From the Guidelines
Oral rehydration therapy (ORT) is the first-line treatment for mild to moderate dehydration in pediatric patients. For children with dehydration from diarrhea, vomiting, or other causes, use a commercially available oral rehydration solution (ORS) such as Pedialyte, Enfalyte, or WHO-formulated solutions containing appropriate concentrations of sodium, potassium, chloride, and glucose, as recommended by the 2017 Infectious Diseases Society of America clinical practice guidelines 1.
Key Considerations
- Begin with small amounts (5-15 mL) every 5-10 minutes and gradually increase as tolerated.
- For mild dehydration (3-5% weight loss), provide 50 mL/kg over 4 hours; for moderate dehydration (6-9% weight loss), give 100 mL/kg over 4 hours.
- After the initial rehydration phase, continue with maintenance fluids plus replacement of ongoing losses.
- For each diarrheal stool, replace with 10 mL/kg of ORS for children under 2 years and 5-10 mL/kg for older children.
- For vomiting, offer 5-10 mL every few minutes.
Rationale
ORT works because the glucose-sodium cotransport mechanism in the small intestine remains intact even during diarrheal illness, allowing efficient absorption of water and electrolytes. This approach is safer than IV fluids for mild to moderate cases, reduces hospitalization rates, and can be administered at home with proper parent education, as supported by the Centers for Disease Control and Prevention guidelines 1.
Severe Dehydration
Severe dehydration (>10% weight loss) or inability to tolerate oral fluids requires intravenous rehydration, as indicated by the 2017 Infectious Diseases Society of America clinical practice guidelines 1.
From the Research
Role of Oral Rehydration Therapy (ORT) in Pediatric Patients
- ORT is an effective treatment for children with mild to moderate dehydration, as indicated by studies 2, 3, 4, 5.
- The use of ORT allows children more flexibility to be treated at home, decreasing hospital stay and enhancing client comfort and autonomy 2.
- ORT can be used more frequently rather than intravenous (IV) rehydration therapy, with evidence showing that the time required to initiate ORT is quicker than IV therapy 2.
- A study found that 61.2% of patients with acute watery diarrhea and moderate dehydration tolerated ORS well and were discharged to continue oral rehydration treatment at home 3.
- The American Academy of Pediatrics (AAP) and World Health Organization (WHO) guidelines support the effectiveness of ORT, but current practice often does not match these guidelines 2.
Effectiveness of ORT in Rehydration
- Studies have shown that ORT is effective in rehydrating infants with mild to moderate dehydration caused by acute diarrhea 4, 5.
- A double-blind clinical trial found that a reduced osmolarity ORS was safe and effective in rehydrating children with acute diarrhea, with beneficial effects on stool output and vomiting 6.
- ORT has been found to be effective in reducing the need for supplemental intravenous therapy and decreasing the duration of diarrhea 3, 6.
Practical Considerations for ORT
- ORS can be prepared easily and applied immediately, making it a practical solution for general pediatric practice and hospital treatment 5.
- The composition of ORS is optimal for the body fluids of patients, making it a suitable treatment for uncomplicated diarrhea 5.
- Public health efforts are needed to promote the use of ORS, particularly among disadvantaged populations 5.