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Oral rehydration therapy

Stephen Freedman, MDCM, MSc
Section Editors
Tej K Mattoo, MD, DCH, FRCP
Anne M Stack, MD
Deputy Editor
Melanie S Kim, MD


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".)


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 [1]. 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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Literature review current through: Nov 2017. | This topic last updated: Jan 25, 2017.
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