GENERAL TREATMENT MEASURES
This is resorted to only in the presence of mild dehydration (3 to 5% fluid deficit), or moderate dehydration (6 to 10% fluid deficit). Rehydration should commence with a fluid containing 50 to 90 mEq/L of sodium. The amount of fluid administered should be50 ml/kg over a period of 2 to 4 hours in mild dehydration, and 100 ml/kg in moderate dehydration. After 2 to 4 hours, hydration status should be assessed and if found to be normal, maintenance therapy can be begun, other-wise rehydration therapy is repeated.
Maintenance therapy—Oral rehydration solutions (ORS)
should be administered as follows:
■■ 1 ml for each gram of diarrhoeal stool, or
■■ 10 ml/kg for every watery stool passed, or
■■ 2 ml/kg for each episode of vomiting.
Limitations of ORT—ORT is not sufficient therapy in thepresence of dysentery (bloody diarrhoea), shock, intestinal ileus, intractable vomiting, high stool output (>10 ml/kg/hr), monosaccharide malabsorption and lactose intolerance.
This is necessary when dehydration is severe (> 10% fluid deficit or shock).* 20 ml/kg boluses of Ringer’s lactate, normal saline, or similar solution is administered until pulse, perfusion, and mental status return to normal. Two separate IV lines may be required, or even alternative access sites such as femoral vein, venous cut-down, or intra-osseus infusion.
Oral rehydration is commenced when condition improves.
Use of such agents such as kaolin-pectin, antimotility drugs (e.g. loperamide), antisecretory drugs, or toxin binders (e.g. cholestyramine), is controversial. Available data do not demon- strate significant beneficial effects. Instead, serious adverse effects can occur, including ileus and anticholinergic syndrome.