**6. Systematic approach to a child with AGE and dehydration: summary of the assessment and management of AGE with dehydration in children**

See **Figure 3**.

*Perspective of Recent Advances in Acute Diarrhea*

*4.6.2 Rapid standard-volume IV rehydration*

*4.6.3 Rapid large-volume IV rehydration*

and therefore is not recommended [29, 30].

**5. Electrolyte disturbances**

treated using ORT.

intake during the illness.

large-volume IV rehydration in pediatric gastroenteritis.

**5.1 Hypernatremia (serum sodium > 145 mmol/L)**

developing hyponatremia during rehydration [23, 33].

**5.2 Hyponatremia (serum sodium < 135 mmol/L)**

known [28].

The clinical standard is to administer 20 mL/kg/h of isotonic crystalloid fluid, such as 0.9% normal saline or lactated Ringer's solution. Reassess the patient after each bolus, and if the patient is still dehydrated, a total of 2–4 fluid boluses may allow rapid restoration of intravascular volume which can bring rapid recovery. Rapid IV rehydration followed by oral fluids is adequate for initial rehydration for most patients requiring IV fluid therapy. For those refusing oral intake, continuous infusion of maintenance IV fluids are to be given until oral fluids are tolerated [27]. Glucose solution should be added once ECF volume has been restored and addition of potassium considered once the child passes urine and serum electrolytes are

Refer to the correction of dehydration using a large volume of fluids over a relatively shorter time (50–60 ml/kg/hour). Ultra-rapid IV rehydration may be associated with electrolyte abnormalities and longer hospital stay or delayed discharge

Children with acute watery diarrhea and severe dehydration, such as cholera,

Dyselectrolytemia is a serious complication of AGE with dehydration. The majority of electrolyte disorders associated with AGE in children can be adequately

Hypernatremia leads to hypertonicity that can be potentially dangerous as there

As in any type of dehydration, the primary aim should be restoration of hemodynamic stability by administration of isotonic fluids. The gradual replacement of water deficit remains the gold standard treatment for hypernatremic dehydration [32]. The recent advance in management of hypernatremia is to give isotonic (0.9% sodium chloride + 5% glucose) than hypotonic solution to correct the calculated fluid deficit slowly. The more the solution contains free water, the higher the risk of

is a greater likelihood of neurological manifestations. Most frequently, it is due to water deficit from increased water losses in diarrhea and due to reduced water

It represents an excess of water in relation to sodium in ECF [34]. Hyponatremia is seldom symptomatic unless the serum Na is <120 or if the hyponatremia occurs quickly [35]. Hyponatremia may be presented with nausea,

who fail ORT, can benefit from large-volume IV rehydration (100 ml/kg) of Ringer's lactate solution or normal saline over 3–6 hours. Frequent reassessment is required, and if hydration status is not improving, IV fluids should be given more rapidly [31]. Further research investigations are needed to justify the use of rapid

**42**

#### **Figure 3.**

*Flow chart for the management of pediatric gastroenteritis with dehydration.*
