treatment plan B - management of patients with some signs of dehydration (WHO recommendations)

Last reviewed 01/2018

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Treatment plan B

These patients should receive oral rehydration therapy (ORT) with ORS solution in a health facility

• if the child's weight is known, this should be used to determine the approximate amount of solution needed.
• the amount may also be estimated by multiplying the child's weight in kg times 75 ml.
• if the child's weight is not known, select the approximate amount according to the child's age.

Approximate amount of ORS solutions to give in the first 4 hours include

Note:

• the exact amount of solution required will depend on the child's dehydration status
• if the patient wants more ORS than shown, give more (check for signs of overhydration)

How to give ORS solution

• for infants and young children - a clean spoon or a cup can be use (feeding bottles should not be used)
• for children under 2 years - a teaspoonful every 1-2 minutes
• older children (and adults) - may take frequent sips directly from the cup
• for babies - a dropper or syringe (without the needle) can be used to put small amounts of solution into the mouth

If vomiting may be seen during the first hour or two of treatment specially in children if they drink the solution too quickly. If the child vomits, wait 5-10 minutes and then start giving ORS solution again, but more slowly (e.g. a spoonful every 2-3 minutes) (1).

Monitoring the progress of oral rehydration therapy

• time to time check the child to ensure that ORS solution is being taken satisfactorily and that signs of dehydration are not worsening. If at any time the child develops signs of severe dehydration, shift to
• after four hours, reassess the child fully, and decide on the next treatment step
• if signs of severe dehydration have appeared, intravenous (IV) therapy should be started following Treatment Plan C
• if the child still has signs indicating some dehydration, continue oral rehydration therapy by repeating Treatment Plan B. At the same time start to offer food, milk and other fluids, as described in Treatment Plan A, and continue to reassess the child frequently.
• if there are no signs of dehydration, the child should be considered fully rehydrated. When rehydration is complete:
• the skin pinch is normal
• thirst has subsided
• urine is passed
• the child becomes quiet, is no longer irritable and often falls asleep.

It is important that patients should meet the normal daily fluid requirements while on rehydration and maintenance therapy.

• breastfeeding infants - continue to breastfeed as often and as long as the infant wants, even during oral rehydration.
• non breastfed infants under 6 months of age
• if using the old WHO ORS solution containing 90 mmol/L of sodium, also give 100-200ml clean water during this period (this is not necessary if the new reduced (low) osmolarity ORS solution containing 75mmol/L of sodium is used)
• after completing rehydration, resume full strength milk (or formula) feeds. Give water and other fluids usually taken by the infant
• older children and adults - offer as much plain water to drink as they wish, in addition to ORS solution

Reference:

• (1) World Health Organization. Cholera. Fact Sheet 107. July 2012
• (2) Colletti JE et al. The management of children gastroenteritis and dehydration in the emergency department. with J Emerg Med. 2010;38(5):686-98