History & exam
- Intake/outputs, vomiting/diarrhea, fever, medications (diuretics, SGLT2)
- Vitals and orthostatics; mental status
- Mucous membranes, skin turgor, capillary refill, tears/urine output
Assessment & Severity
Classify severity
- Mild: thirsty, dry mouth; normal vitals
- Moderate: tachycardia, delayed cap refill, oliguria
- Severe/Shock: hypotension, altered mentation, cool mottled skin
If shock → move to IV isotonic fluid bolus immediately; draw labs but don’t delay resuscitation.
Oral Rehydration Therapy (ORT)
Who qualifies?
- Mild–moderate dehydration and able to tolerate PO
- Prefer oral rehydration solution (ORS) over plain water or sugary drinks
- Consider single-dose ondansetron to facilitate ORT if vomiting
How much?
- Pediatrics: ~50–100 mL/kg over 3–4 hours (replace ongoing losses with 10 mL/kg per stool/emesis)
- Adults: frequent small sips aiming for 2–3 L/day depending on losses and comorbidities
- Continue breastfeeding and age-appropriate diet as tolerated
IV Fluids & Bolus
Resuscitation
Maintenance & replacement
- Pediatrics: 4–2–1 rule for hourly rate; add dextrose/electrolytes as indicated
- Adults: ~1–1.5 mL/kg/hr, titrated to clinical/lab endpoints
- Switch to oral fluids as soon as safe
Labs & Electrolytes
- BMP, hematocrit, urinalysis; consider venous blood gas
- Watch sodium abnormalities—avoid rapid correction
- Replete potassium when needed and renal function allows
Pediatric Pearls
- ORT is first-line for mild–moderate dehydration
- Red flags: lethargy, sunken eyes/fontanelle, no tears, minimal urine, persistent vomiting
- Reassess every 30–60 minutes until stable
- Use weight-based dosing for antiemetics and fluids
Adults & Comorbidities
- Assess for AKI; review meds (ACEi/ARB, diuretics)
- Use judicious fluids in heart failure or cirrhosis
- Consider heat-related illness protocols during exertional/ambient heat exposure
- Early transition to oral fluids with clear return precautions
Disposition & Home Care
- Discharge when vitals normalize, hydration improves, and PO tolerated
- Provide an at-home ORT plan and instructions for ongoing losses
- Return immediately for decreased urine, persistent vomiting, fever, syncope, or worsening weakness
- Arrange follow-up if comorbid or elderly
Quick Fluid Guide
| Scenario | First choice | Typical dose | Referral |
|---|---|---|---|
| Mild–moderate dehydration, tolerating PO | ORS (oral) | Kids 50–100 mL/kg in 3–4 h; adults frequent small volumes | ORT details |
| Severe dehydration or shock | NS/LR (IV) | Peds 20 mL/kg; adults 1–2 L then reassess | IV fluids |
| Ongoing vomiting | Ondansetron | Weight/age-based; single dose often sufficient | Antiemetic use |
Cited Keywords & Referral Links (gyathshammha.com)
Each keyword links to the main website or a related page on gyathshammha.com.
Bottom line
Identify severity fast, start ORT for mild–moderate dehydration, and give isotonic IV fluids for severe cases or shock. Correct electrolytes thoughtfully, reassess frequently, and discharge with a clear home hydration plan and return precautions.
This page is educational and not a substitute for local protocols or specialist advice.