Pediatric Dehydration Rehydration

Use ORS for infants and children with mild-to-moderate dehydration who can protect the airway and tolerate enteral administration. ORS is recommended until clinical dehydration resolves; after correction, continue maintenance fluids and replace stool losses with ORS until vomiting and diarrhea stop. The Lancet+1The LancetOral rehydration for children with gastroenteritis - The LancetIDSAInfectious Diarrhea - IDSA

Use isotonic intravenous fluid—lactated Ringer's solution or 0.9% sodium chloride—when severe dehydration, shock, altered mental status, ileus, or failed ORS therapy is present. Continue intravenous resuscitation until pulse, perfusion, and mental status normalize and the child is awake without aspiration risk; then replace the remaining deficit enterally with ORS. IDSAIDSAInfectious Diarrhea - IDSA

For a child with clinical dehydration who cannot drink sufficient ORS or vomits persistently, administer ORS through a nasogastric tube if shock is absent. Escalate to intravenous therapy when vomiting persists despite oral or nasogastric ORS, when clinical deterioration occurs despite ORS, or when shock is suspected or confirmed. nice org uk+1nice org ukRecommendations | Diarrhoea and vomiting caused by gastroenteritis in under 5s: diagnosis and management | Guidance | NICEnice org uk[PDF] Diarrhoea and vomiting caused by gastroenteritis in under 5s - NICE

For a child with clinical dehydration due to gastroenteritis, give 50 mL/kg of ORS plus maintenance volume over 4 hours. Administer frequent small amounts rather than large boluses, and reassess clinically during the rehydration interval. nice org uk+1nice org ukRecommendations | Diarrhoea and vomiting caused by gastroenteritis in under 5s: diagnosis and management | Guidance | NICEnice org uk[PDF] Diarrhoea and vomiting caused by gastroenteritis in under 5s - NICE

A physiologically appropriate ORS contains 70 to 90 mEq/L sodium and no more than 25 g/L glucose. Do not substitute fruit juice or carbonated beverages for ORS during active rehydration; these fluids are specifically excluded from the recommended supplementation options. publications aap+1publications aapDehydration (Chapter 353) | Pediatric Care Online - AAP Publicationsnice org uk[PDF] Diarrhoea and vomiting caused by gastroenteritis in under 5s - NICE

Continue breastfeeding and other milk feeds after rehydration. For children at increased risk of recurrent dehydration—including those younger than 1 year, particularly younger than 6 months; those with low birth weight; more than five watery stools in 24 hours; or more than two vomiting episodes in 24 hours—consider 5 mL/kg ORS after each large watery stool. nice org uknice org ukRecommendations | Diarrhoea and vomiting caused by gastroenteritis in under 5s: diagnosis and management | Guidance | NICE

For suspected or confirmed shock associated with gastroenteritis, give 0.9% sodium chloride 10 mL/kg as a rapid intravenous infusion. If shock persists after the first infusion, immediately repeat 0.9% sodium chloride 10 mL/kg and reassess the response. nice org uknice org ukRecommendations | Diarrhoea and vomiting caused by gastroenteritis in under 5s: diagnosis and management | Guidance | NICE

In severe dehydration, continue intravenous rehydration until pulse, peripheral perfusion, and mental status normalize and the child awakens without aspiration risk or ileus. At that point, use ORS to replace the remaining deficit rather than continuing intravenous fluid solely for completion of rehydration. IDSAIDSAInfectious Diarrhea - IDSA

Obtain serum sodium, potassium, creatinine, blood urea, and glucose in hospitalized children when electrolyte or renal complications may affect fluid planning. Electrolyte testing helps classify dehydration as isotonic, hyponatremic, or hypernatremic, a distinction that changes fluid planning. Wiley+1WileyEuropean Society for Pediatric Gastroenterology, Hepatology, and ...ScienceDirectDehydration Syndromes: Oral Rehydration and Fluid Replacement - ScienceDirect

Monitor the response to ORS by repeated clinical assessment. Deterioration despite appropriately delivered ORS, inability to retain oral or nasogastric ORS, or evolution of shock should trigger intravenous fluid therapy rather than extending an unsuccessful enteral trial. nice org uk+1nice org ukRecommendations | Diarrhoea and vomiting caused by gastroenteritis in under 5s: diagnosis and management | Guidance | NICEnice org uk[PDF] Diarrhoea and vomiting caused by gastroenteritis in under 5s - NICE

After clinical rehydration, maintain fluid intake and replace continuing stool losses with ORS until diarrhea and vomiting resolve. Continue breastfeeding and other milk feeds; children at high risk for recurrent dehydration may receive 5 mL/kg ORS after each large watery stool. IDSA+1IDSAInfectious Diarrhea - IDSAnice org ukRecommendations | Diarrhoea and vomiting caused by gastroenteritis in under 5s: diagnosis and management | Guidance | NICE

Use a bedside glucose measurement as part of an emergency department ORS assessment pathway. In a child with ketonemia, an initial intravenous hydration course may be needed to permit later oral rehydration tolerance. acep+1acepOral Rehydration Therapy | Pediatric Emergency MedicineIDSAInfectious Diarrhea - IDSA