what indicates referring to a physician or ER
- less than 6 months
- less than 8 kg
- young with fever
- blood or mucus in the stool
- signs of severe dehydration
- change in mental status
- suboptimal response
- another medical condition
when should oral rehydration solutions (such as pedialyte) be used for dehydration
mild to moderate dehydration
what is the problem with clear liquids such as sodas, juices and broths
hyperosmolar, don’t help replace fluid loss
what is the best glucose to sodium ratio for ORS
1:1 or 3.1:1 (like pedialyte)
what is in pedialyte that is converted to bicarbonate
citrate
what are some problems with cola, gatorade or clear liquids
high osmolality
and glucose to sodium ratio is way too high
can worsen diarrhea
what are the two phases of treating dehydration
- replacement and
2. maintenance (with replacement of ongoing losses)
what is the initial replacement therapy for mild dehydration
50 ml ORS/kg over 3-4 hours
what is the initial replacement therapy for moderate dehydration
100 ml ORS/ kg over 3-4 hours
what is the maintenance (ongoing loss) replacement therapy for moderate dehydration
10 kg or less is 60-120 ml ORS for each episode
greater than 10 kg is 120-240 ml ORS for each episode
same as mild
what is the maintenance (ongoing loss) replacement therapy for mild dehydration
10 kg or less is 60-120 ml ORS for each episode
greater than 10 kg is 120-240 ml ORS for each episode
same as moderate
what are some practical issues when giving ORS for mild-moderate dehydration
- start small; like one or two teaspoons every couple minutes
- increase amount slowly, but avoid large single volumes
why is breast feeding okay in acquired lactase deficiency
breast milk contains lactase
what are 5 limitations to ORS therapy
- dysentery
- severe dehydration
- intractable vomiting
- high stool output
- glucose malabsorption
