Oral rehydration therapy: The clear solution to fluid loss

April 1, 2005

ORT is an effective yet underused treatment for acute gastroenteritis. Here's a look at the specifics and benefits of this "low-tech" approach.

Every year in the United States, acute diarrhea leads to more than 1.5 million outpatient visits, 200,000 hospitalizations, and 300 deaths. Worldwide, diarrheal diseases are a major cause of morbidity and mortality in children. In developing countries, some 2 million children younger than 5 years die annually from acute diarrhea.1 Most often, morbidity and mortality result from fluid and electrolyte losses. Assessment of dehydration and correction of fluid and electrolyte losses are, therefore, the mainstays of treatment of acute gastroenteritis.

The American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC) have published practice parameters for the management of acute gastroenteritis.1,2 Both organizations recommend oral rehydration therapy (ORT) as the preferred approach for treating mild to moderate dehydration caused by vomiting or diarrhea.1,2 Despite these recommendations, ORT remains widely underused.1,3 This article reacquaints you with the value of this therapy and the parameters for its use.

Determining the extent of fluid loss Dehydration can be categorized as mild, moderate, or severe, depending on the volume of fluid loss and the patient's clinical status. Classifications by the AAP, CDC, World Health Organization (WHO), and European Society of Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) have defined mild dehydration as a fluid deficit of less than 3% to 5%; moderate dehydration, 5% to 9% or 6% to 10%; and severe dehydration, greater than 9% or 10%.1 Numerous other parameters have been used to categorize dehydrated patients, including blood pressure, pulses, heart rate, skin turgor, mucous membrane dryness, and capillary refill time (Table 1). Recent studies reveal that signs of dehydration in a child may not be evident until there is a fluid deficit of 3% to 4%.4 Signs of severe dehydration are not obvious until a patient has a fluid loss of 9% to 10%.5