ORS Algorithm

Clinician takes history and examines patient aged 1 month to 5 years, with acute diarrhea

(1) Clinician obtains patient’s current weight

(2) Clinician estimates % dehydration if no recent weight for comparison is available

Is one or more of the following present?

(1) Patient >= 10% dehydrated

(2) Signs of shock

(3) Patient unconscious

(4) Ileus present

(1) Hospitalize patient

(2) Give intravenous fluid therapy with bolus of normal saline or Ringer’s lactate, 20-60 (+) ml/kg for one hour or less. Re-evaluate and repeat if necessary.

(3) Begin oral rehydration when patient is stable, as per Box 6

3 4

Yes

Begin oral rehydration therapy at 100 ml/kg over a 4 hour period, plus replacement of ongoing losses

No 6

Is patient 6-9% dehydrated by weight loss and/or clinical estimation?

Yes

Begin oral rehydration therapy at 50 ml/kg over a 4 hour period, plus replacement of ongoing losses.

Is patient 3-5% dehydrated by weight loss or clinical estimation?

7 Yes

Patient with diarrhea is less than 3% dehydrated by weight loss or clinical estimation.

Is patient tolerating oral rehydration therapy?

11 9

Continue oral rehydration therapy for 4-6 hours or until rehydrated.

Yes

(1) Continue child’s regular diet

(2) Consider added glucose-electrolyte solution to replace stool losses, or give more usual dietary fluids.

(1) Institute intravenous therapy

(2) Consider nasogastric tube

Yes

(1) Resume breast feeding, formula, or milk

(2) Resume recommended foods

(3) Replace ongoing losses with glucose-electrolyte solution.