The mainstay treatment for acute watery diarrhea is oral rehydration solution (ORS). However, it is underutilized in several hospitals, which results with moderate degrees of dehydration in children and later are being unreasonably hospitalized to receive intravenous fluids.

Dehydration is the most common complication of acute watery diarrhea in children. The use of ORS has markedly reduced the morbidity and mortality associated with dehydration caused by diarrheal illness regardless of the etiology.

The main objective of the study is to evaluate the efficacy of an ORS tolerance test on preliminary presentation to an emergency department, and also to determine the volume of ORS a child with diarrhea and moderate dehydration requires to tolerate for successful management at home. One hundred and twenty-nine children suffering with acute watery diarrhea along with moderate dehydration were given ORS and observed in a childrens emergency department for a period of 2-4 hours. These children with acute watery diarrhea were admitted and kept in the emergency department for further management or were discharged, based on the evaluation of oral intake and the clinical judgement of the treating health staff.

Seventy-nine children (i.e. 61.2%) tolerated ORS very well. They drank a median of 24.4 ml/kg, and passed the ORS test and were also discharged to continue oral rehydration treatment at home. On days 2 and 5 follow-up, 63/79 (79.7%) children had improved and were sufficiently hydrated and the diarrhea also had reduced. 16 children out of the 79 (i.e. 20.3%) failed the oral home treatment and persisted with diarrhea, vomiting, hypokalemia and weakness. The 63 children who had succeeded tolerated a median of 25.8 ml/kg of ORS in the children’s emergency department, whereas the 16 children who failed the oral home treatment tolerated 11.1 ml/kg of ORS (p < 0.001).

Treatment of diarrhea with ORS can remedy 90% of dehydration from diarrhea. ORS is the cornerstone of diarrhea treatment, according to the World Health Organization (WHO).

Source: J Trop Pediatr. 2019 Dec 1;65(6):583-591.