Milmedika

Oral rehydration is one of the most significant medical advancements of the 20th century, revolutionizing the treatment of diarrhea in children of all ages.

When is oral rehydration used?

In addition to treating dehydration caused by diarrhea and vomiting, oral rehydration is also recommended for other conditions accompanied by high fever, reduced fluid intake, and poor appetite.

One of the main advantages of oral rehydration therapy is that it can be started at home as soon as the first symptoms appear, reducing the risk of severe dehydration and the need for hospitalization. Home rehydration is suitable for children with mild symptoms lasting 1-2 days, who experience no more than five loose stools per day, have stopped vomiting, are willing to eat and drink, urinate regularly, and remain active.

For children with more intense or prolonged symptoms, oral rehydration is initiated after a medical evaluation if there are no signs of dehydration. It is also used for patients who have undergone intravenous fluid therapy and have been discharged for home care.

In addition to rehydration, breastfeeding should continue for infants. For formula-fed babies, regular formula is recommended, though a temporary switch to lactose-free formula may be advised. Older children should gradually return to their normal diet as soon as possible.

How to properly administer oral rehydration

Oral rehydration should begin with small amounts of solution—one teaspoon (5 ml) every five minutes. If the child tolerates this well, the amount can gradually be increased to 10-15 ml. The key is to offer fluids frequently in small sips, as long as the child can keep them down.

As a general guideline, after each episode of watery diarrhea:

• Infants under 2 years should receive 50-100 ml of oral rehydration solution (ORS) over 30-60 minutes.
• Children over 2 years should receive 100-200 ml over 30 minutes.
• Children over 10 years can drink as much as they find comfortable.

If a child is vomiting but does not have diarrhea, ketones may accumulate in the body, worsening nausea. In these cases, giving a small amount of glucose (such as a sugar cube or piece of chocolate) followed by slow administration of ORS (5 ml every five minutes) can help. A 20-minute pause after vomiting is recommended before trying to reintroduce fluids.

What solutions are used for oral rehydration?

Oral rehydration solutions (ORS) are specially balanced mixtures of sugars and electrolytes that help the body absorb fluids effectively, even during diarrhea. The first ORS formula, developed by UNICEF and the World Health Organization, contained a higher amount of salt and was originally designed for cholera treatment. However, due to its strong taste and potential side effects in children, an improved version is now widely used.

The European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) recommends a low-osmolarity ORS formula with 60 mEq/L of sodium, as it has been found to be more effective and better tolerated.

It is important to note that homemade remedies, such as rice water or carrot soup, are not suitable replacements for ORS, as they lack the precise balance of electrolytes necessary for proper rehydration. Parents are advised not to rely solely on these solutions and to avoid giving plain water in large amounts, as this can lead to hyponatremia (low sodium levels in the blood).

Rice water can, however, be used as a dietary supplement or as a base for preparing infant formula.

Future developments

One of the main challenges of ORS solutions is their slightly salty taste, which many children dislike. Efforts to improve the flavor by adding fruit extracts, honey, or carob have not yielded significant success. However, chilling the solution in the refrigerator can make it more palatable.

Additionally, ESPGHAN recommends adding specific probiotics—such as Lactobacillus rhamnosus GG, Saccharomyces boulardii, and L. reuteri DSM 17938——to ORS solutions. These probiotics have been shown to help reduce the duration and severity of diarrhea in children with acute gastroenteritis. The combination of probiotics and ORS represents an important step toward more effective treatment.

Dr. Dušanka Novosel, pediatric-gastroenterologist

Institute for Children's Diseases, Clinical Center of Montenegro