Oral rehydration solution (ORS) is considered the mainstay of treatment of acute watery diarrhea. However, it remains underutilized in several hospitals. Consequently, children with moderate degrees of dehydration have to be hospitalized unnecessarily and administered intravenous fluids. A study was conducted to evaluate the use of an ORS tolerance test on initial presentation to an emergency department, find out the volume of ORS a child with diarrhea, and moderate dehydration require to tolerate to be successfully managed at home. This study involved 129 children with acute watery diarrhea and moderate dehydration. They were given ORS and observed in a Childrens Emergency Department (CED) for 2-4 hours. Patients were admitted, kept in the CED for further management or discharged, based on the assessment of oral intake and the clinical judgment of healthcare professionals. The results showed that 79 (61.2%) patients tolerated ORS well. They drank a median [interquartile range (IQR)] of 24.4 ml (IQR 12.5-28.8) ml/kg, were judged to have passed the ORS test and were discharged to continue oral rehydration treatment at home. At follow-up on days 2 and 5, 63 out of 79 (79.7%) children showed improvement, were adequately hydrated and the diarrhea had reduced. These children had tolerated a median of 25.8 (IQR 18.4-30.0) ml/kg of ORS in the CED. The findings of this study indicate the efficacy of ORS in a majority of children with acute watery diarrhea and moderate dehydration.

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