The treatment of gastroenteritis with ORS occurs in two phases: rehydration and maintenance. Except in hypernatraemia, ORT aims for full rehydration within 4 (or at most 12) hours.
The schedule suggested here for the rehydration phase is a standard rate of replacement for all dehydrated children who are not shocked. The final volume given is determined by clinical assessment of when the child is rehydrated.
During rehydration phase, fluid is given at a rate of 5ml per minute, by teaspoon or syringe. The small volumes decrease the risk of vomiting. The rate (1 teaspoon / minute) is easy to calculate and administer for a parent sitting at the bedside. 25ml every 5 minutes can also be used.
This rate of replacement is already maximal, and is not supplemented for ongoing losses. If the child's ongoing losses exceed an intake at this rate, the child will require nasogastric or intravenous fluids. This rate will rehydrate a moderately dehydrated 1 year old in 2 to 4 hours and a 2 year old in 3 to 5 hours (estimating diarrhoea at 0-10ml per kg per hour).
An alternative rate is 25ml / kg / hr, in small aliquots frequently.
There must be frequent review (at least 2 hourly) in the rehydration phase.
Vomiting is not a contra-indication. Most children with gastroenteritis who vomit, will still absorb a significant percentage of any fluid given by mouth or NG.
Last updated : Thursday, May 18, 2017
Next review date : Friday, May 18,2018