Management of Gastrointestinal Issues with Fluid and Electrolyte Replacement

Composition of Oral Rehydration Solutions

The World Health Organization recommends a standard GI drip containing sodium (90 mmol/L), potassium (20 mmol/L), chloride (80 mmol/L), base (30 mmol/L), and glucose (111 mmol/L or 2%) for optimal fluid and electrolyte replacement in gastrointestinal disorders 1
The WHO-recommended ORS contains sodium (90 mmol/L), potassium (20 mmol/L), chloride (80 mmol/L), base (30 mmol/L), and glucose (111 mmol/L or 2%) 1

For mild dehydration (3-5% fluid deficit), the World Health Organization recommends using oral rehydration solution (ORS) containing 50-90 mEq/L of sodium administered at 50 mL/kg over 2-4 hours 2
For moderate dehydration (6-9% fluid deficit), the World Health Organization recommends using the same ORS administration procedure but increasing fluid amount to 100 mL/kg over 2-4 hours 2
For severe dehydration (≥10% fluid deficit), immediate IV rehydration is required with boluses of Ringer's lactate solution or normal saline until pulse, perfusion, and mental status normalize, as recommended by the World Health Organization and the Infectious Diseases Society of America 2, 3

For patients with high-output stomas, the European Society for Clinical Nutrition and Metabolism recommends a glucose-saline solution with sodium concentration of at least 90 mmol/L 4
Patients with short bowel syndrome should use an isotonic high sodium oral rehydration solution to replace stoma sodium losses, as recommended by the European Society for Clinical Nutrition and Metabolism 5
Maximal sodium absorption occurs with a mixture of 120 mmol/L of sodium chloride and 30 mmol/L of glucose, according to the European Society for Clinical Nutrition and Metabolism 5

During both rehydration and maintenance therapy, ongoing stool and vomit fluid losses must be replaced, as recommended by the World Health Organization 2
For measurable losses, the World Health Organization recommends administering 1 mL of ORS for each gram of diarrheal stool 2
For estimated losses, the World Health Organization recommends providing 10 mL/kg for each watery/loose stool and 2 mL/kg for each episode of emesis 2

The Infectious Diseases Society of America advises that popular beverages such as apple juice, sports drinks, and commercial soft drinks should NOT be used for rehydration 3
The World Health Organization recommends that ORS is not sufficient therapy for bloody diarrhea (dysentery) as these patients may require antimicrobial treatment 6
Patients with intestinal ileus should not receive oral fluids until bowel sounds are audible, as recommended by the World Health Organization 6

For patients with vomiting, the World Health Organization recommends administering small volumes initially (one teaspoon) and gradually increasing as tolerated 2
The World Health Organization suggests that continuous, slow nasogastric infusion of ORS via a feeding tube can be helpful for children who are vomiting 6
After rehydration is complete, the Infectious Diseases Society of America recommends that maintenance fluids should be resumed along with an age-appropriate normal diet 3