Oral fluid therapy in severe diarrheal dehydration

Abstract

1330 children, birth to 24 months old, suffering from diarrhea and moderate to severe dehydration were hospitalized in Tehran university hospital over a period of 11 months. 15% of them had signs of shock, and 305 had marasmus. On admission, plasma sodium ranged from 106 to 144 mmol/l, potassium 1.4 to 7.7 mmol/l, bicarbonate 2 to 24 mmol/l, chloride 83 to 161 mmol/l and PH ranged from 6.48 to 7.56. All patients were treated orally in two phases: A) Rehydration therapy, and B) Maintenance therapy. For rehydration, electrolyte solution A (EA: Sodium 80, potassium 20 mmol/l) was administrated at a rate of 40 ml/kg/h until all signs of dehydration disappeared. Following complete dehydration, the patients were discharged and maintenance therapy was performed at home, by mothers, administrating electrolyte solution B (EB: Sodium 40, potassium 30 mmol/l) ad libitum. Antibiotics, anti-diarrhea and anti-emetic drugs were not used. Intravenous fluids were not used either, even in sever dehydration. The efficacy and safety of this regimen were confirmed by rapid and successful rehydration and correction of the electrolyte abnormalities present on admission. The study indicates that this protocol could be successfully employed in all types and severities of dehydration electrolyte abnormalities. It could be used in both well-nourished and in those with severe marasmus. It could also replace intravenous fluid in the majority of such patients.