Diarrhea and
Dehydration - Dx and Rx
Treatment of
the dehydrated child:
|
Dehydration |
Symptoms
and Physical Findings: |
Approach
to treatment |
Solution |
|
Mild
(3-5%) |
dry
mucous membranes; child is thirsty and alert |
PO only
with oral rehydrating solution
(50
cc/kg over 4-6 hours)
small
amounts frequently
|
Pedialyte,
Infalyte,
Revital
ICE pops
|
|
Moderate
(6-9%) |
increased HR and resp rate; child listless or irritable; lips and
mucosa dry; ant font sunken; no tears |
PO only
with oral rehydrating solution
(100
cc/kg in 4-6 hours)
small
amounts frequently
|
Pedialyte;
Infalyte;
Revital ICE pops
|
|
Severe
(>10%) |
HR and
resp rate increased; child very lethargic; skin cold and clammy; cap
refill > 3 sec |
*IV
bolus: 20 cc/kg until nl vital signs; then 100 cc/kg |
Normal
saline; lactate 1st |
* Note: IV
fluids only in severe dehydration or if fail to improve on oral treatment
Commonly asked questions:
1. Other than Pedialyte, Infalyte, and the new ICE pops, are there other
rehydrating solutions that should be tried?
Answer: No. Not recommended: Cola, Apple Juice, Chicken Broth, Gatorade,
Tea
2. Why not give IV fluids to the moderately dehydrated child?
Answer: Oral rehydration is more physiologic, less painful, and less
expensive
3. What tests should be ordered?
Answer: Electrolytes in moderate and severe dehydration; stool culture
rarely - only if there is blood in the stool, and persistence of more than
8-10 stools per day.
4. What medications should be used to try and stop diarrhea?
Answer: Usually none. Pepto-Bismol has been demonstrated to be helpful
in studies of diarrhea in Chile and Peru (NEJM 1993: 328:1653), but is not
routinely recommended.
Other meds such as Lomotil and Imodium should NEVER be used in children.
5. How should we approach feeding of children with diarrhea in the
following situations?
- Breastfeeding: Continue breastfeeding; Breast milk contains
Bifidobacterium bifidum, a bacterium disrupted in diarrhea.
- Formula feeding: after rehydration, continue with usual formula.
No evidence that half-strength formula helpful; may choose a formula with
no lactose instead.
- Solid Foods: BRAT diet OK; rice particularly helpful; start feeding
as soon as rehydrated. Do not starve the children; starvation stools
result (green, mucoid).
6. How often should dehydrated children be admitted to the hospital?
Answer: Usually necessary only in severely dehydrated children.
**Reference: Contemporary Peds, December 1995, page 68
Next Page |