Oral Rehydration for a 22-Month-Old with Vomiting and Diarrhea
For a 22-month-old child with vomiting and diarrhea, administer small volumes (5-10 mL) of oral rehydration solution (ORS) every 1-2 minutes using a spoon or syringe, gradually increasing the amount as tolerated. 1, 2
Rehydration Approach Based on Dehydration Status
- For mild dehydration (3-5% fluid deficit), administer 50 mL/kg of ORS over 2-4 hours 3
- For moderate dehydration (6-9% fluid deficit), administer 100 mL/kg of ORS over 2-4 hours 3
- For severe dehydration (≥10% fluid deficit) or shock, begin with intravenous rehydration until vital signs normalize, then transition to oral therapy 3
- Success of oral rehydration therapy is associated with intake of at least 18-25 mL/kg of ORS during initial rehydration period 4
Managing Vomiting
- Administer small volumes (5 mL) of ORS every minute using a spoon or syringe under close supervision 1, 2
- Gradually increase volume as tolerated 1, 2
- Never allow a thirsty child to drink large volumes of ORS (ad libitum) from a cup or bottle, as this can worsen vomiting 1
- Simultaneous correction of dehydration often lessens the frequency of vomiting 1
- Over 90% of children with vomiting can be successfully rehydrated orally when using this small-volume, frequent administration approach 1
Appropriate ORS Selection
- For rehydration, especially with high purging rates (>10 mL/kg/hour), use ORS with sodium concentration of 75-90 mEq/L 1, 3
- For maintenance after rehydration, use ORS with sodium concentration of 40-60 mEq/L 1
- Commercially available products like Pedialyte (45 mEq/L sodium) or Ricelyte (50 mEq/L sodium) are appropriate for maintenance therapy 1
- Avoid inappropriate fluids such as apple juice, Gatorade, and commercial soft drinks for rehydration 1
Nutritional Management
- Breastfeeding should continue throughout the illness if applicable 1, 3
- Resume age-appropriate diet during or immediately after rehydration 1
- For formula-fed infants, continue with full-strength formula after rehydration; diluted formula provides no benefit 1
- For toddlers on solid foods, focus on starches, cereals, yogurt, fruits, and vegetables 3, 2
- Avoid therapeutic starvation or "gut rest" as this can reduce enterocyte renewal and increase intestinal permeability 1
Home Management Instructions
- Instruct parents to administer small, frequent volumes of ORS rather than large amounts 1
- Replace ongoing losses from each episode of vomiting or diarrhea with additional ORS 1
- Monitor for signs of worsening dehydration (decreased urine output, lethargy, persistent vomiting) 1
- Return for medical care if the child becomes irritable or lethargic, has decreased urine output, develops intractable vomiting, or has persistent symptoms 1
Common Pitfalls to Avoid
- Allowing the child to drink large volumes of ORS at once, which can worsen vomiting 1
- Using inappropriate fluids like apple juice or sports drinks for rehydration 1
- Withholding food during or after rehydration 1
- Failing to recognize when oral rehydration is inappropriate (severe dehydration with shock, intestinal ileus, or intractable vomiting) 1
- Underestimating the volume of ORS needed for successful rehydration (studies show successful outcomes are associated with intake of at least 18-25 mL/kg) 4
Oral rehydration therapy has been proven effective in over 90% of children with vomiting and diarrhea and is safer and more physiologic than intravenous therapy 1, 5.