What is the recommended Oral Rehydration Solution (ORS) dose for a 20kg child?

Oral Rehydration Solution (ORS) Dosing for a 20kg Child

For a 20kg child, the recommended ORS dose is 120-240 mL after each diarrheal stool or vomiting episode, up to approximately 1L per day. 1

Initial Rehydration Therapy

For a child with dehydration, the initial rehydration dose depends on the severity of dehydration:

• Mild to moderate dehydration: Administer 50-100 mL/kg of ORS over 3-4 hours 1

  • For a 20kg child: 1000-2000 mL total over 3-4 hours

• Severe dehydration: Requires intravenous rehydration until vital signs normalize 1

  • Once stabilized, can transition to oral rehydration

Maintenance and Ongoing Loss Replacement

After initial rehydration or for children without dehydration:

• For children >10kg (including 20kg children): 120-240 mL ORS for each diarrheal stool or vomiting episode 1
• Maximum daily amount: Up to approximately 1L/day 1
• Administration technique: Small, frequent volumes if vomiting is present 1

Type of ORS to Use

• Preferred ORS: Low-osmolarity ORS is recommended for all age groups 1
• Commercial options: Pedialyte, CeraLyte, or Enfalac Lytren 1
• Avoid: Apple juice, sports drinks (like Gatorade), soft drinks, or commercial beverages due to inappropriate electrolyte content and high osmolality 1

Important Clinical Considerations

• Monitoring: Assess hydration status after 3-4 hours of therapy to determine if rehydration is adequate 1

• Feeding during illness: Continue age-appropriate feeding during diarrheal illness 1

  • Do not delay feeding until diarrhea stops 1
  • Offer food every 3-4 hours 1

• Warning signs: Parents should seek medical attention if the child:

  • Continues to pass many stools 1
  • Appears very thirsty 1
  • Has sunken eyes 1
  • Develops fever 1
  • Does not show improvement 1

Special Situations

• If unable to drink: Consider nasogastric administration of ORS at 15 mL/kg/hour for children who cannot tolerate oral intake but are not in shock 1

• Vomiting: Start with small volumes (5 mL) and gradually increase as tolerated 1

• Severe dehydration with altered mental status: Intravenous fluids are required initially, then transition to ORS when the child is stable 1

Pitfalls to Avoid

• Don't use anti-diarrheal medications: These are contraindicated in children with acute diarrhea 1

• Don't restrict fluids: Adequate hydration is essential for recovery 1

• Don't use inappropriate fluids: Sports drinks, juices, and sodas have improper electrolyte composition and can worsen diarrhea 1

• Don't stop feeding: Continued feeding speeds recovery and prevents nutritional deterioration 1