• Dehydration accompanying infantile gastroenteritis should be treated with early oral rehydration and early refeeding strategies.
• Infants with gastroenteritis should be offered maintenance solution to prevent dehydration. Parents and daycare centres should keep maintenance solution on hand in anticipation of episodes of infectious diarrhea.
• Oral rehydration solution (ORS) and maintenance solutions and instructions in their use should be made available at reasonable costs.
• Medical facilities should have oral rehydration therapy (ORT) protocols available for staff and patients.
• Antidiarrheal drugs, antibiotics and antiemetic therapy are rarely indicated in gastroenteritis in childhood and should be discouraged.
• Home-made oral rehydration solutions are discouraged since serious errors in formulation have occurred.
• Infants with mild-to-moderate dehydration should be treated under medical supervision with ORT in preference to intravenous rehydration.
• Infants with severe dehydration should initially be treated with intravenous or intraosseous rehydration.
• Breast-fed infants with dehydration should be given ORT in conjunction with continued breastfeeding.
• Early refeeding should commence as soon as vomiting has resolved, approximately 6-12 hours.
• Non-lactose containing formulae or milks may be used if diarrhea and abdominal cramps persist beyond expected 5- to 7-day course suggesting clinical lactose intolerance.
• Further initiatives to encourage ORT use by patients and professionals should be developed.

Vomiting associated with rotavirus gastroenteritis is more common and prolonged than with other causes of pediatric gastroenteritis.¹¹ While oral rehydration can be effective in cases of mild-to-moderate dehydration, the combination of vomiting and diarrhea typically associated with rotavirus gastroenteritis can complicate this form of therapy, potentially leading to hospitalization.^6,17 Intravenous rehydration may be necessary if the patient is severely dehydrated or in shock.⁸

Oral Rehydration Therapy (ORT)

ORT, which replaces fluids and electrolytes lost through diarrhea and vomiting, is usually given in 2 phases:²⁷

• Rehydration: to quickly replace water and electrolyte loss
• Maintenance: continued to replace fluid loss and provide adequate diet intake

Specially formulated, commercially available ORS is designed to replace water, electrolytes, glucose, and amino acids lost from an episode of rotavirus gastroenteritis.

The World Health Organization recommends that oral rehydration solution (ORS) contains:²⁵

• the solution should have an osmolarity similar to, or less than that of plasma, i.e., about ≤300 mOsmol/L;
• the concentration of sodium should be sufficient to efficiently replace the sodium deficit in children or adults with clinically significant dehydration;
• the ratio of glucose to sodium (in mmol/L) should be at least 1:1 to achieve maximum sodium absorption;
• the concentration of potassium should be about 20 mmol/L in order adequately to replace potassium losses;
• the concentration of base should be 10 mmol/L for citrate or 30 mmol/L for bicarbonate, which is satisfactory for correcting base-deficit acidosis due to diarrhea.