What are the best drinks for individuals with gastroenteritis?

Best Drinks for Gastroenteritis

Oral rehydration solutions (ORS) with low osmolarity are the best drinks for gastroenteritis, while popular beverages like apple juice, Gatorade, sports drinks, and soft drinks should be avoided for rehydration. 1

Recommended Drinks

First-Line: Oral Rehydration Solutions

• Low-osmolarity ORS is the gold standard for all ages and causes of diarrhea, containing the optimal balance of sodium (50-90 mEq/L) and glucose to maximize fluid absorption. 1, 2
• Commercial ORS products include Pedialyte, CeraLyte, and Enfalac Lytren, which provide appropriate electrolyte concentrations for rehydration. 1
• The WHO-recommended formulation contains approximately 90 mM sodium, 20 mM potassium, 80 mM chloride, 30 mM bicarbonate, and 111 mM glucose with total osmolarity <250 mmol/L. 1, 2

Dosing by Severity

For mild to moderate dehydration:

• Infants and children: 50-100 mL/kg ORS over 3-4 hours 1, 2
• Adolescents and adults (≥30 kg): 2-4 L ORS over 3-4 hours 1

For ongoing losses during maintenance:

• Children <10 kg: 60-120 mL ORS for each diarrheal stool (up to ~500 mL/day) 1, 2
• Children >10 kg: 120-240 mL ORS for each diarrheal stool (up to ~1 L/day) 1, 2
• Adolescents and adults: Ad libitum, up to ~2 L/day 1, 2

Drinks to AVOID

Inappropriate Beverages

• Apple juice, Gatorade, sports drinks, and commercial soft drinks should NOT be used for rehydration because they have inappropriate electrolyte content and high osmolality. 1, 3
• Fruit juices are low in sodium (1-3 mEq/L) compared to stool losses (20-40 mEq/L), predisposing patients to hyponatremia. 1
• Hypotonic fluids (water, tea, coffee, alcohol) and hypertonic fluids (fruit juices, colas) can worsen diarrhea by stimulating fluid secretion or increasing intestinal fluid influx. 1

Why Sports Drinks Fail

• While one study showed Gatorade was as effective as Pedialyte for mild viral gastroenteritis in adults, hypokalemia persisted in the Gatorade group at 24 and 48 hours, demonstrating inadequate electrolyte replacement. 4
• The IDSA explicitly states that popular beverages should not be used for rehydration due to suboptimal composition. 1

Special Considerations

For Mild Illness Only

• Patients with very mild dehydration and no vomiting may tolerate diluted fruit juices, clear soups, and saltine crackers to meet basic fluid and salt needs. 1
• However, this approach is only appropriate when dehydration is minimal—once moderate dehydration develops, proper ORS is essential. 1, 2

Breastfeeding

• Breastfed infants should continue nursing throughout the illness without interruption. 1, 2

Common Pitfalls to Avoid

• Do not restrict fluids—adequate hydration is essential for recovery. 3
• Do not use diluted formula—it provides no benefit and may worsen nutritional status. 1
• Do not give ORS in bottles to toddlers—use cups to prevent prolonged exposure of teeth to sugars and reduce dental caries risk. 1
• Do not assume all "rehydration drinks" are equal—only properly formulated ORS provides the sodium-glucose cotransport mechanism needed for optimal fluid absorption. 1

When to Escalate to IV Fluids

• Severe dehydration (≥10% fluid deficit), shock, altered mental status, or failure of oral rehydration therapy requires intravenous isotonic crystalloid (lactated Ringer's or normal saline). 1, 2
• Persistent vomiting preventing oral intake despite antiemetics may necessitate IV rehydration. 2