treatment plan C - management of patients with signs of severe dehydration (WHO recommendations)

Last reviewed 01/2018

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Treatment plan C

Rapid intravenous rehydration is the preferred treatment in this group of patients.

  • if the patient can drink, give ORS by mouth until the drip is set up.
  • start 100 ml/kg Ringer's Lactate Solution (if not available normal saline may be used) divided as follows:
    • infants under 12 months
      • first give 30 ml/kg in 1 hour (repeat once if radial pulse is still very weak or not detectable)
      • then give 70ml/kg in 5 hours
    • older
      • first give 30 ml/kg in 30 minutes (repeat once if radial pulse is still very weak or not detectable)
      • then give 70ml/kg in 2 1/2 hours

Monitoring the progress of intravenous rehydration

  • assess patients every 15-30 minutes until a strong radial pulse is present and at least every hour thereafter to confirm that hydration is improving. If the hydration is not improving, give the IV drip more rapidly
  • once the planned amount of IV fluid has been given (after 3 hours for older patients, or 6 hours for infants), the hydration status should be reassessed fully according to the WHO scale for dehydration
    • if signs of severe dehydration are still present, repeat the IV fluid infusion as outlined above (very unusual, may be seen in children who pass large watery stools frequently during the rehydration period)
    • if the child is improving (able to drink) but still shows signs of some dehydration, discontinue the IV infusion and give ORS solution for four hours as mentioned in  treatment plan B
    • if there are no signs of dehydration, follow treatment plan A

If the child needs to be discharged, educate the mother on how to give treatment at home following treatment plan A, provide enough ORS packets for two days. Also inform her that if the child develops the following signs to immediately seek medical help

  • starts to pass many watery stools
  • has repeated vomiting
  • becomes very thirsty
  • is eating or drinking poorly
  • develops a fever
  • has blood in the stool
  • the child does not get better in three days (1)

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