Oral rehydration therapy
- Stephen Freedman, MDCM, MSc
Stephen Freedman, MDCM, MSc
- Associate Professor of Paediatrics
- Alberta Children’s Hospital, University of Calgary
- Alberta Children’s Hospital Research Institute
- Lead, Alberta Provincial Pediatric Enteric Infection Team
- Section Editors
- Tej K Mattoo, MD, DCH, FRCP
Tej K Mattoo, MD, DCH, FRCP
- Section Editor — Pediatric Nephrology
- Professor of Pediatrics
- Wayne State University School of Medicine
- Anne M Stack, MD
Anne M Stack, MD
- Section Editor — Pediatric Procedures
- Associate Professor, Department of Pediatrics
- Harvard Medical School
Globally, diarrheal disease remains one of the leading causes of childhood mortality and morbidity. Loss of intestinal fluid caused by gastroenteritis may lead to severe hypovolemia, shock, and death, particularly in children younger than five years of age in areas of the world with limited resources. In developed countries, such as the United States, diarrhea caused by gastroenteritis remains a major cause of hospitalizations. (See "Approach to the child with acute diarrhea in resource-limited countries".)
Although the total number of deaths globally from diarrheal diseases from gastroenteritis remains high, the overall mortality rate has steadily declined over the last few decades. This decline, especially in developing countries, is largely due to the use of early and appropriate oral rehydration therapy (ORT), improved nutrition and water sanitation measures, and effective vaccination for rotavirus. (See "Approach to the child with acute diarrhea in resource-limited countries", section on 'Prevention'.)
The composition of oral rehydration solutions and the clinical application of ORT in patients with diarrhea due to gastroenteritis are discussed in this topic review. The assessment and treatment of hypovolemia, and prevention and treatment of viral gastroenteritis in children are discussed separately. (See "Clinical assessment and diagnosis of hypovolemia (dehydration) in children" and "Treatment of hypovolemia (dehydration) in children" and "Acute viral gastroenteritis in children in resource-rich countries: Management and prevention".)
DEFINITIONS OF HYPOVOLEMIA AND DEHYDRATION
The terms volume depletion (hypovolemia) and dehydration often are used interchangeably. However, these terms differentiate physiologic conditions resulting from different types of fluid loss. Much of the clinical literature does not differentiate between the two terms and uses them interchangeably. Thus, we will follow this convention and use the terms hypovolemia, volume depletion, and dehydration interchangeably as referring to all types of fluid deficits. (See "General principles of disorders of water balance (hyponatremia and hypernatremia) and sodium balance (hypovolemia and edema)".)
Although oral rehydration therapy (ORT) was first introduced in 1945, its use declined because of reports of multiple cases of hypernatremia due to the use of oral rehydration solution (ORS) with inappropriately high carbohydrate levels . However, the success of intravenous (IV) hydration in decreasing mortality and morbidity in children with diarrhea in developing countries led to renewed efforts in the 1960s to develop an effective ORT that would be less expensive and easier to administer [2,3]. Subsequently, improvements in ORS formulations have led to ORT's successful use in treating hypovolemia caused by gastroenteritis [4-6]. (See 'Efficacy' below.)
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- Freedman SB, Willan AR, Boutis K, Schuh S. Effect of Dilute Apple Juice and Preferred Fluids vs Electrolyte Maintenance Solution on Treatment Failure Among Children With Mild Gastroenteritis: A Randomized Clinical Trial. JAMA 2016; 315:1966.
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- DEFINITIONS OF HYPOVOLEMIA AND DEHYDRATION
- Physiologic basis
- - Water absorption
- ORS properties
- - Osmolality
- - Carrier organic solute
- CLINICAL MANAGEMENT
- ORT based on degree of dehydration
- - Assessment of dehydration
- No dehydration
- Mild to moderate dehydration
- Severe dehydration
- - Discharge from medical setting and return to home management
- - Contraindications to ORT
- Commercial and standard ORS
- Other therapeutic measures
- - Common household beverages and fluids
- - Zinc
- - Antiemetic therapy
- Barriers for use in developed countries
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS