What are the treatment options for moderate volume depletion in pediatric dehydration?

Updated: Nov 12, 2018
  • Author: Alex Koyfman, MD; Chief Editor: Muhammad Waseem, MBBS, MS, FAAP, FACEP, FAHA  more...
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Answer

The literature supports use of oral rehydration for the moderately dehydrated child. Similar outcomes have been achieved in randomized studies comparing ORS with intravenous fluid therapy with fewer complications and higher parent satisfaction in the ORS groups. Moreover, ORS can typically be initiated sooner than IV fluid therapy. However, children must be cooperative and have caregivers available to instruct and administer the oral fluids. [11]

With ORS, patients should receive approximately 50-100 mL/kg body weight over 2-4 hours, again starting with 5 mL every 5 minutes. [5] If the child can tolerate this amount and asks for more fluids, the amount given can gradually be increased. Once the fluid deficit has been corrected, parents should be instructed on how to replace volume losses at home if the child continues to have vomiting or diarrhea.

Children in whom ORS fails should be given a bolus (20 mL/kg) of isotonic fluid intravenously. This may be followed by 1.5-2 times maintenance therapy. Over the next few hours, the patient may be transitioned to oral rehydration as tolerated, at which point the intravenous therapy may be discontinued.

Children with moderate volume depletion may require inpatient treatment if they are unable to tolerate oral fluids despite rehydration. Hospitalization may also be required for treatment of the underlying cause of the fluid deficit.


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