00:01
Now we're going to talk about
Oral Rehydration Therapy.
00:05
So there are some
treatment principles
we want to think about
when thinking about
dehydrated patients.
00:11
And when we're using
oral replacement therapy.
00:15
You want to use pediatric oral
rehydration solutions
as often as possible
if they are available to you.
00:23
You want to start rehydration
pretty immediately,
as soon as you notice that pediatric
patients might become dehydrated.
00:31
If they have any reason for
dehydration,
starting earlier is better.
00:37
You want to offer age appropriate
and unrestricted diet
as soon as the dehydration is
corrected.
00:43
And you want to continue
breastfeeding
if the infant is
initially breastfed.
00:48
So some mothers feel like
they need to stop breastfeeding
and turn to an
oral rehydration solution.
00:56
But actually continuing
breastfeeding can be helpful.
01:00
If an infant is formula fed,
then you want to make sure
that you continue that formula,
and there's no need
to dilute that formula.
01:09
It's actually not recommended.
01:11
We just want to keep giving
the same formula
that the infant is used to.
01:16
Additional oral replacement
solution should be administered
on an ongoing basis,
even if you feel like you've caught
up to the initial dehydration,
if the patient is still having
a reason to be dehydrated.
01:29
For example, if the patient
is continuing to have a
couple of bouts of diarrhea a day
or is still vomiting a little bit.
01:37
They're not showing signs of
dehydration anymore clinically,
but they're still having
that vomiting or diarrhea.
01:44
You want to continue giving them
that solution
so that we don't get behind again.
01:50
And then lastly,
we don't need to get
unnecessary labs or
give unnecessary meds.
01:56
It's really enough to kind
of watch those
clinical signs and symptoms
and continue orally
rehydrating patients
if the dehydration is mild.
02:06
So the most crucial aspect in the
management of diarrhea
is the need to replace
these fluid losses.
02:12
So again, that's why early, early
oral replacement therapy
is recommended.
02:18
And then really
continuing to maintain
that adequate nutrition intake.
02:24
So oral placement solutions
are administered at a rate
that hopefully will replace
existing losses.
02:31
And if the dehydration is mild,
then we can usually do this.
02:36
So the CDC recommends
5 mL of fluid every five minutes.
02:42
So what this looks like is really
you are giving an infant or child
just a tiny little bit of fluid
very frequently.
02:50
Because if you give them
a whole cup to chug down
and they've been vomiting,
and they vomit all of that backup,
then clearly that's not
going to help the patient at all.
03:00
So they may tolerate
the lower volume of fluids.
03:03
So just a small amount 5 mL,
and continually offer that
every five minutes.
03:10
So in mild to moderate
dehydration.
03:12
The goal of this is
to really give them
50 to 100 mL/kg of this
oral replacement solution
over about three to four hours.
03:22
And hopefully if you can
get them to take that
5 mL every five minutes,
then you'll get to
this eventual goal.
03:31
So oral replacement solution
is administered,
hopefully at a rate that will
replace these existing losses.
03:38
And you're really going to monitor
until those symptoms subside.
03:43
It is really important
to note
that this is not used
in severe dehydration
in the United States in particular.
03:52
Oral rehydration
therapy is only used
for mild and sometimes in to
moderate dehydration.
03:59
But severe dehydration needs to be
handled differently.
04:02
And we'll talk about that
in a later presentation.
04:06
So why are commercial solutions
better than sports drinks
like Gatorade for oral
rehydration therapy?
The reason you don't
want to give sports drinks
are the fact that it just does not
have the right mix of ingredients
that is needed to really help that
dehydrated pediatric patient.
04:27
So commercial solutions contain that
mix of salt and sugar.
04:31
They also have potassium and
other minerals
that are going to help replace
what the patient is
losing in those fluids.
04:41
There are some things to avoid in
oral replacement therapy.
04:45
You really don't want to give
sodas and Gatorade.
04:49
They're not recommended anyway in
children less than two years of age.
04:52
And they really have a
high glucose load.
04:55
They don't have enough
sodium.
04:57
They don't have enough electrolytes.
04:58
And that high glucose load
can really lead to even more
vomiting and diarrhea
in these cases.
05:05
Additionally, you don't want to give
any fluids that have caffeine in it.
05:09
Caffeine encourages diuresis, which
just as another way of losing fluid.
05:14
And so it is not going to be
helpful in a patient
that is already dehydrated.
05:18
So no soda, no coffee, no tea.
05:23
Cow's milk can also
be problematic.
05:26
Because as we've discussed
in a previous presentation,
it has a very high solute load.
05:31
And if you're dehydrated,
that high solute load
could really stress out
the kidneys.
05:37
It can just become problematic
and it doesn't really
have the correct components,
including those electrolytes
that you're going to be
losing in
if you have vomiting or diarrhea.
05:47
So we would also avoid
cow's milk
for oral replacement therapy.
05:55
Definitely want to avoid
anything acidic,
because the stomach is
probably already pretty upset.
06:01
So avoid juices like orange juice,
or even very sugary juices.
06:06
Apple juice should also be avoided
even though it's not as acidic.
06:09
It has a lot of glucose,
a lot of sugar in that juice.
06:13
And again, that's going to cause
a problem for a patient
that's already dehydrated.
06:18
And it's not going
to have those electrolytes
that need to be replaced.
06:23
So, again, what to avoid
in oral replacement therapy?
Don't give the child
too much plain water.
06:31
It doesn't have
electrolytes in it.
06:33
And we really need to replace
those electrolytes.
06:36
Vomiting and diarrhea
can cause a lot of loss of
salts and electrolytes.
06:42
So rehydration fluids
should also contain
all of these salts and electrolytes.
06:50
There are some recommendations
by the World Health Organization
about oral replacement therapy.
06:56
And they again recommend
that the treatment of diarrhea
which is a large cause
of dehydration
in other countries that
should begin at home
and with the first sign
of the diarrhea.
07:08
Don't wait until the
patient looks dehydrated.
07:11
They also recommend
oral rehydration preparations
because it has that correct
concentration of electrolytes.
07:19
And also to remember that it's
often a two phase treatment.
07:23
You're going to catch up
for the dehydration,
and then you're going
to continue to give these
Oral Replacement
Therapy Solutions
as long as the patient
is having ongoing losses.
07:34
So if they're still vomiting,
if they're still
having any diarrhea,
you want to continue giving
those oral replacement solutions.