From the Guidelines
For a 16 kg child requiring rehydration, I recommend using oral rehydration solution (ORS) at a rate of 50-100 mL/kg over 3-4 hours, which translates to 800-1,600 mL over 3-4 hours, as the first-line therapy for mild to moderate dehydration. This approach is based on the 2017 Infectious Diseases Society of America (IDSA) clinical practice guidelines for the diagnosis and management of infectious diarrhea 1. The guidelines recommend ORS as the first-line therapy for mild to moderate dehydration in infants, children, and adults with acute diarrhea from any cause.
Key Considerations
- The degree of dehydration should be assessed to determine the appropriate rehydration therapy, with mild to moderate dehydration typically managed with ORS and severe dehydration requiring intravenous isotonic crystalloid boluses initially.
- The recommended ORS regimen is 50-100 mL/kg over 3-4 hours for infants and children, which can be adjusted based on the child's response and ongoing losses.
- Replacement of ongoing losses during maintenance should be done with ORS, using 60-120 mL for each diarrheal stool or vomiting episode in children under 10 kg, and 120-240 mL for each episode in children over 10 kg, up to a maximum of 1 L/day.
Rehydration Therapy
- For mild to moderate dehydration, ORS is the preferred rehydration solution, with a low-osmolarity ORS being safe for all age groups and causes of diarrhea.
- Intravenous rehydration should be reserved for severe dehydration, shock, or altered mental status, and failure of ORS therapy, with isotonic intravenous fluids such as lactated Ringer’s and normal saline solution being recommended 1.
Ongoing Management
- After rehydration is complete, maintenance fluids should be resumed along with an age-appropriate normal diet offered every 3-4 hours.
- Breastfed infants should continue nursing throughout the illness, and children previously receiving a lactose-containing formula can typically tolerate the same product after rehydration.
From the Research
Rehydration Fluid Rate for a 16 kg Child
- The World Health Organization (WHO) plan C is used for rehydration in children with acute diarrhea and severe dehydration 2.
- According to the study, children with acute diarrhea and severe dehydration were given either Normal Saline (NS) or Ringer Lactate (RL) as per WHO plan C 2.
- However, the study does not provide specific information on the fluid rate for rehydration in a 16 kg child.
- The study focuses on the equivalence of NS and RL in terms of change in serum sodium levels during correction of severe dehydration in children with acute diarrhea 2.
- The fluid rate for rehydration is not explicitly mentioned in the study, but it is implied that the WHO plan C guidelines were followed 2.