Oral Rehydration Therapy for Moderate Dehydration in a 1-Year-Old
A 1-year-old with moderate dehydration from diarrhea should receive reduced-osmolarity oral rehydration solution (ORS) at a dose of 100 mL/kg over 2-4 hours, using commercially available products like Pedialyte, CeraLyte, or Enfalac Lytren. 1, 2
Specific Fluid Recommendations
First-Line Treatment: Oral Rehydration Solution
- Administer 100 mL/kg of ORS over 2-4 hours for moderate dehydration (6-9% fluid deficit) 2, 3
- Use reduced-osmolarity ORS formulations as first-line therapy, which are as effective as intravenous fluids and avoid complications like phlebitis 1
Commercially Available Products in the United States
The following products are appropriate and readily available 1:
- Pedialyte (45 mEq/L sodium)
- CeraLyte (sodium content varies by formulation)
- Enfalac Lytren (Mead Johnson product)
Important context on sodium concentration: While the Infectious Diseases Society of America and CDC note that solutions with 75-90 mEq/L sodium are theoretically preferable for active rehydration 1, Pedialyte and similar products with 40-60 mEq/L sodium can be used effectively for moderate dehydration when the alternative is IV fluids or inappropriate beverages 1, 4. Research demonstrates that both Pedialyte and similar maintenance solutions successfully rehydrate infants with mild to moderate dehydration without requiring IV therapy 4.
Critical Fluids to AVOID
Never use the following for rehydration 1, 3:
- Apple juice
- Gatorade or sports drinks
- Commercial soft drinks
- These contain inappropriate electrolyte content and excessive osmolality that can worsen diarrhea
Ongoing Loss Replacement
After initial rehydration, replace continuing losses 2, 3:
- 10 mL/kg of ORS for each watery stool
- 2 mL/kg of ORS for each vomiting episode
Feeding During Rehydration
- Continue breastfeeding throughout the illness if the child is breastfed 1
- Resume age-appropriate normal diet immediately after rehydration is complete (or even during rehydration) 1
- Do not dilute formula or restrict feeding, as this provides no benefit 1
When to Escalate to IV Therapy
Switch to intravenous fluids (lactated Ringer's or normal saline) if 1, 3:
- ORS therapy fails (approximately 4% of cases)
- Severe dehydration with shock develops
- Altered mental status occurs
- Paralytic ileus is present
Consider nasogastric ORS administration at 15 mL/kg/hour if the child cannot tolerate oral intake but is not in shock 3.
Common Pitfalls to Avoid
- Do not give anti-diarrheal medications to children under 18 years with acute diarrhea 1, 3
- Do not delay or restrict feeding once rehydration begins 1, 3
- Do not use homemade salt-sugar solutions when commercial ORS is available, as incorrect mixing can cause electrolyte imbalances 1
- When using solutions with >60 mEq/L sodium for maintenance after rehydration, provide additional low-sodium fluids (breast milk, formula, or water) to prevent sodium overload 1