What is the recommended approach for fluid rehydration in a 5-year-old child with food poisoning?

Fluid Rehydration in a 5-Year-Old with Food Poisoning

For a 5-year-old child with food poisoning, use oral rehydration solution (ORS) such as Pedialyte exclusively, administering 50 mL/kg (mild dehydration) or 100 mL/kg (moderate dehydration) over 2-4 hours, followed by replacement of ongoing losses with 120-240 mL for each diarrheal stool or vomiting episode. 1, 2

Initial Assessment

First, clinically assess the degree of dehydration:

• Mild dehydration: Increased thirst, slightly dry mucous membranes 2
• Moderate dehydration: Loss of skin turgor, dry mucous membranes, delayed capillary refill 2
• Severe dehydration: Severe lethargy or altered consciousness, prolonged skin tenting, absent tears 2, 3

Weight loss is the most reliable clinical indicator of dehydration severity 3

Rehydration Phase (First 2-4 Hours)

For mild dehydration (most common in food poisoning):

• Administer 50 mL/kg of ORS over 2-4 hours 1, 2
• For a typical 20 kg 5-year-old, this equals approximately 1000 mL 2

For moderate dehydration:

• Administer 100 mL/kg of ORS over 2-4 hours 1, 2
• For a 20 kg child, this equals approximately 2000 mL 2

Practical Administration Tips

• If vomiting is present, start with very small volumes (5 mL or one teaspoon) every 1-2 minutes, then gradually increase as tolerated 1, 4, 3
• Use a teaspoon, syringe, or medicine dropper for precise small-volume administration 1
• Oral rehydration of a vomiting child is feasible and should be attempted before escalating to other routes 3

Maintenance Phase and Ongoing Loss Replacement

After the initial rehydration period, replace ongoing losses:

• 120-240 mL of ORS for each diarrheal stool or vomiting episode 1, 2, 4
• Alternative calculation: 10 mL/kg for each watery stool and 2 mL/kg for each vomiting episode 1, 2

Choice of Rehydration Solution

Use only commercially available low-osmolarity ORS formulations such as Pedialyte, CeraLyte, or Enfalac Lytren 1, 2, 4

Critical Pitfall to Avoid

Never use apple juice, Gatorade, sports drinks, cola, or soft drinks for rehydration - these contain inappropriate electrolyte content and excessive osmolality that can worsen diarrhea 1, 2, 4, 3

Feeding During Illness

• Resume age-appropriate diet within 3-4 hours after rehydration is complete 1, 4
• Do not delay feeding until diarrhea stops - early feeding shortens the duration of diarrhea 4, 3
• Offer food every 3-4 hours during the illness 4

When to Escalate Care

Consider nasogastric tube administration at 15 mL/kg/hour if:

• The child cannot tolerate oral intake but is not in shock 1, 2, 4

Switch to IV rehydration if:

• Severe dehydration with shock is present 1, 2
• Altered mental status exists 2
• ORS therapy fails after appropriate trial 2
• Dehydration exceeds 10% of body weight 5

For severe dehydration, administer isotonic crystalloid at 20 mL/kg IV boluses until vital signs normalize, then transition to oral rehydration 1

Reassessment

• Reassess hydration status after 2-4 hours of therapy by checking skin turgor, mucous membranes, urine output, and vital signs 1, 4
• If dehydration persists, reassess the fluid deficit and restart rehydration therapy 1

Additional Considerations

• Do not give anti-diarrheal medications to children with acute diarrhea - they provide no benefit and can prolong illness 1, 2, 4
• Continue rehydration as long as diarrhea or vomiting persists 1
• Oral rehydration is as effective as IV therapy for mild to moderate dehydration and avoids complications like phlebitis 2, 6