What is the recommended dose of Pedialyte (oral rehydration solution) for children with dehydration?

Recommended Pedialyte Dosing for Children with Dehydration

For children with dehydration, Pedialyte (oral rehydration solution) should be administered at 50-100 mL/kg over 3-4 hours for mild to moderate dehydration, followed by 60-120 mL after each diarrheal stool or vomiting episode for children under 10 kg, and 120-240 mL for children over 10 kg. 1, 2

Initial Rehydration Based on Dehydration Severity

Mild to Moderate Dehydration (3-9% fluid deficit)

• Administer 50-100 mL/kg of Pedialyte over 3-4 hours 1
• For mild dehydration (3-5% deficit): 50 mL/kg over 2-4 hours 1
• For moderate dehydration (6-9% deficit): 100 mL/kg over 2-4 hours 1
• Start with small volumes (e.g., one teaspoon) using a teaspoon, syringe, or medicine dropper, then gradually increase as tolerated 1
• Reassess hydration status after 3-4 hours to determine if rehydration is adequate 2

Severe Dehydration (≥10% fluid deficit)

• Requires immediate IV rehydration with isotonic fluids until pulse, perfusion, and mental status normalize 1
• Once the patient is stabilized and alert, transition to oral rehydration therapy 1
• Administer up to 20 mL/kg IV boluses until vital signs normalize 1

Replacement of Ongoing Losses

For Children <10 kg

• 60-120 mL of Pedialyte for each diarrheal stool or vomiting episode 1
• Maximum daily amount: approximately 500 mL/day 1

For Children >10 kg

• 120-240 mL of Pedialyte for each diarrheal stool or vomiting episode 1
• Maximum daily amount: approximately 1 L/day 1, 2

Alternative Calculation Method

• 10 mL/kg for each watery or loose stool passed 1
• 2 mL/kg for each episode of vomiting 1

Practical Administration Tips

• For children with vomiting, start with very small volumes (5 mL) and gradually increase as tolerated 2
• Children who can tolerate at least 25 mL/kg of ORS during initial rehydration are more likely to succeed with continued oral rehydration at home 3
• If the child cannot drink but is not in shock, consider nasogastric administration at 15 mL/kg/hour 1, 2
• Continue rehydration as long as diarrhea or vomiting persists 1

Important Clinical Considerations

• Use only commercially available ORS formulations like Pedialyte (Abbott Nutrition), CeraLyte (Cero Products), or Enfalac Lytren (Mead Johnson) 1
• Do not use apple juice, Gatorade, or commercial soft drinks for rehydration due to inappropriate electrolyte content and high osmolality 1, 2
• Breastfed infants should continue nursing throughout the illness 1
• Resume age-appropriate diet within 3-4 hours after rehydration is complete 1, 2
• Avoid anti-diarrheal medications in children with acute diarrhea 2

Monitoring Response

• Assess for signs of improved hydration: normal skin turgor, moist mucous membranes, normal capillary refill time, and normal mental status 4
• If dehydration persists after initial rehydration period, reassess the fluid deficit and restart rehydration therapy 1
• If the child shows signs of worsening dehydration, severe lethargy, or inability to drink, seek immediate medical attention 1

Pedialyte with either glucose-based or rice syrup solids-based formulations is effective for rehydration of children with mild to moderate dehydration, with similar clinical outcomes 5.