Oral Rehydration Therapy (Nursing)

00:01 Now we're going to talk about Oral Rehydration Therapy.

00:05 So there are some treatment principles we want to think about when thinking about dehydrated patients.

00:11 And when we're using oral replacement therapy.

00:15 You want to use pediatric oral rehydration solutions as often as possible if they are available to you.

00:23 You want to start rehydration pretty immediately, as soon as you notice that pediatric patients might become dehydrated.

00:31 If they have any reason for dehydration, starting earlier is better.

00:37 You want to offer age appropriate and unrestricted diet as soon as the dehydration is corrected.

00:43 And you want to continue breastfeeding if the infant is initially breastfed.

00:48 So some mothers feel like they need to stop breastfeeding and turn to an oral rehydration solution.

00:56 But actually continuing breastfeeding can be helpful.

01:00 If an infant is formula fed, then you want to make sure that you continue that formula, and there's no need to dilute that formula.

01:09 It's actually not recommended.

01:11 We just want to keep giving the same formula that the infant is used to.

01:16 Additional oral replacement solution should be administered on an ongoing basis, even if you feel like you've caught up to the initial dehydration, if the patient is still having a reason to be dehydrated.

01:29 For example, if the patient is continuing to have a couple of bouts of diarrhea a day or is still vomiting a little bit.

01:37 They're not showing signs of dehydration anymore clinically, but they're still having that vomiting or diarrhea.

01:44 You want to continue giving them that solution so that we don't get behind again.

01:50 And then lastly, we don't need to get unnecessary labs or give unnecessary meds.

01:56 It's really enough to kind of watch those clinical signs and symptoms and continue orally rehydrating patients if the dehydration is mild.

02:06 So the most crucial aspect in the management of diarrhea is the need to replace these fluid losses.

02:12 So again, that's why early, early oral replacement therapy is recommended.

02:18 And then really continuing to maintain that adequate nutrition intake.

02:24 So oral placement solutions are administered at a rate that hopefully will replace existing losses.

02:31 And if the dehydration is mild, then we can usually do this.

02:36 So the CDC recommends 5 mL of fluid every five minutes.

02:42 So what this looks like is really you are giving an infant or child just a tiny little bit of fluid very frequently.

02:50 Because if you give them a whole cup to chug down and they've been vomiting, and they vomit all of that backup, then clearly that's not going to help the patient at all.

03:00 So they may tolerate the lower volume of fluids.

03:03 So just a small amount 5 mL, and continually offer that every five minutes.

03:10 So in mild to moderate dehydration.

03:12 The goal of this is to really give them 50 to 100 mL/kg of this oral replacement solution over about three to four hours.

03:22 And hopefully if you can get them to take that 5 mL every five minutes, then you'll get to this eventual goal.

03:31 So oral replacement solution is administered, hopefully at a rate that will replace these existing losses.

03:38 And you're really going to monitor until those symptoms subside.

03:43 It is really important to note that this is not used in severe dehydration in the United States in particular.

03:52 Oral rehydration therapy is only used for mild and sometimes in to moderate dehydration.

03:59 But severe dehydration needs to be handled differently.

04:02 And we'll talk about that in a later presentation.

04:06 So why are commercial solutions better than sports drinks like Gatorade for oral rehydration therapy? The reason you don't want to give sports drinks are the fact that it just does not have the right mix of ingredients that is needed to really help that dehydrated pediatric patient.

04:27 So commercial solutions contain that mix of salt and sugar.

04:31 They also have potassium and other minerals that are going to help replace what the patient is losing in those fluids.

04:41 There are some things to avoid in oral replacement therapy.

04:45 You really don't want to give sodas and Gatorade.

04:49 They're not recommended anyway in children less than two years of age.

04:52 And they really have a high glucose load.

04:55 They don't have enough sodium.

04:57 They don't have enough electrolytes.

04:58 And that high glucose load can really lead to even more vomiting and diarrhea in these cases.

05:05 Additionally, you don't want to give any fluids that have caffeine in it.

05:09 Caffeine encourages diuresis, which just as another way of losing fluid.

05:14 And so it is not going to be helpful in a patient that is already dehydrated.

05:18 So no soda, no coffee, no tea.

05:23 Cow's milk can also be problematic.

05:26 Because as we've discussed in a previous presentation, it has a very high solute load.

05:31 And if you're dehydrated, that high solute load could really stress out the kidneys.

05:37 It can just become problematic and it doesn't really have the correct components, including those electrolytes that you're going to be losing in if you have vomiting or diarrhea.

05:47 So we would also avoid cow's milk for oral replacement therapy.

05:55 Definitely want to avoid anything acidic, because the stomach is probably already pretty upset.

06:01 So avoid juices like orange juice, or even very sugary juices.

06:06 Apple juice should also be avoided even though it's not as acidic.

06:09 It has a lot of glucose, a lot of sugar in that juice.

06:13 And again, that's going to cause a problem for a patient that's already dehydrated.

06:18 And it's not going to have those electrolytes that need to be replaced.

06:23 So, again, what to avoid in oral replacement therapy? Don't give the child too much plain water.

06:31 It doesn't have electrolytes in it.

06:33 And we really need to replace those electrolytes.

06:36 Vomiting and diarrhea can cause a lot of loss of salts and electrolytes.

06:42 So rehydration fluids should also contain all of these salts and electrolytes.

06:50 There are some recommendations by the World Health Organization about oral replacement therapy.

06:56 And they again recommend that the treatment of diarrhea which is a large cause of dehydration in other countries that should begin at home and with the first sign of the diarrhea.

07:08 Don't wait until the patient looks dehydrated.

07:11 They also recommend oral rehydration preparations because it has that correct concentration of electrolytes.

07:19 And also to remember that it's often a two phase treatment.

07:23 You're going to catch up for the dehydration, and then you're going to continue to give these Oral Replacement Therapy Solutions as long as the patient is having ongoing losses.

07:34 So if they're still vomiting, if they're still having any diarrhea, you want to continue giving those oral replacement solutions.