Monday, September 14, 2015

When "drink plenty of fluids" isn't enough

- Jennifer Middleton, MD, MPH

Treating the dehydration that can accompany foodborne illness may seem straightforward, and many physicians advise little more than "drink plenty of fluids" to patients who are only mildly ill. In the current issue of AFP, though, the authors of "Diagnosis and Management of Foodborne Illness" recommend making specific recommendations about oral rehydration therapy, especially for younger patients.

Without specific guidance, many parents will use soft drinks and juices to prevent and treat their children's dehydration. These sugar-rich and electrolyte-poor beverages can exacerbate diarrhea and cause hyponatremia. Sports beverages that tout electrolyte replacement are also not appropriate as they typically contain excessive sugar. Physicians should instead recommend oral rehydration solutions with an appropriate balance of carbohydrate and electrolytes; in the US, Pedialyte and Enfalyte are options. These commercially available solutions eliminate the risk of preparation error (and possible electrolyte imbalances and/or worsening diarrhea) of homemade oral rehydration solutions.

Physicians may wish to counsel families of infants and young children to keep these solutions on hand at well visits, so that they are immediately available should their child become ill. For outpatient treatment of mild dehydration, parents may give 1 mL per kg every 5 minutes over a 4-hour period. For maintenance after that time, parents should aim for 1 oz of oral rehydration per hour for infants, 2 oz per hour for toddlers, and 3 oz per hour for older children for as long as illness symptoms persist. As they recover, patients will experience decreased thirst, which inherently protects against over-hydration. If you'd like more information, check out the AFP By Topic on Gastroenteritis and Diarrhea in Children, which includes this 2012 article with more detail about using oral rehydration solutions.

Physicians may find it helpful to have patient information handouts (either on paper and/or integrated into electronic health records) for patients to refer to at home like this one from or this Information from Your Family Doctor on treating dehydration. Either way, providing specific recommendations about oral hydration can help our younger patients better recover from foodborne illness.