A critique of oral therapy of dehydration due to diarrheal syndromes

Abstract

Under the circumstances of limited health resources and immediate need for preventing the dehydration associated with diarrhea in infants, breast-feeding should be encouraged throughout the diarrheal episode. When this is not possible because of cessation or failure of lactation, an oral electrolyte solution should be administered. It should be sterile and provide a quantity of electrolytes not greatly in excess of 30 mEq/liter of sodium and potassium. There should be little possiblity of an error in the dilution of the mixture if it is to be supplied in powdered form. Milk should be reintroduced after 24 hr and the electrolyte mix rapidly discontinued so as to minimize nutritional deficits. If no such electrolyte mixture is available, it is reasonable to alternate feedings of commercial soft drinks or bland teas with milk feedings. There should be specific instructions that the infant should be brought to the hydration center if more than three sequential feedings are lost by vomiting, if fever is present, or if the stools exceed the volume of three feedings. In general, dehydration of less than 5% of body weight can be managed by this program in the home. Dehydration greater than 5% but less than 10% requires supervision by health authorities. Dehydration greater than 10% requires intravenous therapy in a hydration center. In those countries with cholera and during epidemics of shigellosis or enterotoxigenic Escherichia coli, solutions containing 90 mEq/liter of sodium should be given under ambulatory supervision. This solution should be discontinued when fecal losses moderate (less than 60 ml/kg per day) and the lower electrolyte solution (30 mEq/liter) substituted.