Pediatric Nutrition in Practice

60 Prince  Fuchs

greatest mortality and morbidity, many affected
children have concomitant malnutrition. Malnu-
trition results in an increased incidence, severity,
and duration of diarrhea and is an underlying
cause of much of the diarrheal disease-related
mortality. Optimal prevention and management
of diarrheal disease, therefore, requires attention
to nutritional therapy including continued
breastfeeding in breastfed infants and early
refeeding during a diarrheal disease episode.
Zinc supplementation promotes recovery from
acute and persistent diarrhea; as well as decreas-

ing postdiarrheal disease morbidity, it is now

universally recommended as adjunctive treat-

ment for children with diarrhea older than 6

months of age. Severely malnourished children

with diarrhea have unique, stereotypical clinical

abnormalities and require a specific, protocoled

regimen to ensure safe, efficacious f luid and elec-

trolyte reconstitution. Due to the limited data, a

potential role for zinc in the treatment of acute

diarrhea in developed countries has not been

identified [1 2].

Ta b l e 1. Treatment of acute watery diarrhea, modified from King et al. [11]

Degree of
dehydration

Signs Rehydration therapy

(within 4 h)

Replacement

of losses

Nutrition

Minimal
(<3%)

Well, alert Not applicable For each diarrheal stool or

vomiting episode give

60 – 120 ml ORS

if <10 kg body weight and

120 – 240 ml ORS

if >10 kg body weight

Continue

breastfeeding

or resume

age-appropriate diet

after initial rehydration

Mild to
moderate
(3 – 9%)

Sunken eyes, sunken fontanelle,

loss of skin turgor, dry buccal

mucous membranes

ORS 50 – 100 ml/kg

over 3 – 4 h

Same as above Same as above

Severe
(10%)

Signs of moderate dehydration

with one of the following:

rapid thready pulse, cyanosis,

cold extremities, deep breathing,

lethargy, unconsciousness

Intravenous fluids

30 ml/h until pulse,

perfusion, and mental

status improve; then,

ORS 100 ml/kg over 4 h

Same as above;

if unable to drink, give by

nasogastric tube

Age First give

30 ml/kg overa

Then give

70 ml/kg overb

Infants (<12 months) 1 h 5 h

Older children and adults 30 min 2.5 h

Modified from the WHO manual [2]. Preferably start intravenous Ringer’s

lactate (with or without 5% dextrose; normal saline is acceptable) immedia-

tely; give an oral rehydration solution until the intravenous line is started if

the child can drink.

a Repeat once if the radial pulse remains weak or not detectable.

b If the child is able to drink and keep up with stool losses, introduce the ORS

as described in table 1.

Ta b l e 2. Guidelines for intravenous
fluids for severe dehydration

Koletzko B, et al. (eds): Pediatric Nutrition in Practice. World Rev Nutr Diet. Basel, Karger, 2015, vol 113, pp 56–61

DOI: 10.1159/000367869