Slide 12
How to give oral fluidsThese two mothers are both giving their children a drink of 'ORS Solution'. The mother from
Afghanistan is giving it with a spoon from a cup. The mother from Indonesia is giving the solution straight
from a glass. Both ways are good.
Q. How often would you tell a mother to give her child a drink? And how much fluid each time?
A. She should give frequent, small drinks. But you have to watch that she does not give drinks too
frequently. She should never give more than 1 teaspoonful (that is, 5 ml.) each minute. But exactly how much depends on the size of the child
and how dehydrated he is. (The Exercise with the Teacher's Note gives more details).
Q. What happens if you give fluids too fast?
A. If you give fluids too fast, the child may or refuse to take any more. Often a child is thirsty,
and he decides to take a very big drink, but soon he vomits it back. Then everyone thinks that this
treatment is no good. They lose confidence and stop trying to give oral rehydration fluids. If a
child vomits, give drinks of about 5-10 ml (1-2 teaspoonfuls) every 5-10 minutes. Then there is
more time for the fluid in the stomach to pass on into the intestine and to be absorbed before the next
drink arrives. 'Little and often' is the rule for oral rehydration. It requires
patience and persistence from mothers and nurses.
Teacher's Note
We strongly recommend that you turn off the projector at this point and ask the audience to do
the following Exercise. Then give them the scheme from the Table in="diarrhoea-management-appendix2.htm" target="_blank"> Appendix 2 to copy for
later reference. |
Exercise (Not recorded)
Ask the audience to work out the fluid requirements for a moderately dehydrated child of 14 months weighing
10 kg. for the first 24 hours. Give them these facts:
-
How much fluid does the child need?
-
How fast should the mother give it?
Discussion (not recorded)
How much fluid does the child need?
There are three quantities to consider:
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The replacement fluid that the child needs to
correct the dehydration.
-
The fluid that he needs to replace concurrent
losses from continuing diarrhoeas.
-
The fluid he needs for maintenance - that is, his
normal daily needs.
The child is moderately dehydrated, so he has lost nearly 10% of his body weight - so he has lost 10% of
10 kg. or 1 kg. of water approximately that is 1,000 ml.
So he needs 1,000 ml. fluid as replacement.
He needs 100 ml. per kg. per day for his normal daily needs.
So he needs another 1,000 ml. per day maintenance.
He needs something more to replace his concurrent
losses. You have to try to measure the volume of stool he is passing. Let us say for this child it is about
another (300 ml).
So he needs altogether 2300 ml. in the first 24 hours.
How fast should the mother give it?
The 1,000 ml. for replacement should be given quite quickly, if possible during the first 4-6 hours of
rehydration. If the mother gives 1 teaspoonful (5 ml.) every minute, she will give 300 ml. per hour, so she
will give 1,000 ml. in 3 4 hours. If the child takes and keeps this amount down, then
she can give it. If he vomits, then she can give it a little more slowly - say 1
teaspoonful every 2 minutes, or 5-10 tsp. every 10 minutes. The 1,000 ml. for maintenance, and the (300
ml. +I-) for continuing losses can be given more slowly during the remaining 18-20 hours for the first 24
hours.
One teaspoonful every 5 minutes gives the child 60 ml. every hour, or 300 ml. in 5 hours. That would give
1.200 ml. in 20 hours.
For the next 24 hours
If the child is now rehydrated. with a good urine flow,
you should only need to give fluid equal to
maintenance needs and concurrent losses. If he still
shows signs of dehydration - including poor urine
output - then he may need additional replacement fluid.
This may occur if rehydration was slowed up by some
vomiting.
Appendix 2 contains a simple table to decide how much
fluid a child needs.
