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Summary of recommendations

Suspect hypernatraemic dehydration if there are any of the following:
• jittery movements
• increased muscle tone
• hyperreflexia
• convulsions
• drowsiness or coma.
4.2 Laboratory investigations for assessing dehydration

Do not routinely perform blood biochemical testing.
Measure plasma sodium, potassium, urea, creatinine and glucose concentrations if:
• intravenous fluid therapy is required or
• there are symptoms and/or signs that suggest hypernatraemia.
Measure venous blood acid–base status and chloride concentration if shock is suspected or
confirmed.

Chapter 5 Fluid management
5.1 Primary prevention of dehydration

In children with gastroenteritis but without clinical dehydration:
• continue breastfeeding and other milk feeds
• encourage fluid intake
• discourage the drinking of fruit juices and carbonated drinks, especially in those at increased
risk of dehydration
• offer oral rehydration salt (ORS) solution as supplemental fluid to those at increased risk of
dehydration.

5.2 Treating dehydration
Use ORS solution to rehydrate children, including those with hypernatraemia, unless intravenous
fluid therapy is indicated.

5.3 Optimal composition and administration of oral fluids
In children with clinical dehydration, including hypernatraemic dehydration:

• use low-osmolarity ORS solution (240–250 mOsm/l)* for oral rehydration therapy
• give 50 ml/kg for fluid deficit replacement over 4 hours as well as maintenance fluid
• give the ORS solution frequently and in small amounts
• consider supplementation with their usual fluids (including milk feeds or water, but not fruit
juices or carbonated drinks) if they refuse to take sufficient quantities of ORS solution and do
not have red flag symptoms or signs (see Table 4.6)
• consider giving the ORS solution via a nasogastric tube if they are unable to drink it or if
they vomit persistently
• monitor the response to oral rehydration therapy by regular clinical assessment.
5.4 Intravenous fluid therapy
Use intravenous fluid therapy for clinical dehydration if:

• shock is suspected or confirmed
• a child with red flag symptoms or signs (see Table 4.6) shows clinical evidence of
deterioration despite oral rehydration therapy
• a child persistently vomits the ORS solution, given orally or via a nasogastric tube.

* The BNF for Children (BNFC) 2008 edition lists the following products with this composition: Dioralyte®, Dioralyte® Relief,
Electrolade® and Rapolyte®.

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