Rehydration therapy

Rehydration therapy is the corner stone of treatment in a dehydrated patient. (1) Oral rehydration therapy (ORT) or intravenous fluids and electrolytes are used according to the degree of dehydration

Extracellular fluid is lost mostly during dehydration. Hence the main aim of rehydration therapy is

• first to restore the circulating blood volume, if required
• secondly to restore the interstitial fluid volume
• lastly to maintain hydration and replace continuing losses, such as diarrhoea and increased insensible losses caused by fever

Correction of rehydration requires the accurate estimation of deficit, based on the weight of the child and the clinical assessment of the percentage dehydration.

Note that mild or moderate dehydration can be treated very effectively with oral rehydration fluids, even if there is deranged biochemistry.

The following signs indicate that the patient is receiving adequate rehydration therapy:

• skin goes back normally when pinched
• thirst has subsided
• urine has been passed
• pulse is strong

Reference:

1. Shane AL, Mody RK, Crump JA, et al. 2017 Infectious Diseases Society of America clinical practice guidelines for the diagnosis and management of infectious diarrhoea. Clin Infect Dis. 2017 Nov 29;65(12):e45-80.