It has been repeatedly demonstrated that oral rehydration is as effective as intravenous therapy in treating infants with mild to moderate dehydration. 789 and 10 It has had an enormous impact in developing countries, where prepackaged electrolyte solutions are available in lieu of infinitely more expensive intravenous solutions. Although time constraints may limit oral therapy in emergency departments in the United States, emergency physicians who do work in international medicine must be familiar with its use.
Water and electrolyte solutions created for treating dehydrated patients differ from maintenance solutes primarily in the composition of electrolytes. Rehydration solutions contain 60 to 90 meq/L sodium and 2% to 2.5% glucose, compared with maintenance solutions, which contain approximately 45 to 50 meq/L sodium ( Table 128-3). The higher sodium content is thought to facilitate the absorption of water in the small intestine. Some controversy exists regarding the propensity of the World Health Organization's rehydrating formula, containing 90 meq/L sodium, to cause hypernatremia. In dehydrated patients, this appears to be rare, but reformulated oral rehydrating solutions containing 50 to 60 meq/L sodium are in use. Studies continue to investigate the optimum sodium content of oral rehydration solutions, as well as the optimum composition of sugars. Current evidence indicates that reduced osmolarity formulas limit the duration of diarrhea. In practice, maintenance solutions can be effectively used if rehydrating solutions are unavailable.
TABLE 128-3 Composition of Commercial Oral Hydration Solutions
Fluid replacement is accomplished by administering 50 mL/kg over 4 h to mildly dehydrated patients and 100 mL/kg to patients with moderate dehydration. Vomiting can be reduced by administering the fluid slowly. This can be done be using a teaspoon or eyedropper. Ongoing losses from continuing diarrhea are also replaced. Once adequate hydration is reestablished, supplemental feeding should be encouraged. This is especially important in malnourished infants.
Severe dehydration, persistent vomiting, continuing severe diarrhea, or significant hypernatremia may preclude the use of oral rehydration when intravenous therapy is available. If necessary, however, the vast majority of these patients can be salvaged by persistent administration of small quantities of oral fluids. Fluid can also be administered by nasogastric tube, if necessary.
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