What fluids should be given to an enteric fever patient for hydration?

Fluid Management for Enteric Fever Patients

For enteric fever patients requiring hydration, administer oral rehydration solution (ORS) containing 50-90 mEq/L sodium at 100 mL/kg over 2-4 hours for moderate dehydration, or use intravenous isotonic crystalloids (lactated Ringer's or normal saline) for severe dehydration with hemodynamic compromise. 1, 2

Severity Assessment Determines Route

The critical first step is determining dehydration severity, which dictates whether oral or intravenous therapy is appropriate:

Mild to Moderate Dehydration (Oral Route)

• Use WHO-recommended reduced osmolarity ORS as first-line therapy containing 50-90 mEq/L sodium, administered at 100 mL/kg over 2-4 hours 1
• Physical findings indicating moderate dehydration include loss of skin turgor with tenting, dry mucous membranes, decreased capillary refill, and rapid deep breathing 1
• ORS formulations work through glucose-sodium cotransport mechanism, allowing optimal absorption of water and electrolytes regardless of the infectious cause 3

Severe Dehydration (Intravenous Route)

• Begin immediate IV rehydration with isotonic crystalloids (lactated Ringer's or normal saline) if tachycardia, altered mental status, or hemodynamic instability is present 2
• Administer 20 mL/kg boluses until pulse normalizes, perfusion improves, and tachycardia resolves 2, 4
• Target resuscitation endpoints include normalization of vital signs and urine output >0.5 mL/kg/hour 2
• Once stabilized, transition to ORS for ongoing loss replacement 2, 4

Ongoing Loss Replacement Protocol

After initial rehydration, continuous replacement of fluid losses is essential:

• Administer 10 mL/kg of ORS for each watery or loose stool passed 1
• Give 2 mL/kg of ORS for each vomiting episode 1
• Continue replacement therapy until diarrhea and fever resolve 1

Critical Pitfalls to Avoid

What NOT to Use

• Do not use sports drinks, fruit juices, soft drinks, or chicken broth for rehydration due to inappropriate electrolyte content and excessive osmolality 5
• Avoid antimotility agents (loperamide) entirely, as they can worsen outcomes and potentially cause complications 1, 2

Common Mistakes

• Do not delay IV fluids to attempt oral rehydration first when tachycardia is present—this indicates ORS alone is insufficient 2
• Vomiting is NOT a contraindication to ORS; start with small volumes (5 mL) and gradually increase as tolerated 4, 6
• If oral intake is impossible but the patient is not in shock, consider nasogastric administration at 15 mL/kg/hour 4, 3

Monitoring During Rehydration

• Reassess clinical status every 30-60 minutes during the first 2-4 hours of therapy 2
• Monitor vital signs, skin turgor, mucous membranes, and urine output 4
• If dehydration persists after the initial rehydration period, reassess fluid deficit and restart therapy 4

Nutritional Management

• Resume age-appropriate diet immediately after or during rehydration completion—continuing nutrition during illness improves outcomes 1, 2
• Do not restrict diet or use outdated approaches like the "BRAT diet" 2
• Early feeding accelerates recovery and maintains nutritional status 2

Special Considerations for Enteric Fever

While the evidence provided focuses on general dehydration management, enteric fever patients may have prolonged fever and ongoing fluid losses from diarrhea. The same principles apply, but be prepared for:

• Extended duration of fluid replacement needs due to the typical 1-2 week fever course
• Potential for significant ongoing losses requiring vigilant replacement
• Need for concurrent antimicrobial therapy (though this does not change fluid management strategy)