Oral Rehydration Solution Guidelines

Indications and Administration

The Centers for Disease Control and Prevention recommends ORS as first-line therapy for prevention of dehydration when administered early at home 1
The Centers for Disease Control and Prevention advises against allowing thirsty children to drink large volumes ad libitum from a cup or bottle, and instead recommends administering small volumes (5-10 mL) every 1-2 minutes via spoon, syringe, or cup, with gradual increases 1
The Centers for Disease Control and Prevention suggests that nasogastric administration via continuous slow infusion can be effective for patients unable to tolerate oral intake 1

The Centers for Disease Control and Prevention recommends that ORS should NOT be used in severe dehydration with shock or near-shock, and instead IV fluids should be used initially 1
The Centers for Disease Control and Prevention advises against using ORS in intestinal ileus, and instead recommends waiting until bowel sounds return 1
The Centers for Disease Control and Prevention recommends that ORS should NOT be used in true glucose malabsorption, which is diagnosed when stool output dramatically increases with ORS and immediately decreases with IV therapy 1

The World Health Organization recommends low-osmolarity ORS with sodium 65-70 mEq/L and glucose 75-90 mmol/L for optimal absorption, but this information is not directly cited, however, the Centers for Disease Control and Prevention notes that commercial preparations like Pedialyte and Ricelyte contain lower sodium (45-50 mEq/L) and are designed primarily for maintenance rather than rehydration 2

The Centers for Disease Control and Prevention recommends that ORS enables earlier treatment and prevention of dehydration at home, and is safer and more physiologic than IV administration 1
The Centers for Disease Control and Prevention suggests that ORS must be combined with appropriate dietary therapy, as acute diarrhea endangers nutritional status through anorexia, malabsorption, and excess losses 1
The Centers for Disease Control and Prevention recommends that early feeding reduces severity, duration, and nutritional consequences of diarrhea 2

The World Health Organization recommends reduced osmolarity ORS as first-line therapy for mild to moderate dehydration 3
Oral rehydration therapy works through the coupled transport of sodium and glucose across the intestinal brush border, enabling enhanced water absorption 3

Both Walyte and ORSL are indicated for the treatment of mild to moderate dehydration in infants, children, and adults 4
Both are hypotonic solutions recommended for rehydration 5
Both can be administered orally or via nasogastric tube when necessary 4

First-line therapy for mild to moderate dehydration in infants, children, and adults with acute diarrhea from any cause is recommended by the World Health Organization 4
Maintenance therapy after rehydration until diarrhea and vomiting are resolved is recommended 6

For mild dehydration, 50-100 mL/kg of ORS over 3-4 hours is recommended by the Centers for Disease Control and Prevention 7
For moderate dehydration, 100-200 mL/kg of ORS over 3-4 hours is recommended by the Centers for Disease Control and Prevention 7
Children under 2 years should receive 50-100 mL of ORS after each loose stool, as recommended by the Centers for Disease Control and Prevention 7
Older children should receive 100-200 mL of ORS after each loose stool, as recommended by the Centers for Disease Control and Prevention 7

ORS should be used before resorting to intravenous fluids, except in cases of severe dehydration, shock, altered mental status, or ileus, as recommended by the World Health Organization 6
Nasogastric administration of ORS may be considered when patients cannot tolerate oral intake, as recommended by the World Health Organization 6
Antimotility drugs should not be given to children under 18 years with acute diarrhea, as recommended by the American Academy of Pediatrics 6
Isotonic intravenous fluids should be administered only when there is severe dehydration, shock, altered mental status, failure of ORS therapy, or ileus, as recommended by the World Health Organization 6