Treatment plan A - management of patients with no signs of dehydration (WHO recommendations)

management of patients with no signs of dehydration (WHO recommendations)

Treatment plan A

Children with no signs of dehydration need extra fluids and salt to replace their losses of water and electrolytes due to diarrhea to avoid development of signs of dehydration

Mothers should be educated about the importance of extra fluid and how to prevent malnutrition by continuing to feed the child.

Most fluids that a child normally takes can be used. Wherever possible, these should include at least one fluid that normally contains salt.

• fluids that normally contain salt
  • ORS solution
  • salted drinks (e.g. salted rice water or a salted yoghurt drink)
  • vegetable or chicken soup with salt.
• fluids that normally do not contain salt
  • plain water
  • water in which a cereal has been cooked (e.g. unsalted rice water)
  • unsalted soup
  • yoghurt drinks without salt
  • green coconut water
  • weak tea (unsweetened)
  • unsweetened fresh fruit juice

Drinks sweetened with sugar such as commercial carbonated beverages or commercial fruit juices should be avoided since it may lead to osmotic diarrhoea and hypernatraemia

In general give as much fluid as the child or adult wants until diarrhoea stops. As a guide, after each loose stool, give:

• children under 2 years of age: 50-100 ml (a quarter to half a large cup) of fluid
• children aged 2 up to 10 years: 100-200 ml (a half to one large cup)
• older children and adults: as much fluid as they want.

Give supplemental zinc (10 - 20 mg) to the child, every day for 10 to 14 days.

Feeding should be continued to prevent malnutrition. The aim is to give as much nutrient rich food as the child will accept

• an infant's usual diet should be continued during diarrhoea and increased afterwards
• food should never be withheld and the child's usual foods should not be diluted
• breastfeeding should always be continued
• frequent, small feedings are tolerated better than less frequent, large ones (1)

Reference:

• (1) World Health Organization. Cholera. Fact Sheet 107. July 2012
• (2) Colletti JE et al. The management of children gastroenteritis and dehydration in the emergency department. with J Emerg Med. 2010;38(5):686-98