oral rehydration solutions are liquids that contain a carbohydrate (glucose or rice syrup) and electrolyte (sodium potassium chloride and citrate or bicarbonate). originally the world health organization developed the who-ors to rapidly rehydrate victims of the severe diarrheal illness cholera. the who-ors solution contains glucose and electrolytes. the glucose in the solution is important because it forces the small intestine to quickly absorb the fluid and the electrolytes. the purpose of the electrolytes in the solution is the prevention and treatment of electrolyte deficiencies. in the united states convenient premixed commercial ors products that are similar to the who-ors are available for rehydration and prevention of dehydration. examples of these products are pedialyte rehydralyte infalyte and resol. most of the commercially available ors products in the u. s. contain glucose. infalyte is the only one that contains rice carbohydrate instead of glucose. most doctors believe that there are no important differences in effectiveness between glucose and rice carbohydrate. infants and young children. most acute diarrhea in infants and young children is due to viral gastroenteritis and is usually short-lived. antibiotics are not routinely prescribed for viral gastroenteritis. however fever vomiting and loose stools can be symptoms of other childhood infections such as otitis media (infection of the middle ear) pneumonia bladder infection sepsis (bacterial infection in the blood) and meningitis. these illnesses may require early antibiotic treatment. infants with acute diarrhea also can quickly become severely dehydrated and therefore need early rehydration. for these reasons sick infants with diarrhea should be evaluated by their pediatricians to identify and treat underlying infections as well as to provide instructions on the proper use of oral rehydration products. infants with moderate-to-severe dehydration usually are treated with intravenous fluids in the hospital. the pediatrician may decide to treat infants who are mildly dehydrated due to viral gastroenteritis at home with ors. infants that are breast-fed or formula-fed should continue to receive breast milk during the rehydration phase of their illness if not prevented by vomiting. during and for a short time after recovering from viral gastroenteritis babies can be lactose intolerant due to a temporary deficiency of the enzyme lactase (necessary to digest the lactose in milk) in the small intestine. patients with lactose intolerance can develop worsening diarrhea and cramps when dairy products are introduced. therefore after rehydration with ors an undiluted lactose-free formula and diluted juices are recommended. milk products can be gradually increased as the baby improves. older children and adults. during mild cases of diarrhea diluted fruit juices soft drinks containing sugar sports drinks such as gatorade and water can be used to prevent dehydration. caffeine and lactose containing dairy products should be temporarily avoided since they can aggravate diarrhea the latter primarily in individuals with transient lactose intolerance. if there is no nausea and vomiting solid foods should be continued. foods that usually are well tolerated during a diarrheal illness include rice cereal bananas potatoes and lactose-free products. ors can be used for moderately severe diarrhea that is accompanied by dehydration in children older than 10 years of age and in adults. these solutions are given at 50 ml/kg over four to six hours for mild dehydration or 100 ml/kg over six hours for moderate dehydration. after rehydration the ors solution can be used to maintain hydration at 100 ml to 200 ml/kg over 24 hours until the diarrhea stops. directions on the solution label usually state the amounts that are appropriate. after rehydration older children and adults should resume solid food as soon as any nausea and vomiting subside. solid food should begin with rice cereal bananas potatoes and lactose-free and low-fat products. the variety of foods can be expanded as the diarrhea subsides.
how can dehydration from diarrhea be prevented and treated?