including those with mild to moderate dehydration associated with vomiting or severe diarrhea.
When administering ORS, it's essential to start with small, frequent sips to help the patient tolerate the fluid intake. The solution can be commercial or homemade, with the latter being made by mixing 1 teaspoon of salt and 8 teaspoons of sugar in 1 liter of water. Key points to consider when using ORS include:
- Administering the solution in small, frequent amounts to prevent overwhelming the patient
- Monitoring the patient's hydration status and adjusting the ORS intake accordingly
- Considering nasogastric administration of ORS in infants, children, and adults with moderate dehydration who cannot tolerate oral intake 1
In cases where the patient shows signs of severe dehydration, shock, altered mental status, or failure of ORS therapy, isotonic intravenous fluids such as lactated Ringer’s and normal saline solution should be administered 1. This is particularly important in people with ketonemia, where an initial course of intravenous hydration may be necessary to enable tolerance of oral rehydration. Once the patient is rehydrated, maintenance fluids should be administered to replace ongoing losses in stools, and ORS should be continued until diarrhea and vomiting are resolved 1.
From the FDA Drug Label
Dehydration Fluid and electrolyte depletion often occur in patients who have diarrhea In such cases, administration of appropriate fluid and electrolytes is very important. The first treatment for a patient with vomiting and diarrhea is administration of appropriate fluid and electrolytes to prevent dehydration and electrolyte depletion 2.
From the Research
Treatment for Patient Vomiting and Diarrhea
The first treatment for a patient vomiting and diarrhea is oral rehydration therapy (ORT) as it is an effective and inexpensive treatment for dehydration associated with gastroenteritis 3.
- ORT is recommended for children with mild to moderate dehydration, and it has been shown to be equally efficacious as intravenous (i.v.) rehydration in most studies 4.
- The American Academy of Pediatrics recommends oral rehydration therapy over a 4-hour period for treatment of mild to moderate dehydration arising from viral gastroenteritis 5.
- If oral rehydration has failed or is contraindicated, rapid intravenous rehydration (RIR) may be used, and its safety and efficacy are supported by current scientific evidence 6.
Oral Rehydration Therapy (ORT)
ORT is the preferred treatment for dehydration associated with gastroenteritis, and it has several benefits, including:
- Lower risk of treatment failures compared to intravenous therapy 3
- Shorter hospital stays 3
- Lower risk of phlebitis 3
Rapid Intravenous Rehydration (RIR)
RIR may be used in certain situations, such as:
- When oral rehydration has failed or is contraindicated 6
- In patients with mild to moderate dehydration secondary to acute gastroenteritis, unless expressly contraindicated or acute severe comorbidity 6
- Isotonic fluids, such as saline fluid, are recommended for RIR, and a rhythm of 20 cc/kg/h is suggested during 1-4 h 6