These children with 2 or more clinical signs of ‘some’ dehydration should initially be managed in a clinic or hospital if possible as they can progress to ‘severe’ dehydration: They can be treated with oral rehydration solution with a close watch for repeated vomiting or a refusal to drink. It is best if the oral [...]
These children are losing excessive amounts of fluid and electrolytes in their stools and therefore must still be given extra fluid and electrolytes to prevent signs of dehydration from appearing. These children should be managed at home or at a clinic using commercial oral rehydration solution or sugar and salt solution to replace fluid losses. [...]
Zinc is an important trace element which can speed up the recovery from diarrhoea and help to prevent further diarrhoea. Once the child is taking feeds well, one tablet of zinc (20 mg) should be given daily for 10 days. Children under 6 months should have half a tablet daily.
Once dehydration has been corrected, the total amount of fluid needed is normal maintenance requirements plus any ongoing fluid losses. The normal fluid needs of most infants are about 100 ml/kg daily. If possible this fluid should be given orally as rehydration solution or milk. Thirst is usually a good guide to the infant’s fluid [...]
Give intravenous Ringer’s lactate or normal saline 20 ml/kg as fast as possible. Continue to give fluid at this fast rate until the signs of shock have disappeared. An easily felt radial pulse and normal capillary filling time are very reassuring signs of a good response to management. Once shock has been corrected, Ringer’s lactate, [...]
The management of children with severe diarrhoea leading to severe dehydration is a medical emergency. Look carefully for shock in all children with severe dehydration and treat immediately. Immediately start an intravenous infusion with Ringer’s lactate (or half normal saline or half strength Darrows/dextrose solution). Give 30 ml/kg over the first half hour (30 minutes). [...]
