Fluid Management for a 21-Month-Old Child with Dehydration
For a 21-month-old child with dehydration, oral rehydration solution (ORS) such as Pedialyte should be the first-line fluid choice, administered at 60-120 mL for each diarrheal stool or vomiting episode. 1
Initial Assessment and Management
- For mild to moderate dehydration, administer oral rehydration solution (ORS) at 50-100 mL/kg over 3-4 hours 2
- For severe dehydration, begin with intravenous isotonic crystalloid boluses (up to 20 mL/kg) until pulse, perfusion, and mental status normalize, then transition to oral rehydration 1
- Start with small volumes (5-10 mL) using a teaspoon, syringe, or medicine dropper if the child is vomiting, and gradually increase as tolerated 2
Type of Fluid to Use
- Use commercially available, low-osmolarity ORS such as Pedialyte (45 mEq/L sodium) or Ricelyte (50 mEq/L sodium) 1
- Do not use apple juice, Gatorade, or commercial soft drinks for rehydration as they have inappropriate electrolyte content and high osmolality 1, 2
- For a child weighing less than 10 kg, administer 60-120 mL ORS for each diarrheal stool or vomiting episode 1
- For a child weighing more than 10 kg, administer 120-240 mL ORS for each diarrheal stool or vomiting episode 1
Ongoing Fluid Management
- Continue ORS administration as long as diarrhea or vomiting persists 1
- If the child is breastfed, continue nursing throughout the illness 1
- Resume age-appropriate diet within 3-4 hours after rehydration is complete 2, 3
- For maintenance fluids after rehydration, continue with ORS and add other appropriate fluids like breast milk or formula 1
Monitoring Response
- Reassess hydration status after 3-4 hours to determine if rehydration is adequate 3
- Monitor for signs of worsening dehydration: increased thirst, sunken eyes, decreased urine output, lethargy 4
- If the child cannot tolerate oral intake but is not in shock, consider nasogastric administration of ORS at 15 mL/kg/hour 3
Special Considerations
- Studies show that children who successfully tolerate at least 20-25 mL/kg of ORS during initial rehydration are more likely to be successfully managed at home 5
- Both glucose-based (Pedialyte) and rice-based (Ricelyte) ORS are effective for rehydration of infants with mild to moderate dehydration 6
- For hypernatremic dehydration, slow administration of ORS containing either 75 or 90 mEq/L sodium has been shown to be safe and effective 7
Common Pitfalls to Avoid
- Avoid anti-diarrheal medications in children with acute diarrhea 2
- Do not restrict fluids, as adequate hydration is essential for recovery 3
- Do not delay feeding until diarrhea stops; early feeding can reduce the severity, duration, and nutritional consequences of diarrhea 1
- Do not use homemade salt-sugar solutions due to risk of incorrect preparation; use commercially available ORS when possible 8