Pediatric emergency medicine trisk 0525 0525

concentration of 2% to 2.5%. Soda, juice, popsicles, and soups are inappropriate
rehydration solutions in dehydrated infants and children and should be
discouraged as they do not have the appropriate glucose-to-sodium ratio and are
not absorbed as easily as electrolyte solutions. Studies have evaluated half
strength apple juice (mixed with water) as an alternate therapy as compared to
ORT and have found fewer treatment failures most likely secondary to patient
taste preference. In developing countries, the addition of zinc supplementation in
patients older than 6 months of age with diarrhea has been shown to have
improved outcomes however current evidence does not show a benefit in wellnourished children in settings with low prevalence of zinc deficiency.
TABLE 22.4
ONDANSETRON DOSING FOR GASTROENTERITIS
Patient weight
(kg)

Dose

8–15
>15–30
>30

2-mg orally disintegrating tablet (½ tablet)
4-mg orally disintegrating tablet
8-mg orally disintegrating tablet

The amount of fluid to be administered is dependent on the degree of
dehydration. Mild dehydration reflects up to 5% weight loss, so 5% of the child’s
body weight (50 mL/kg) should be administered as small-volume frequent feeds.
Moderate dehydration represents up to 10% weight loss, so 10% of the child’s
weight (100 mL/kg) should be administered. An easy rule of thumb to remember
is that a mildly dehydrated patient can receive 1 mL/kg every 5 minutes and a
moderately dehydrated patient can receive 2 mL/kg every 5 minutes. As the child

tolerates the feeds, the volume can be increased as well as the frequency. The
rehydration should be completed over a 4-hour time frame ( Fig. 22.2 ). ORT has
been shown to be equivalent to IV fluid therapy in terms of rehydration efficacy
and it has been shown that it takes less time to institute therapy with ORT (i.e.,
teach the parents how to administer the fluids) than to start an IV line in a child,
and there is less staff time involved in administering care to these patients as well
as shorter ED stays. There are a significant number of patients with gastroenteritis
who will be unable to perform ORT and will subsequently require alternative
methods for rehydration. Nasogastric (NG) tube use is an acceptable alternative
as it has been shown to be as effective as IV hydration. They are relatively easy to