Acute Diarrhea and Dehydration

According to WHO guidelines for rehydration therapy in acute diarrhea, what is the recommended osmolarity of oral rehydration solution (ORS)?

A 2-year-old girl from Delhi is brought to the pediatric emergency department with acute-onset watery diarrhea and vomiting for 18 hours. Her parents report she has had 6–7 stools in the last 6 hours and is refusing feeds. On examination, she is alert and playful, eyes are slightly sunken, she drinks eagerly when offered water (though vomits shortly after), and skin turgor is mildly decreased (pinch goes back in <2 seconds). Capillary refill is normal. Her weight is 13 kg (baseline 13.5 kg). Serum sodium is 135 mEq/L, potassium 3.8 mEq/L, and HCO₃⁻ is 18 mEq/L. What is the most appropriate fluid management plan?

A 18-month-old boy from rural Maharashtra presents to the emergency department with a 3-day history of watery diarrhea (8–10 stools/day) and vomiting. On examination: sunken eyes, skin turgor returns slowly (>2 seconds), mucous membranes dry, urine output reduced. Vital signs: HR 140/min, BP 90/60 mmHg, RR 28/min. Weight 10 kg. The child is alert and able to drink. What is the most appropriate next step in management?

A 2-year-old child presents with acute watery diarrhea and moderate dehydration (10% fluid loss). Oral rehydration therapy is planned. Which is the drug of choice for antimotility in this child?

A 18-month-old boy from rural Maharashtra presents to the emergency department with a 3-day history of watery diarrhea and vomiting. His mother reports he has passed 8–10 loose stools per day for the past 2 days. On examination, he appears lethargic, his anterior fontanelle is sunken, skin turgor is decreased (skin pinch goes back in >2 seconds), and mucous membranes are dry. Capillary refill time is 2.5 seconds. His weight is 11 kg (baseline 12 kg). Serum sodium is 128 mEq/L, potassium 3.2 mEq/L, chloride 98 mEq/L, and HCO₃⁻ is 12 mEq/L. What is the most appropriate immediate management?