Homemade Oral Rehydration Solution as Alternative to Pedialyte
If you don't have Pedialyte, make a homemade oral rehydration solution by mixing 3.5 g salt (½ teaspoon), 2.5 g baking soda (½ teaspoon), 1.5 g salt substitute containing potassium (¼ teaspoon), and 20 g sugar (4 teaspoons) per liter of clean water. 1
WHO-Recommended Homemade Formula
The most reliable alternative is the World Health Organization formula, which can be prepared at home or by a pharmacy: 1
- 3.5 g sodium chloride (NaCl) - approximately ½ teaspoon table salt
- 2.5 g sodium bicarbonate (NaHCO₃) - approximately ½ teaspoon baking soda (or 2.9 g sodium citrate if available)
- 1.5 g potassium chloride (KCl) - approximately ¼ teaspoon salt substitute
- 20 g glucose - can substitute with 40 g table sugar (4 tablespoons) or 50-60 g cooked cereal flour (rice, wheat, potato)
- Mix in 1 liter (approximately 1 quart) of clean water 1
This creates a solution with approximately 90 mM sodium, 20 mM potassium, 80 mM chloride, 30 mM bicarbonate, and 111 mM glucose—the optimal composition for rehydration. 1
Critical Safety Considerations
Homemade solutions carry significant risk of mixing errors. In one clinical trial, 3% of parents made dangerous mixing errors resulting in sodium concentrations >100 mEq/L, though children refused these hypertonic solutions and remained safe. 2 The mean sodium concentration of correctly mixed homemade solutions was 60 ± 10 mEq/L, which is acceptable but variable. 2
Commercial dietary "clear" fluids are NOT appropriate alternatives: 3
- Sports drinks, fruit juices, soft drinks, and chicken broth have inappropriate electrolyte compositions 4
- Analysis of 91 commercial beverages showed sodium ranging from 0-175 mmol/L, potassium 0-52 mmol/L, and osmolality 50-914 mmol/kg water—far too variable for safe rehydration 3
- Apple juice, Gatorade, and commercial soft drinks should not be used for rehydration 5
When Homemade Solutions Are Acceptable
Use homemade ORS only for mild dehydration in carefully selected cases where commercial products are unavailable. 2 Homemade solutions are not the safest alternative for regular clinical use due to mixing error risk. 2
For exertional dehydration (not diarrheal illness), alternative beverages have been studied: 1
- Coconut water and 2% milk promote rehydration after exercise-associated dehydration 1
- Lemon tea-based drinks and Chinese tea with caffeine are similar to water for rehydration 1
- If these are unavailable, potable water may be used 1
- However, for optimal exercise rehydration, 5-8% carbohydrate-electrolyte solutions are preferred 1
Cereal-Based Alternatives
Rice-based oral rehydration solutions can be prepared at home by substituting 50-60 g of cooked rice flour for glucose in the WHO formula. 1 However, clinical trials show cereal-based ORS offers no clinically significant advantage over glucose-based solutions, and children refuse them more frequently (43% for homemade cereal-based vs 9% for Pedialyte). 2
Administration Guidelines
Once prepared, administer the homemade solution using the same approach as commercial ORS: 6
- For mild dehydration (3-5%): Give 50 mL/kg over 3-4 hours 6
- For moderate dehydration (6-9%): Give 100 mL/kg over 3-4 hours 6
- Replace ongoing losses: 10 mL/kg for each watery stool, 2 mL/kg for each vomiting episode 6
- Start with small volumes: 5-10 mL every 1-2 minutes via spoon or syringe if vomiting is present 6
When to Avoid Homemade Solutions
Do not use homemade solutions for: 7, 2
- Severe dehydration (≥10% fluid deficit, shock, altered mental status)—requires IV fluids 7
- Infants under 4 months of age—higher risk from mixing errors
- High purging rates (>10 mL/kg/hour)—requires higher sodium concentration solutions 1
- Situations where careful measurement is not possible 2
Provide additional low-sodium fluids (breast milk, water, diluted formula) alongside homemade ORS to prevent sodium overload, especially during the maintenance phase after rehydration. 1