**4.3 Discharge criteria**

*Perspective of Recent Advances in Acute Diarrhea*

**3.2 Laboratory assessment of dehydration**

management and outcome of a specific patient.

for uncomplicated gastroenteritis in children [18].

osmolality to maximize clinical efficacy [19].

**4. Management of dehydration**

**4.1 Oral rehydration therapy (ORT)**

cases [11]. Clinical dehydration scales are imprecise and of limited diagnostic value in children with gastroenteritis [12]. As a screening test of dehydration, historical points are moderately sensitive. Classification of dehydration into NO, SOME, and

Prolonged capillary refill time, abnormal skin turgor, and abnormal respiratory pattern still remain the best three individual examination signs for assessment of dehydration. Increased capillary refill time was the strongest individual sign as an isolated finding to predict dehydration, and the poor predictor of dehydration was reduced urine output. Combinations of signs perform much better than individual

Blood biochemistry is generally not accurate and not routinely required for assessment of dehydration. Commonly done laboratory tests such as blood urea nitrogen (BUN) and bicarbonate concentrations are generally helpful only when the results are markedly abnormal. A normal serum bicarbonate concentration of more than 15 or 17 mEq/L appears to be valuable in reducing the likelihood of dehydration. These laboratory tests done for assessing dehydration should not be considered definitive, which could be reserved for children requiring IV fluids and suffering from severe dehydration, altered conscious state or convulsions, suspected hypernatremia, suspicion of hemolytic uremic syndrome and children with pre-existing medical conditions that predispose to electrolyte abnormalities [14, 15]. Historical points and laboratory tests only have limited utility for assessing dehydration [10]. Laboratory investigations should be performed if the results will influence the

Oral rehydration should be the first line of treatment for pediatric gastroenteritis

with intravenous (IV) fluid therapy being used if the oral route fails [16, 17].

Oral rehydration is the preferred method for replacing fluid and electrolyte deficits resulting from dehydration secondary to acute gastroenteritis. ORT is a safe, easy-to-use, efficacious, and cost-effective alternative to intravenous rehydration

The use of ORT is based on the principle of glucose-facilitated sodium transport across the intestinal mucosa. The ORT facilitates the absorption of water and sodium for the compensation of fluid losses. Additionally, the absorption can be adequate for the replacement of significant fluid loss, such as in cholera. The absorption of potassium and bicarbonate is maintained by the osmotic gradient in the intercellular space. Metabolic acidosis, usually associated with dehydration, can be safely corrected by this mechanism. The currently available ORT contains an appropriate amount of sodium, glucose, and other electrolytes and is of appropriate

The WHO, Centers for Disease Control (CDC), and the American Academy of Pediatrics (AAP) all support the use of ORT for some (mild–moderate) dehydration [8, 20, 21]. Rapid ORT in mild dehydration is done by giving 50 ml/kg over 4 hours. For moderate dehydration, 100 ml/kg can be given over the same duration.

Generally, children being enterally rehydrated do not require blood tests.

SEVERE are recommended by WHO and other groups [1, 8].

signs. History taking and laboratory tests show limited utility [13].

**40**

Children can be discharged home when the following levels of recovery are achieved: satisfactory rehydration status as shown by clinical improvement, IV or NG fluids not required, and no significant losses. Adequate family education, proper instructions, and medical follow-up should be provided.
