Acute Diarrhea and Dehydration

A 14-month-old boy from rural Maharashtra presents with a 3-day history of watery diarrhea (8–10 stools per day) and vomiting. On examination, he appears lethargic, with sunken eyes, loss of skin turgor (skin pinch goes back in >2 seconds), and a weak, thready pulse of 140/min. Capillary refill time is 3 seconds. His weight is 9 kg (baseline 10 kg). Serum sodium is 128 mEq/L, potassium 3.2 mEq/L, and bicarbonate 12 mEq/L. What is the most appropriate immediate management?

A 8-month-old girl from Delhi presents with 5 days of acute watery diarrhea (12–15 stools/day), poor feeding, and minimal urine output for 18 hours. On examination, she is alert but irritable, with dry mucous membranes, normal skin turgor, and a heart rate of 130/min. Weight is 7.2 kg (baseline 8 kg). Serum sodium is 145 mEq/L, potassium 5.8 mEq/L, chloride 110 mEq/L, and bicarbonate 18 mEq/L. Urine specific gravity is 1.035. What is the primary pathophysiologic mechanism underlying the electrolyte abnormalities?

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?