From the Guidelines
The best oral fluids for managing vomiting and diarrhea are oral rehydration solutions (ORS) like Pedialyte, Ceralyte, or WHO-formulated ORS, as they contain the optimal balance of water, sodium, potassium, chloride, and glucose to replace lost fluids and electrolytes. These solutions are recommended by the Infectious Diseases Society of America and the World Health Organization as the first-line therapy for mild to moderate dehydration in infants, children, and adults with acute diarrhea from any cause, and in people with mild to moderate dehydration associated with vomiting or severe diarrhea 1.
Key Characteristics of Oral Rehydration Solutions
- Contain 75-90 mEq/L of sodium, which is essential for replacing lost electrolytes
- Have an optimal balance of water, sodium, potassium, chloride, and glucose to promote effective rehydration
- Can be given to all age groups, with any cause of diarrhea, and are safe in the presence of hypernatremia as well as hyponatremia (except when edema is present)
Administration Guidelines
- Start with small amounts (1-2 tablespoons or 15-30 mL) every 15 minutes and gradually increase as tolerated
- For infants and children, administer 50–100 mL/kg over 3–4 hours for mild to moderate dehydration, and replace ongoing losses with 60–120 mL ORS for each diarrheal stool or vomiting episode 1
- For adolescents and adults, administer 2–4 L of ORS over 3–4 hours for mild to moderate dehydration, and replace ongoing losses with up to 2 L/day of ORS 1
Additional Considerations
- Clear broths, diluted fruit juices (mixed 1:1 with water), and sports drinks like Gatorade can also help, though they're less ideal than medical ORS
- Avoid caffeinated beverages, full-strength fruit juices, and milk products initially as these may worsen symptoms
- Plain water alone is insufficient for significant fluid losses as it doesn't replace electrolytes
- For children, follow the doctor's recommendations precisely regarding fluid type and amount
These solutions work because the glucose in them helps sodium absorption in the small intestine through co-transport mechanisms, which pulls water along with it, effectively rehydrating the body while replacing crucial electrolytes lost through vomiting and diarrhea 1.
From the Research
Oral Rehydration Solutions
The best oral fluids for managing vomiting and diarrhea are oral rehydration solutions (ORS) that contain electrolytes and carbohydrates.
- The World Health Organization (WHO) recommends a reduced osmolarity ORS that contains glucose and electrolytes 2, 3.
- These solutions are effective in rehydrating patients with diarrhea and vomiting, and can be used in both children and adults.
- The use of ORS has been shown to decrease mortality and morbidity associated with acute diarrheal illnesses 3.
Characteristics of Oral Rehydration Solutions
The ideal ORS should have the following characteristics:
- Contain electrolytes such as sodium and potassium
- Contain carbohydrates such as glucose or rice-based solutions
- Have a reduced osmolarity to prevent excessive sodium intake
- Be inexpensive and easily accessible
- Examples of ORS include the WHO-ORS and rice-based ORS 2, 3, 4.
Other Oral Fluids
Other oral fluids that can be used to manage vomiting and diarrhea include:
- Sport drinks, but these are not recommended as a primary treatment due to their high sugar and sodium content 2
- Juice and soft drinks, but these are not recommended due to their high sugar content and lack of electrolytes 2
- Chicken broth, but this is not a recommended primary treatment due to its low electrolyte content 2.
- Sucrose/electrolyte solutions, which have been shown to be effective in rehydrating patients with acute diarrhea 4.
Management of Acute Diarrhea and Dehydration
The management of acute diarrhea and dehydration includes: