## Acute Diarrhea and Dehydration Management in Pediatrics ### First-Line Approach: Oral Rehydration Therapy **Key Point:** WHO and UNICEF guidelines recommend ORT with low-osmolarity solution (75 mEq/L Na^+^, 65 mmol/L glucose) as the gold standard for rehydration in acute diarrhea, even in **moderate dehydration**, unless the child has severe vomiting or altered consciousness preventing oral intake. **Clinical Pearl:** ORT is successful in 90–95% of cases of acute gastroenteritis with dehydration. IV fluids are reserved for: - Severe dehydration (>10% fluid loss) - Persistent vomiting preventing oral intake - Altered mental status or shock - Inability to tolerate oral fluids In this case, the child has moderate dehydration and severe vomiting — ORT should still be attempted with small, frequent sips or nasogastric tube administration if needed, before resorting to IV therapy. ### Zinc Supplementation **High-Yield:** Zinc (10 mg/day for children ≥6 months; 5 mg/day for <6 months) for 10–14 days is a WHO-endorsed intervention that: - Reduces diarrhea duration by ~25% - Decreases stool output - Reduces risk of subsequent infections for 2–3 months - Should be initiated early in all acute diarrhea cases ### Antimotility Agents **Warning:** Loperamide and other antimotility agents are **contraindicated** in acute infectious diarrhea because they: - Increase risk of toxic megacolon - Prolong bacterial shedding - Increase risk of hemolytic uremic syndrome (HUS) in Shiga toxin–producing E. coli (STEC) infection - Are associated with worse outcomes in invasive bacterial diarrhea ### Why IV Bolus Is NOT First-Line in Moderate Dehydration **Key Point:** A 100 mL/kg bolus over 30 minutes is appropriate for **severe dehydration or hypovolemic shock**, not moderate dehydration. In moderate dehydration, the correct IV approach (if ORT fails) is: - Slower rehydration: 50–100 mL/kg over 2–4 hours - Maintenance fluids + ongoing losses - Reassess for ORT tolerance after initial stabilization The stem correctly identifies that IV bolus therapy is **not** the initial step — ORT is. ### Summary Table | Dehydration Severity | First-Line Treatment | IV Indication | |---|---|---| | Mild (3–5%) | ORT, 50 mL/kg over 4 hrs | Not needed | | Moderate (6–9%) | ORT first; IV only if vomiting/unable to drink | Reassess after ORT trial | | Severe (≥10%) | IV bolus 100 mL/kg over 30 min | Immediate | | Shock | IV bolus + vasopressors | Immediate | [cite:Park 26e Ch 7]
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