Diarrhea (cont.)
How can dehydration be prevented and treated?
Oral rehydration solutions (ORS) are liquids that contain a carbohydrate
(glucose or rice syrup) and electrolyte (sodium, potassium, chloride,
and citrate or bicarbonate). Originally, the World Health Organization
(WHO) developed the WHO-ORS to rapidly rehydrate victims of the severe
diarrheal illness, cholera. The WHO-ORS solution contains glucose and electrolytes. The
glucose in the solution is important because it forces the small intestine to
quickly absorb the fluid and the electrolytes. The purpose of the electrolytes
in the solution is the prevention and treatment of electrolyte deficiencies.
In
the United States, convenient, premixed commercial ORS products that are similar to the
WHO-ORS are available for rehydration and prevention of dehydration. Examples of
these products are Pedialyte, Rehydralyte, Infalyte, and Resol.
Most of the commercially available ORS products in the U.S. contain glucose.
Infalyte is the only one that contains rice carbohydrate instead of glucose.
Most doctors believe that there are no important differences in effectiveness
between glucose and rice carbohydrate.
Infants and young children. Most acute diarrhea in infants and young
children is due to viral gastroenteritis and is usually short-lived. Antibiotics
are not routinely prescribed for viral gastroenteritis. However, fever,
vomiting, and loose stools can be symptoms of other childhood infections such as
otitis media (infection of the middle ear), pneumonia, bladder infection, sepsis
(bacterial infection in the blood) and
meningitis. These illnesses may require
early antibiotic treatment.
Infants with acute diarrhea also can quickly become
severely dehydrated and therefore need early rehydration. For these reasons,
sick infants with diarrhea should be evaluated by their pediatricians to
identify and treat underlying infections as well as to provide instructions on
the proper use of oral rehydration products.
Infants with moderate to severe dehydration usually are treated with
intravenous fluids in the hospital. The pediatrician may decide to treat infants
who are mildly dehydrated due to viral gastroenteritis at home with ORS.
Infants that are breast-fed or formula-fed should continue to receive
breast milk
during the rehydration phase of their illness if not prevented by vomiting. During,
and for a short time after recovering from viral gastroenteritis, babies can
be lactose intolerant due to a temporary deficiency of the enzyme, lactase (necessary
to digest the lactose in milk) in the small intestine. Patients with
lactose intolerance can develop worsening diarrhea and cramps when dairy
products are introduced. Therefore, after rehydration with ORS, an undiluted
lactose-free formula and diluted juices are recommended. Milk products can be
gradually increased as the baby improves.
Older children and adults. During mild cases of diarrhea, diluted fruit
juices, soft drinks containing sugar, sports drinks such as Gatorade, and water
can be used to prevent dehydration. Caffeine and lactose containing dairy
products should be temporarily avoided since they can aggravate diarrhea, the
latter primarily in individuals with transient lactose intolerance. If
there is no nausea and vomiting, solid foods should be continued. Foods that
usually are well tolerated during a diarrheal illness include rice, cereal,
bananas, potatoes, and lactose-free products.
ORS can be used for moderately severe diarrhea that is accompanied by
dehydration in children older than 10 years of age and in adults. These
solutions are given at 50 ml/kg over 4-6 hours for mild dehydration or 100 ml/kg
over 6 hours for moderate dehydration. After rehydration, the ORS solution can
be used to maintain hydration at 100 ml to 200 ml/kg over 24 hours until the
diarrhea stops. Directions on the solution label usually state the amounts that
are appropriate. After rehydration, older children and adults should resume
solid food as soon as any nausea and vomiting subside. Solid food should begin
with rice, cereal, bananas, potatoes, and lactose free and low fat products. The
variety of foods can be expanded as the diarrhea subsides.
Next: How is diarrhea treated? »
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