Paediatric diarrhoea--rehydration therapy revisited.
Acute infective diarrhoea remains one of the most common causes of morbidity and mortality in children under 5 years of age. This paper reports on a 7-year experience of management of paediatric diarrhoea at King Edward VIII Hospital, Durban, in which an inpatient case-fatality rate of nearly 25% was reduced to less than 7%, and the admission rate was reduced by 60% by a cumulative effect of the following measures: one of four paediatric wards was converted into a diarrhoea ward; improved attention to protocol resulted in a rapid reduction in the inpatient case-fatality rate, but further improvement resulted from a strong commitment to an efficient outpatient oral rehydration protocol to reduce the pressure on inpatient beds, as well as a simplified approach to fluid therapy; and a formula was developed based on units of 5 ml/kg/h, and applicable to both oral and intravenous routes. The most important assessment of dehydrated patients is determination of a need for resuscitation. In less severely ill patients it is not necessary to calculate rehydration fluid requirements by a 'percent dehydration' formula.