Oral Rehydration Salt Solutions for Children: A Review

Dehydration continues to be a major contributor to morbidity and mortality in children globally. Oral rehydration salts (ORS) solutions can successfully treat mild to moderate dehydration. However, the uptake of this simple and cost-effective intervention remains low in both high-income and low-to-mid-income countries. The low-osmolality ORS solution recommended by the World Health Organization (WHO) contains an appropriate balance of electrolytes and glucose that helps effectively absorb water and electrolytes, irrespective of the cause of gastroenteritis. ORS solution can be administered orally in most cases of mild to moderate dehydration; however, a nasogastric tube can be used in cases of oral intolerance in selected cases. The amount of ORS solution required for rehydration depends on the estimates of fluid losses and the child's weight. Severe dehydration could be managed with intravenous fluids initially; however, oral rehydration therapy can be used as soon as the patient is stable. The few contraindications for the use of oral rehydration solution include altered mental status, inability to tolerate oral or nasogastric intake of fluids, underlying gastrointestinal problems such as ileus, anatomical abnormalities, and gut malabsorption. This review describes the use of different ORS solutions in the United States and discusses the newly studied, non-glucose-based ORS solutions. The review also discusses hydration strategies for fluid loss during exercise and in hot environments.