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

Recommended Treatment for Dehydration Using Oral Rehydration Solution (ORS)

Reduced osmolarity oral rehydration solution (ORS) is the first-line therapy for mild to moderate dehydration in infants, children, and adults with acute diarrhea from any cause. 1

Patient Assessment and ORS Administration

Severity-Based Approach:

1. Mild to Moderate Dehydration:

   • Use reduced osmolarity ORS with composition of 75-90 mEq/L sodium, 20 mEq/L potassium, 65-80 mEq/L chloride, 10 mEq/L citrate, and 75-111 mmol/L glucose (2-2.5%) 2
   • Continue ORS until clinical dehydration is corrected 1
   • Typical effective volume: 25-30 mL/kg (patients who tolerated <15 mL/kg during initial rehydration are more likely to fail oral therapy) 3

2. Severe Dehydration:

   • Start with isotonic intravenous fluids (lactated Ringer's or normal saline) at 60-100 mL/kg over 2-4 hours 1, 4
   • Once pulse, perfusion, and mental status normalize, transition to ORS 1
   • The remaining deficit can then be replaced using ORS 1

3. Special Circumstances:

   • For patients who cannot tolerate oral intake but have normal mental status, consider nasogastric administration of ORS 1
   • For patients with ketonemia, an initial course of intravenous hydration may be needed before transitioning to oral rehydration 1

Maintenance Phase and Ongoing Management

• Once rehydrated, provide maintenance fluids and replace ongoing losses with ORS until diarrhea and vomiting resolve 1
• Resume age-appropriate diet during or immediately after rehydration 1
• Continue human milk feeding in infants and children throughout the diarrheal episode 1

Contraindications for ORS

• Altered mental status
• Inability to tolerate oral/nasogastric intake
• Ileus or other gastrointestinal anatomical abnormalities
• Gut malabsorption 5

Common Pitfalls to Avoid

1. Using inappropriate fluids: Sports drinks, juices, soft drinks, and broths are not recommended for rehydration as they have improper electrolyte composition 6

2. Inadequate fluid replacement: Ensure the rate of replacement exceeds ongoing losses 2

3. Premature discontinuation: Continue ORS until diarrhea resolves completely 1

4. Failure to recognize when IV therapy is needed: Watch for signs of severe dehydration, shock, altered mental status, or persistent vomiting 1

5. Neglecting nutritional support: Resume feeding early rather than prolonged fasting 2

Adjunctive Therapies

• Consider zinc supplementation for children 6 months to 5 years of age in countries with high prevalence of zinc deficiency or signs of malnutrition 1
• Probiotic preparations may reduce symptom severity and duration in immunocompetent individuals 1
• Antimotility agents (e.g., loperamide) should not be given to children <18 years but may be considered in adults with non-bloody diarrhea after adequate hydration 1

ORS remains the cornerstone of dehydration management, with newer formulations like HAMS-ORS (containing high-amylose maize starch) showing promise in reducing diarrhea duration 7. However, the standard reduced osmolarity ORS recommended by WHO remains the most widely validated and accessible option for effective rehydration therapy.