Oral rehydration solution (ORS) is the cornerstone for treating acute watery diarrhea. Still, it is underutilized in many hospitals, causing children with moderate degrees of dehydration to be unnecessarily hospitalized and receive intravenous fluids. 

A recent study by Kauna R. et al. assessed the utility of an ORS tolerance test on initial presentation to an emergency department and determined the volume of ORS a child with diarrhea and moderate dehydration needed to tolerate to be successfully managed at home. 

The study administered ORS in One hundred and twenty-nine children with acute watery diarrhoea and moderate dehydration and observed them in a Children′s Emergency Department (CED) for 2–4 h. It admitted Patients and kept them in the CED for further management or discharged them based on the assessment of oral intake and the clinical judgment of the treating health workers. 

It observed-

• 61.2% of patients tolerated ORS well.
• They drank a median of 24.4 ml/kg, passed the ORS test, and received a discharge to continue oral rehydration treatment at home.
• At follow-ups on days 2 and 5, 79.7% of children showed improvement, were adequately hydrated, and had reduced diarrhea.
• 20.3% of the children failed oral home treatment, with persisting diarrhoea, vomiting, hypokalaemia, and/or weakness.
• The patients who succeeded had tolerated a median of 25.8 ml/kg of ORS in the CED, whilst the 16 who failed oral home treatment had tolerated 11.1 ml/kg ORS.

Kauna R, Sobi K, Pameh W, et al. Oral Rehydration in Children with Acute Diarrhoea and Moderate Dehydration—Effectiveness of an ORS Tolerance Test. Journal of Tropical Pediatrics. 2019;65(6):583–591. https://doi.org/10.1093/tropej/fmz017