Rehydration Therapy

• Dehydrated patients who can sit up and drink should be given oral rehydration salts (ORS) solution immediately and be encouraged to drink. Other types of fluids, such as juice, soft drinks, and sports drinks should be avoided.   
• Offer ORS solution frequently, measure the amount drunk, and measure the fluid lost as diarrhea and vomitus.
• Patients who vomit should be given small, frequent sips of ORS solution, or ORS solution by nasogastric tube.
• ORS solution should be made with safe water. Safe water means the water has been boiled or treated with a chlorine product or household bleach.
• The approximate amount of ORS (in milliliters) needed can also be calculated by multiplying the patient’s weight in kg by 75.
• A rough estimate of oral rehydration rate for older children and adults is 100 ml ORS every five minutes, until the patient stabilizes.
• If the patient requests more than the prescribed ORS solution, give more.
• Patients should continue to eat a normal diet or resume a normal diet once vomiting stops.
• For infants: Encourage the mother to continue breastfeeding.

Assessment

• Reassess the patient after 1 hour of therapy and then every 1 to 2 hours until rehydration is complete.
• During the initial stages of therapy, while still dehydrated, adults can consume as much as 1000 ml of ORS solution per hour, if necessary, and children as much as 20 ml/kg body weight per hour.
• The volumes and time shown are guidelines based on usual needs. If necessary, amount and frequency can be increased, or the ORS solution can be given at the same rate for a longer period to achieve adequate rehydration. Similarly, the amount of fluid can be decreased if hydration is achieved earlier than expected.

• Patients with severe dehydration, stupor, coma, uncontrollable vomiting, or extreme fatigue that prevents drinking should be rehydrated intravenously.

• For severe dehydration, start intravenous fluids (IV) immediately. If the patient can drink, give ORS solution by mouth while the IV drip is set up.
• It is important to measure the amount of IV fluids delivered and measure the fluid lost as diarrhea and vomitus.

Assessment

• Reassess the patient every 1-2 hours and continue hydrating. The volumes and time intervals shown are guidelines provided on the basis of usual needs.
  • If necessary, the rate of fluid administration can be increased, or the fluid can be given at the same rate for a longer period, to achieve adequate rehydration. If hydration is not improving, give fluids more rapidly. 200ml/kg or more of intravenous fluids may be needed during the first 24 hours of treatment.
  • Similarly, the amount of fluid can be decreased if hydration is achieved earlier than expected.
  • If the patient requests more than the prescribed ORS solution, give more.
• Switch from intravenous hydration to oral rehydration solution once hydration is improved and the patient can drink. This will conserve IV fluids and reduce the risk of phlebitis and other complications.
  • Nasogastric tubes can be used to administer oral rehydration solution if patient is alert but unable to drink sufficient quantities independently.

*Repeat once if radial pulse is still very weak or not detectable