Hydration and Rehydration Solutions
By Jane-Alexandra Krehbiel BS ES RN
I remember when we moved to our farm hearing about a family who resided there a hundred years ago who lost all the children in their large family, one by one, to a diarrheal illness. I told myself that health, hygiene and general wellness had improved exponentially in the past hundred years and that this had no real bearing on myself or my family.
As time passed and I spoke to local veterinarians, I learned that an organism called shigella is often present in local surface water, and that it often is an issue for local dogs, and also for local campers. It is possible that the children who resided on our farm 100 years ago died from dehydration secondary to shigella infection, particularly since at the time, most everyone used a shallow dug well. The fact is that even today, any diarrheal illness can cause severe illness and death in a few hours to a day in an infant or a young child, in part because the younger the child the larger the percentage of body water they have. Dehydration can occur in either adults and children through fever, diarrhea, vomiting, or diminished thirst due to illness, or a combination of these. It can be challenging to replace the amount of fluids lost in a home setting. Dehydration is not just the loss of fluids and blood volume, but also the loss of electrolytes, which are the essential salts and minerals which are essential in balance to continued life. Unless you are medically trained, have access to a laboratory for determining the electrolyte level in a patient, and have access to unexpired and physician ordered intravenous fluid and electrolyte solutions, you are then restricted to using oral rehydration solutions.
Ideally, your pediatrician should see any child under one or two who has vomiting or diarrhea of greater than a couple of hours duration or if accompanied by a fever. If you have an infant who has a dry tongue, a sunken fontanel (soft spot on his head) or who cries without tears, during the course of an illness, and you cannot see your pediatrician quickly, you should take your child to the Emergency Room.
In many cases, you may wish to try to replace fluids and electrolytes in balance orally while heading to the pediatrician or the emergency room. Many times also, following a trip to the pediatrician, you will need to continue to replace fluids at home orally. Most physicians would rather than children under about two receive a commercially prepared rehydration solution during an illness with diarrhea or vomiting. Pedialyte, is frequently recommended in the US for this purpose, and comes in a variety of flavors and an unflavored.
Children over six can certainly use Pedialyte, but can often progress quickly to a regular Gatorade solution. (Not the G2 low calorie version) if tolerated. It is important not to push highly sugared fluids too quickly because sugar alone can cause and worsen diarrhea.
Most healthy adults can begin treating a gastrointestinal (diarrheal or vomiting) illness using whatever flavor of Gatorade they prefer. If it is not tolerated, one can buy Pedialyte and start with that, and ultimately advance to the Gatorade. This can be expensive, and large families should probably head to Sam’s Club in advance of an illness, for about $13.00 worth of Gatorade, which is a case, which comes in a variety of types and flavors.
Interestingly, in the Third World where intravenous treatment is rarer and may be more hazardous, oral rehydration is common. Many places in the world do not have Gatorade, and these locations use either a Unicef rehydration solution or another powdered preparation added to water exactly as directed on the package.
Sometimes in an emergency, a family is unable to continue to obtain Gatorade or to continue to locate some in a sufficient quantity to care for their entire family. This may well be the case because rotavirus, salmonella, and other gastrointestinal illnesses often occur in clusters and a number of families would be depleting a local supply at the same time. For this reason, many physicians recommend the assembly of an oral rehydration kit on would keep in ones home, and mix up EXACTLY AS DIRECTED in such an emergency.
The most up to date data in assembling a rehydration kit may be found at:
Please print these directions now, and place them in a first aid notebook under Rehydration. Print out an extra copy to place in your rehydration kit. Add a package of straws to your hydration kit as many children drink more in total using a straw.
Please also realize that every family should go out and buy a package of Morton Lite Salt, which is potassium. When the rehydration solutions call for a potassium source, this will suffice. Please be very careful to use the amounts exactly as specified in their directions.
Another very basic rehydration solution would be:
Take 4 cups of boiled filtered water
Add ONE TEASPOON of normal household SALT (Sodium Chloride)
Add EIGHT TEASPOONS of normal household SUGAR
Add ONE PINCH of Morton Lite Salt (Potassium Chloride)
You may wish to keep a packet of Orange Kool Aid without sugar, to add a small amount to make the rehydration solution more palatable to you and to children.
Wait about 8-10 minutes after vomiting before offering the solution. The patient may drink as much as they wish as often as they wish. Make fresh solution about every 24 hours. You may serve the solution at room temperature as cold solution can produce stomach cramping in persons with gastroenteritis. Your goal would be that your child or the ill adult would urinate every few hours and would have a yellow urine of moderate amount, not an amber one. A person who is well hydrated will often have a pale yellow urine.
Popsicles may be palatable to children, but studies indicate that they do not actually obtain much fluid from them, in fact, people on fluid restrictions, are often given popsicles.
Families should keep Pedialyte in their homes for gastroenteritis emergencies. They should keep Gatorade available for adults and for older children. They should also keep in a package together, a large freezer bag with all the components of the Basic Rehydration Solution as written above. This way, even an ill person could prepare their own in an emergency.
Although infants and children are at greatest risk for death from dehydration and fluid and electrolyte imbalance, adults and elderly patients can also succumb. In addition, anyone with a chronic medical condition can be less tolerant to fluid and electrolyte problems as well. Death can occur not only from insufficient fluid and blood circulating (hypovolemia) resulting in an inability to oxygenate body organs, but also from cardiac arrythmia from disruptions in potassium and other electrolytes.
If you have a diabetic child or diabetic family member, have your endocrinologist prepare a Sick Day Plan, and his desired rehydration solution directions, well in advance of an actual emergency. Advance preparation can be the difference between survival and not, especially for those with a chronic illness, even a well managed one.
In addition, if you camp, travel or do missionary work, you may wish to research a water filtration system such as the British Berkefeld or “Big Berkey”. Commissioned originally by Queen Victoria who became tired of experiencing diarrhea on visiting some of the farther reaching portions of the empire, they have been filtering the water of missionaries, campers, and those in emergencies for many years.
Once your ailing family member is well hydrated and hungry, you may wish to proceed slowly. Bananas, (a great source of potassium), rice, a little apple juice (move slowly here), toast, weak tea, are all wise ideas before moving on to the stomach challenging foods like chili that children seem to love so much. Advance the diet of a sick person slowly.
It is well worth the advance reading, planning and the assemblage of a home rehydration kit. It may help you and your family when you are least able yourself to leave home and seek the items you would need in it. For those of us who have an interest in preparedness issues, beyond the standard first aid kit, a well stocked rehydration kit may well be the most important aspect of a medical kit you ever assemble.
Oral Rehydration Solution: A “Low Tech” Oft Neglected Therapy
Darlene G. Kelly MD Phd Joseph Nadeau BS R Ph
Practical Gatroenterology October 2004