Thursday, June 23, 2016

Dehydration and the Need for Oral Rehydration Solution




Parents who bring in their children to my office with vomiting or severe diarrhea for the very first time often tell me their child is drinking a lot of “water” to stay hydrated.  Children lose electrolytes through vomiting and diarrhea, such as sodium, potassium, chloride and bicarbonate.  Water alone cannot replace these losses, but Oral Rehydration Solution (ORS) can.   I always recommend lots of ORS until signs a child is on their way to recovery. 



Some parents persist with the “water plan” however and inevitably, their child ends up back in my office 2 days later.  They look and feel worse, appear more tired and weak, and usually have started throwing up again.  Their little bodies cannot recover until electrolytes and fluid volume losses have been adequately replaced. 



A recent, ground breaking article in the Journal of Pediatrics studied aggressive management for children with Ebola less than 5 years of age.  Mortality (death) rate in previous outbreaks was estimated at 75-80%.  With this new protocol, during an outbreak in Sierra Leone, they were able to reduce mortality to 31%.  That is a HUGE achievement.  One part of the protocol involves recommendations for Oral Rehydration Solution. The results are applicable to non-nursing children over 1 year of age with vomiting, diarrhea, and dehydration caused by other viral illnesses.  Since reading this study, I have started more aggressive rehydration in children with influenza and they too are recovering more quickly. 



Paraphrased Oral Rehydration Recommendations: 

1.    All children are encouraged to drink Oral Rehydration Solution throughout their illness. It is best to start your child on 1-2 teaspoons (5-10ml) of an ORS every 10-15 minutes.  You may advance slowly from there with no maximum amount they should drink.  It should be guided by thirst and parents should provide positive reinforcement for drinking enough.

2.    The exact amount of ORS needed is dependent on the degree to which a child is dehydrated and how much vomiting or diarrhea is continuing to occur. 

3.    Children with severe diarrhea may be expected to drink up to 20ml/kg of ORS per hour when initially dehydrated if not given IV fluids.  If your child is 20 pounds, their goal for fluid intake would be approximately 6oz. per hour; if they are 40 pounds, 12 oz. is a reasonable hourly goal. 

4.  NO Sports drinks or sugary drinks such as fruit-flavored and carbonated commercial drinks should be given to children as they can worsen diarrhea.

5.   Please do NOT rehydrate your children with water.  It takes longer for them to recover and could actually be harmful in the long run.  (This is my own added recommendation.)



Disclaimer:  The caveat is if your child refuses ORS then you could mix in a melted Popsicle or juice for palatability.  If you are breastfeeding, this article is not applicable and hydration recommendations would be completely different.



IF something as simple as Oral Rehydration Solution can save the lives of so many children age 5 and under from Ebola, then think of what it can do for garden variety vomiting, diarrhea and dehydration in children?



Now here the MAGIC part where I say something new you might not read anywhere else.  The best method for administration of Oral Rehydration Solution is to use a syringe.   It sounds crazy, but is worth a try. I have looked like the “baby whisperer” before because children are more than willing to take liquids from me by syringe as if it were medicine without a fight. 



My own children have been trained from toddlerhood that with Pedialyte they will soon feel better.  They grab a bottle of their favorite flavor, a 10ml syringe, and go to work practically rehydrating themselves.   They love the grape and strawberry flavors best; blue raspberry is my personal preference to drink. Try a few different ones to see which your family prefers.  It tastes better cold and you can mix 1 part juice to 2 parts ORS to help with tolerability.



The take home message with vomiting and diarrheal illness is hydrate, hydrate, hydrate.  But do NOT hydrate with plain water; Oral Electrolyte containing solution truly decreases their time to recovery and returns them to the healthy energetic kids we want them to be. 


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