What is the recommended concentration for Walyte (Oral Rehydration Solution)?

Recommended Concentration for Walyte Oral Rehydration Solution

The American Academy of Pediatrics recommends that oral rehydration solutions used for rehydration should contain 75-90 mEq/L of sodium, while solutions for maintenance hydration should contain 40-60 mEq/L of sodium. 1

Sodium Concentration Guidelines

• For initial rehydration therapy in dehydrated children, solutions with sodium concentrations of 75-90 mEq/L are preferable 1
• For maintenance therapy and prevention of dehydration, solutions with sodium concentrations of 40-60 mEq/L are recommended 1
• When using solutions with sodium concentrations greater than 60 mEq/L for maintenance, additional low-sodium fluids (breast milk, formula, or water) should be administered to prevent sodium overload 1
• For severe diarrhea with high purging rates (>10 mL/kg/hour), solutions with 75-90 mEq/L sodium are specifically recommended for rehydration 1

Commercially Available ORS in the United States

• Most widely used commercial ORS products in the US contain lower sodium concentrations:
  • Pedialyte: 45 mEq/L of sodium 1
  • Ricelyte: 50 mEq/L of sodium 1
• These lower sodium solutions are primarily intended for maintenance hydration and prevention of dehydration in clinical practice 1
• While higher sodium concentrations (75-90 mEq/L) are preferable for rehydration, lower sodium solutions can be used when the alternative would be inappropriate fluids or IV therapy 1

Clinical Considerations for ORS Use

• The bicarbonate component in WHO-ORS has been replaced with citrate for longer shelf life, with equivalent efficacy 1
• Lower sodium solutions (40-60 mEq/L) more closely approximate stool-sodium losses in viral diarrhea, which is common in the United States 1
• Rice-based ORS (like Ricelyte) has been successfully used for both rehydration and maintenance therapy 1
• Reduced osmolarity ORS has been shown to reduce the need for unscheduled IV fluid infusions, lower stool output, and decrease vomiting compared to standard WHO-ORS 2, 3

Important Pitfalls to Avoid

• Do not use inappropriate fluids like apple juice, sports drinks, or soft drinks for rehydration due to their inappropriate electrolyte content and high osmolality 4, 5
• Avoid using solutions with excessive glucose content, as this can create an osmotic load and potentially worsen diarrhea 1
• When using high-sodium solutions (>60 mEq/L) for maintenance, remember to provide additional low-sodium fluids to prevent sodium overload 1
• For children with vomiting, start with small volumes (5 mL) and gradually increase as tolerated 4, 5

Administration Guidelines

• For mild dehydration (3-5% fluid deficit): administer 50 mL/kg of ORS over 2-4 hours 4, 5
• For moderate dehydration (6-9% fluid deficit): administer 100 mL/kg of ORS over 2-4 hours 4, 5
• For ongoing losses: provide 60-120 mL for children under 10 kg and 120-240 mL for children over 10 kg for each diarrheal stool or vomiting episode 4, 5