Oral rehydration therapy.

This paper discusses the use of oral rehydration therapy (ORT) in the clinical management of diarrhea with no dehydration, diarrhea with some dehydration, and diarrhea with severe dehydration. The 1st step in ORT is to weigh the patient and assess the degree of dehydration. It should be recognized that a child who has had 4 loose stools in the past 24 hours and is thirsty has some degree of dehydration, and ORT should start as soon as possible. If the child has no signs of dehydration, the mother should be given 3 instructions for treating diarrhea at home: 1) give the child more fluids more often; 2) continue to breastfeed; and 3) return the child to the clinic if he develops signs of dehydration, if the diarrhea gets worse, or if he is not better after 2 days. If a child has 2 or more of the signs of some dehydration (4-10 loose stools/day, more than a little vomiting, thirstiness, and less urine than usual), he should be rehydrated with oral rehydration solution (ORS). If available, the World Health Organization ORS packets should be used. After the child has been given 10-20 ml/kg of ORS each hour for 4 hours, the hydration should be reassessed. ORS should be given for each loose stool. If the child has 2 or more of the signs of severe dehydration (more than 10 loose stools/day, much vomiting, inability to drink fluids, and no urine for 6 hours), intravenous rehydration is necessary. A major problem with use of ORS is the time involved to explain the process to parents. Parents must understand that ORS does not treat the diarrhea per se; rather, it replaces fluids and salts lost by the child and prevents dehydration. If parents do not understand this, they may become discouraged if the diarrhea continues and stop ORT. ORT is as effective in treating adults with diarrhea as it is in children. In addition, ORT is just as good as intravenous rehydration, except in cases where the dehydration is severe.