What is the recommended treatment for dehydration in pregnant women using Oral Rehydration Solution (ORS)?

Oral Rehydration Solution (ORS) for Dehydration in Pregnant Women

The World Health Organization (WHO) recommends oral rehydration solution (ORS) as the first-line treatment for mild to moderate dehydration in pregnant women, using a reduced osmolarity formula containing 65-70 mEq/L sodium and 75-90 mmol/L glucose. 1

Preparation and Administration of ORS

Standard ORS Composition

• The WHO-recommended ORS formula consists of:
  • 3.5g sodium chloride (NaCl)
  • 2.5g sodium bicarbonate (NaHCO₃) or 2.9g trisodium citrate dihydrate
  • 1.5g potassium chloride (KCl)
  • 20g glucose
  • Dissolved in 1 liter of clean drinking water 1, 2

Dosing Guidelines for Pregnant Women

• Pregnant women should be encouraged to drink as much ORS as desired 3
• For adults with dehydration, the general recommendation is to consume ORS after each loose stool 3
• If vomiting occurs, small frequent sips should be taken rather than large volumes at once

Assessment of Dehydration Severity

Clinical Assessment

• Evaluate:
  • Duration of illness
  • Quantity, frequency, and consistency of stool
  • Presence of blood in stool
  • Frequency of vomiting
  • Presence of fever 3

Signs of Dehydration to Monitor

• Mild to moderate dehydration:
  • Thirst
  • Dry mucous membranes
  • Decreased skin turgor
  • Decreased urine output
• Severe dehydration:
  • Rapid breathing
  • Altered mental status
  • Hypovolemic shock 3

Treatment Algorithm

1. Mild to Moderate Dehydration:

   • Oral rehydration with WHO-recommended ORS formula 1
   • Monitor fluid intake and output
   • Continue normal diet alongside ORS

2. Severe Dehydration:

   • Intravenous (IV) fluids required (isotonic fluids such as lactated Ringer's or normal saline)
   • Continue until pulse, perfusion, and mental status normalize
   • Transition to oral rehydration when able to tolerate 1

3. Prevention of Dehydration:

   • Increase normal fluid intake
   • Use locally available fluids known to prevent dehydration (e.g., cereal-based gruels, soup, rice water) 3
   • Avoid soft drinks due to high osmolality 3

Special Considerations for Pregnant Women

• Pregnant women are at higher risk for dehydration and electrolyte imbalances
• Dehydration can lead to complications such as preterm labor
• Osmotic laxatives should be used only short-term to avoid dehydration or electrolyte imbalances 4
• Careful monitoring of hydration status is essential throughout treatment

Nutritional Management During Rehydration

• Continue normal feeding during rehydration
• Resume age-appropriate diet during or immediately after rehydration 1
• Avoid spicy foods, coffee, alcohol, and foods high in simple sugars and fats 1

Monitoring and Follow-up

• Regularly assess hydration status through:
  • Monitoring weight
  • Assessing signs of dehydration
  • Tracking fluid intake and output 3
• Return for medical attention if:
  • Diarrhea continues or worsens
  • Vomiting persists
  • Signs of dehydration develop or worsen
  • Fever develops 1

Common Pitfalls to Avoid

• Using inappropriate fluids like sports drinks, juices, or soft drinks for rehydration in moderate to severe dehydration 5
• Failing to recognize when oral rehydration is insufficient and IV fluids are needed
• Not monitoring for electrolyte imbalances, particularly in prolonged diarrhea
• Discontinuing ORS too early before adequate rehydration is achieved

ORS therapy has been successfully used in pregnant women with acute diarrheal disease, including those with cholera-like symptoms 6, making it a safe and effective first-line treatment for dehydration in pregnancy.