What is the recommended oral rehydration solution (ORS) dose for children with mild to moderate dehydration?

Recommended Oral Rehydration Solution (ORS) Dosing for Children with Mild to Moderate Dehydration

For children with mild dehydration, administer 50 mL/kg of ORS over 2-4 hours; for moderate dehydration, administer 100 mL/kg of ORS over 2-4 hours, as recommended by the World Health Organization and the American Academy of Pediatrics. 1

Dosing Guidelines Based on Dehydration Severity

Mild Dehydration (3-5% fluid loss)

• Initial rehydration: 50 mL/kg of ORS over 2-4 hours 1
• Clinical signs: minimal electrolyte disturbances, thirst, slightly dry mucous membranes

Moderate Dehydration (6-9% fluid loss)

• Initial rehydration: 100 mL/kg of ORS over 2-4 hours 1
• Clinical signs: higher risk of electrolyte abnormalities, decreased skin turgor, dry skin

Ongoing Replacement for Continued Losses

After initial rehydration is complete, continue with:

• 10 mL/kg of ORS after each loose stool 1
• 2 mL/kg of ORS after each episode of vomiting 1

Age-Specific Guidelines

The American Academy of Pediatrics recommends the following volumes:

• Children under 2 years: 50-100 mL of ORS after each stool 1
• Children over 2 years: 100-200 mL of ORS after each stool 1

Optimal ORS Composition

The World Health Organization and CDC recommend ORS containing:

• Sodium: 65-70 mEq/L
• Glucose: 75-90 mmol/L
• Potassium: 20 mEq/L 1

Administration Techniques

For successful oral rehydration:

• Administer small volumes frequently (5-15 mL every 5-10 minutes)
• Gradually increase volume as tolerated
• Use a syringe, spoon, or cup depending on the child's age and cooperation

Clinical Pearls and Pitfalls

Success Indicators

Research shows that children who successfully tolerate approximately 25 mL/kg of ORS during initial treatment are more likely to complete oral rehydration successfully at home 2. Those who tolerate less than 11 mL/kg have higher failure rates.

Common Pitfalls

1. Underutilization of ORS: Despite evidence supporting ORS efficacy, many clinicians still default to IV fluids for moderate dehydration 3
2. Administering too much fluid too quickly: This can lead to vomiting and treatment failure
3. Failing to continue feeding: The American Academy of Pediatrics recommends continuing feeding during rehydration 1

Special Considerations

• Breastfed infants should continue breastfeeding on demand during rehydration 1
• Formula-fed infants may benefit from lactose-free formulas after rehydration 1
• Children should be offered age-appropriate foods every 3-4 hours during rehydration 1

Monitoring Response

• Reassess hydration status every 2-4 hours
• Monitor weight daily
• Look for signs of improved hydration: increased urine output, moist mucous membranes, improved skin turgor, and normal mental status

ORS has been proven as effective as intravenous fluids for moderate dehydration, with the added benefits of being less invasive and requiring less time to initiate therapy 3.