Oral Rehydration Therapy Protocol in Pediatric Dehydration

1. See Also
   1. Pediatric Dehydration Management
2. Indications
   1. Mild to moderate Pediatric Dehydration
3. Protocol
   1. Use Oral Rehydration Solution (e.g. Pedialyte, WHO-ORS)
      1. Do not use soda, gatorade or juice for Diarrhea replacement (too hypotonic)
   2. Consider a single dose of Zofran to aid starting Oral Rehydration Therapy
4. Management: Mild Dehydration
   1. Initial replacement
      1. Give ORS 50 ml/kg over 4 hours via spoon or cup (e.g. 1 ml/kg every 5 minutes)
      2. Pause for 30 minutes if Vomiting occurs
   2. Maintenance
      1. Replace 24 hour fluid requirements
         1. See Maintenance Fluid Requirements in Children
         2. Simplified protocol
            1. Infants: 1 ounce per hour
            2. Toddlers: 2 ounces per hour
            3. Older children: 3 ounces per hour
      2. Replace ongoing losses
         1. Replace 10 ml/kg per loose stool
         2. Replace 2 ml/kg per Emesis episode
5. Management: Moderate Dehydration
   1. Initial replacement
      1. Give 100 ml/kg over 4 hours
      2. Performed while observed in ER or Clinic
      3. Also uses Oral Rehydration Solution (e.g. Pedialyte)
      4. Fluids may be administed by Nasogastric Tube if unable to take orally
         1. Safe, effective, and less expensive than intravenous fluids
         2. Nager (2002) Pediatrics 109(4): 566-72
   2. Triage patient to home or admission
      1. May go home if initial replacement is successful and ongoing losses are not severe
   3. Home Protocol
      1. Same maintenance protocol for mild dehydration (see above)
      2. Reassess every 2 hours
      3. Indications to return to emergency department
         1. Losses (Diarrhea, Vomiting) exceed 25% of hourly fluid requirements
         2. Unable to maintain fluids orally
6. Management: Severe Dehydration
   1. See Dehydration Management
7. References
   1. Canavan (2009) Am Fam Physician 80(7): 692-6