Oral Rehydration Therapy - Administration

Administration

Current WHO/UNICEF guidelines, recommend that ORT should begin at home with "home fluids" or a home-prepared "sugar and salt" solution at the first sign of diarrhea to prevent dehydration. Feeding should be continued at all times. After initial fluid volume has been restored, the regimen should be switched to official preparations of oral rehydration salts (ORS) at the appropriate dosing times to maintain adequate hydration and proper electrolyte balance.

During the home-prepared stage, care should be taken to select the proper type of fluid to administer. The fluids given must contain both sugar and salt in the proper amounts. Liquids without salt can lead to low body salt (hyponatremia) because the diarrheal stool contains salt that must be replenished. Additionally, sugar must also be present in the administered fluid because salt absorption is coupled with sugar in the intestine via the SGLT1 transporter.

Appropriate drinks to administer during the home-prepared stage include official ORSs, salted rice water, salted yogurt-based drinks, and vegetable or chicken soup with salt. Clean water should always be used when preparing a solution. Drinks to be avoided include soft drinks, sweetened fruit drinks, sweetened tea, coffee, and medical tea infusions with diuretic effects due to high sugar content and/or caffeine. In addition, drinks with a high concentration (osmolarity) of sugar can worsen diarrhea as they draw water out of the body and into the intestine because of their hypertonicity.

If dehydration ensues even when ORT is begun with a home-prepared solution, if available, a qualified health professional should manage further rehydration with ORS to ensure proper electrolyte balance and to facilitate rapid rehydration, and treatment of the underlying cause of dehydration if appropriate.