What is the typical composition of a GI drip for managing gastrointestinal issues?

Typical Composition of a GI Drip for Managing Gastrointestinal Issues

The standard GI drip should contain sodium (90 mmol/L), potassium (20 mmol/L), chloride (80 mmol/L), base (30 mmol/L), and glucose (111 mmol/L or 2%) as recommended by the World Health Organization (WHO) for optimal fluid and electrolyte replacement in gastrointestinal disorders. 1

Composition Based on Severity of Dehydration

Mild to Moderate Dehydration

• For mild dehydration (3-5% fluid deficit), use oral rehydration solution (ORS) containing 50-90 mEq/L of sodium administered at 50 mL/kg over 2-4 hours 1
• For moderate dehydration (6-9% fluid deficit), use the same ORS administration procedure but increase fluid amount to 100 mL/kg over 2-4 hours 1
• The WHO-recommended ORS contains sodium (90 mmol/L), potassium (20 mmol/L), chloride (80 mmol/L), base (30 mmol/L), and glucose (111 mmol/L or 2%) 1

Severe Dehydration

• For severe dehydration (≥10% fluid deficit), immediate IV rehydration is required with boluses of Ringer's lactate solution or normal saline until pulse, perfusion, and mental status normalize 1
• Once the patient is stabilized, transition to oral rehydration can begin 1

Special Formulations for Specific Conditions

High-Output Jejunostomy/Ileostomy

• For patients with high-output stomas, a glucose-saline solution with sodium concentration of at least 90 mmol/L is recommended 1
• Restrict hypotonic fluids (water, tea, coffee, fruit juices) and hypertonic fluids (fruit juices, colas) to less than 500 mL daily 1
• The WHO cholera solution (without potassium chloride) is commonly used for these patients 1

Short Bowel Syndrome

• Patients with short bowel syndrome should use an isotonic high sodium oral rehydration solution to replace stoma sodium losses 1
• Maximal sodium absorption occurs with a mixture of 120 mmol/L of sodium chloride and 30 mmol/L of glucose 1
• Limit intake of both hypotonic and hypertonic fluids to reduce output in patients with net-secretion and high output jejunostomy 1

Replacement of Ongoing Losses

• During both rehydration and maintenance therapy, ongoing stool and vomit fluid losses must be replaced 1
• For measurable losses, administer 1 mL of ORS for each gram of diarrheal stool 1
• For estimated losses, provide 10 mL/kg for each watery/loose stool and 2 mL/kg for each episode of emesis 1

Contraindications and Cautions

• Popular beverages that should NOT be used for rehydration include apple juice, sports drinks, and commercial soft drinks 1
• ORS is not sufficient therapy for bloody diarrhea (dysentery) as these patients may require antimicrobial treatment 1
• Patients with intestinal ileus should not receive oral fluids until bowel sounds are audible 1
• For intractable vomiting, administer small volumes (5-10 mL) every 1-2 minutes with gradual increase in amount 1

Administration Guidelines

• For patients with vomiting, administer small volumes initially (one teaspoon) and gradually increase as tolerated 1
• Continuous, slow nasogastric infusion of ORS via a feeding tube can be helpful for children who are vomiting 1
• After rehydration is complete, maintenance fluids should be resumed along with an age-appropriate normal diet 1

Common Pitfalls to Avoid

• Allowing thirsty patients to drink large volumes of ORS (ad libitum) from a cup or bottle can worsen vomiting 1
• Using inappropriate fluids like fruit juices or sodas can cause osmotic diarrhea and electrolyte imbalance 1
• Premature discontinuation of fluid therapy can lead to recurrence of dehydration 1
• Failure to replace ongoing losses can result in persistent dehydration despite initial rehydration 1