Out Patient ORS Protocol


eMediNexus    23 March 2018

No IV in mild dehydration in adults

Oral hydration is a low-cost, evidence-based solution hospitals can implement to treat adults with mild rehydration.

The suggested protocol is for people with mild dehydration from diarrhea, vomiting, morning sickness but not for people who have major electrolyte imbalances, such as kidney disease. Also oral rehydration should not replace IV fluids in patients with moderate or severe dehydration or in those unable to take liquids orally but is ideal for patients with pharyngitis, gastroenteritis, and upper respiratory tract infections.

The Protocol: Patient consumes 500 to 1000 mL oral fluids in the clinic or the ER and continue rehydrating at home, along with pain relief, antipyretics, and antiemetics as needed.

Patient can chose from water, dilute juice, an artificially flavored oral electrolyte solution, or dilute sports drinks (latter two if clinicians suspect electrolyte imbalance.)

After receiving a straw, a 30-mL medicine cup, and 1000 mL of the liquid chosen, the patient is instructed to drink 30 mL every 3 to 5 minutes. Consume half within 50 to 80 minutes, and all of it between 1 hour and 40 minutes and 2 hours and 40 minutes. A 20-minute delay in drinking is recommended for patients who vomit. Pateint can be discharged once he or she passes urine.

Give antiemetics or pain control as needed, and switch out drinks if the patient does not like the first one.

Clinical judgment is used when choosing oral hydration in patients with coexisting conditions such as renal disease, diabetes, or heart failure. [Medscape]

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