Oral Rehydration

Therapy

Oral Rehydration Therapy

preferred first-line treatment of fluid and
electrolyte losses caused by diarrhea due
to gastroenteritis in children with mild to
moderate dehydration
used to treat hypovolemia caused by
gastroenteritis independent of age,
causative agent, or initial sodium values

Oral Rehydration Therapy

Advantages of ORT compared with
intravenous (IV) hydration:

lower cost
easier administration
less invasive intervention
can be done or continued at home

Assessment of
Dehydration
Identify patients who are not dehydrated
ORT maintenance

Identify patients who are mildly to

moderately dehydrate
ORT is the preferred therapy for rehydration

Identify patients who are severely

dehydrated
require IV rehydration

Phases
Rehydration phase
The fluid deficit is replaced quickly over three to
four hours, returning the patient to a euvolemic
state. ORS is administered in frequent, small
amounts of fluid by spoon or syringe
Five mL (one teaspoon), administered every one
to two minutes, allows as much as 150 to
300mL/hourto be given.

Maintenance phase
Maintenance calories and fluids are
administered.

Mild to Moderate
Dehydration
Repletion phase
Hydration should be restored by administering ORS
at a volume of 50 to 100mL/kgover four hours.
Additional ORS is given to replace ongoing
gastrointestinal losses (eg, stool or emesis).

Maintenance phase
ORT is continued for ongoing gastrointestinal losses.
The patient's hydration status and ongoing stool
and emesis losses should be calculated, with the
total hourly loss added to the amount to be given
over the next hour.

Contraindications to ORT
Altered mental status with concern for
aspiration
Abdominal ileus
Underlying disorder that limits intestinal
absorption of ORT (eg, short gut,
carbohydrate malabsorption)
Severe dehydration

ORT to IV Hydration
Once ORT has been initiated, intervention
with IV hydration is indicated:
If stool output continues to be excessive, and
ORT is unable to adequately rehydrate the
child
If there is severe and persistent vomiting,
and inadequate intake of ORS