ORT in Clinical Management of Diarrhea,Treatment,Advantage,Limitation

4th Pediatric Infectious Diseases Conference

ISSN 0973 - 0958

Gastrointestinal Disorders in Children

Oral Rehydration Therapy

Gastrointestinal Disorders in Children

Zinc and ORS

Acute Diarrhea in Children

Inflammatory Bowel Disease/IBD

Acute Childhood Diarrhea: Review of Recent Advances in Standard Management

Zinc For The Prevention Of Diarrhea

Oral Rehydration Therapy

Approach To Acute Abdominal Pain In Children

Trachea oesophageal fistula

Vomiting and Diarrhea in Children

Upper Gastrointestinal bleed

ORS - Which one to use?

Acute Abdomen

Malabsorption syndromes

Prevention of Diarrhea

Lactose Intolerance in Infants, Children, and Adolescents

Biliary Atresia and Kasai's Surgery - When is it too Late

Clinical Tools

Clinical Vignettes

Diseases & Conditions

Drugs Interaction Calculator

Podcasts

Patient Management Online

Diagnostic Dilemma

Question of the Day

Diagnostic Aid

VACCINE REMINDER

"Get the Vaccine Schedule for your child."

Ask Queries

SPECIALIST ANSWERS

Today's Poll

Should teicoplannin, colistin be used in case of neonatal sepsis where culture does not reveal any organism_?

No, it should be used only after drug sensitivity report

Yes, under guidance of an infectious disease expert

Vote

Results

ORAL REHYDRATION THERAPY

Related topics

History and Background

Pathophysiology and Physiology of Diarrhea

Scientific Basis For ORS

Swati Kolpuru,
Fellow- Pediatric GI, University of Maryland, USA

Address for Correspondence:

Dr Swati Kolpuru, Pediatric GI Department, University of Maryland, USA. Email: skgupta29@hotmail.com

Role of ORT in clinical management

The recognition and treatment of dehydration are at the heart of case management of diarrheal disease. ORT is a simple, cheap, and effective treatment for diarrhea-related dehydration.

The general principles of case management include ORT and proper dietary management, with emphasis on appropriate, available, cost-effective methods of assessing and treating dehydration.

Principles of ORT treatment

   1. Adequate rehydration therapy using an appropriate ORS
   2. Replacement of ongoing fluid losses from vomiting and diarrhea with ORS
   3. Frequent feeding of appropriate foods as soon as dehydration is corrected.

ORT is recommended as first-line therapy for both mildly and moderately dehydrated children. ORT seems to be a preferred treatment option for patients with moderate dehydration from gastroenteritis⁸.

The 1st step in ORT is to weigh the patient and assess the degree of dehydration. ORT depends on the degree of dehydration. (See table2)

Table 2: ORT in the management of diarrhea

No dehydration	Replace stool loses with ORS* Continue age appropriate feeding
Mild dehydration (3-5% volume loss)	Repletion phase - Hydration should be restored by administering ORT at a volume of 50 mL/kg over four hours. Additional ORS is given to replace ongoing loss of stool*. Reassessment of the patient's hydration status and replacement of ongoing losses should occur at least every two hours. Maintenance phase - Once repletion is completed, feeding and fluids should be started. ORT is continued for ongoing diarrheal losses.
Moderate dehydration (6-9% volume loss)	Repletion phase - Hydration should be restored by administering ORT at a volume of 100 mL/kg over four hours. Additional ORS is given to replace ongoing loss of stool*. At the end of each hour, the patient's hydration status and continuing stool and emesis losses should be calculated, with the total hourly loss added to the amount to be given over the next hour. Maintenance phase - Once repletion is completed, feeding and fluids should be started. ORT is continued for ongoing diarrheal losses.
Severe dehydration ( 10 % or greater volume loss.)	Repletion phase - Emergent intravenous therapy with rapid infusion of 20 mL/kg of isotonic saline should be given. As the patient's clinical condition stabilizes and his/her level of consciousness returns to normal, therapy can be changed to ORT. A nasogastric tube can be used in patients who have a normal mental status but may be too weak to adequately drink the necessary volume of fluid. The intravenous line should remain in place until it is certain there is successful transition to ORT. ORT therapy is started at a volume of 100 mL/kg over four hours. Additional ORS is given to replace ongoing loss of stool*. At the end of each hour, the patient's hydration status and continuing stool and emesis losses should be calculated, with the total hourly loss added to the amount to be given over the next hour. Maintenance phase - Once repletion is completed, feeding and fluids should be started. ORT is continued for ongoing diarrheal losses.
* 1 mL of ORS should be administered for each gram of diarrheal stool or, 10 mL/kg of body weight of ORS should be administered for each watery or loose stool, and 2 mL/kg of body weight for each episode of emesis.

Advantages of ORT

Low cost

Elimination of the need for IV line placement

Treatment that can be done or continued at home.

Safe and few side effects

Limitations of ORT use

Altered mental status with concern for aspiration

Abdominal ileus

Underlying disorder that limits intestinal absorption of ORT (eg, short gut, carbohydrate malabsorption)

Severe dehydration

If stool output continues to be excessive, and ORT is unable to adequately rehydrate the child.

If there is severe and persistent vomiting, and inadequate intake of ORS, intravenous therapy is recommended.

References

Victora CG, Bryce J, Fontaine O, Monasch R. Reducing deaths from diarrhoea through oral rehydration therapy. Bull. World Health Organ. 2000;78(10):1246-55.
Sarkar K, Sircar BK, Roy S, Deb BC, Biswas AB, Biswas R. Global review on ORT (oral rehydration therapy) programme with special reference to Indian scene. Indian J Public Health. 1990 Jan-Mar;34(1):48-53.
Turner JR, Black ED, Ward J, et al. Transepithelial resistance can be regulated by the intestinal brush-border Na(+)/H(+) exchanger NHE3. Am J Physiol Cell Physiol 2000; 279:C1918.
Rao MC. Oral rehydration therapy: New explanations for an old remedy. Annu Rev Physiol 2004; 66:385
Avery ME, Snyder J. Oral Therapy for Acute Diarrhea. New Engl J Med 1990. 323(13):891-4
Lankinen KS , Bergstrom S, Makela PH, Peltomaa M. Health and Disease in Developing Countries, Macmillan 1994.
Hahn S, Kim Y, Garner P. Reduced osmolarity oral rehydration solution for treating dehydration due to diarrhoea in children: systematic review. BMJ 2001:323;81-5.
Spandorfer PR, Alessandrini EA, Joffe MD, Localio R, Shaw KN. Oral versus intravenous rehydration of moderately dehydrated children: a randomized, controlled trial. Pediatrics. 2005;115:295-301.