Fluid and Dietary Management of Acute Infantile Diarrhoea

Acute diarrhoea is a principal cause of morbidity and mortali ty among children in developing countries. The prompt and correct use of an o ral glucose elect roly te solution, developed and advocated by the World Health Organisation (WHO) and UNICEF, has revolutionized the management of acute diarrhoea. Yet these solutions were widely underused in diarrhoeal episodes, partly due to the inability of the standard WHO solution to decrease stool volume and to shorten the durat ion o f d iarrhoea. Improvements in the formulations of oral rehydration therapy have been made in the past 20 years. This article aims to rev iew the rat ionales and cl in ical efficacies of d i fferen t types o f o ral rehydrat ion solut ions. The rationales fo r early refeed ing is also rev iewed. Management guidelines as suggested by the American Academy of Paed iatrics (AAP) and other reviews wi ll be summarised. Abstract Oral rehydration solution is not widely used in Hong Kong for treatment of acute diarrhoea despite its well proven efficacy. Hypotonic oral rehydration solutions with osmolarity of 200 to 250 mmol/L and containing sodium of 60 mmol/L are safe in developed countries with the added effects of decreasing stool output and the duration of diarrhoea. Rice-based oral rehydration solutions are well tolerated in infants younger than 6 months of age. More evidence is required to justify i ts rep lacement of the glucose-based hypotonic oral rehydration solutions. Rehydration should be achieved within 4 hours. Breast feeding should be continued in acute diarrhoea. Resumption of lactose-containing normal diet immediately after rehydration does not result in worsening of diarrhoea, increased lactose intolerance and prolongation of the duration of diarrhoea but results in significantly better weight gain. Routine dilution of milk and routine use of lactose-free milk are unnecessary in most cases. Anti-d iarrhoeal agents should not be used to treat acute diarrhoea in children.