A 6-month-old with rotavirus gastroenteritis is assessed as having 8% dehydration (moderate). He is alert, has mildly sunken fontanelle, reduced skin turgor, and serum Na 145 mEq/L. The preferred initial rehydration approach is:
- A IV 0.9% NaCl bolus 20 mL/kg over 1 hour then reassess
- B IV Ringer's lactate at 1.5x maintenance rate over 24 hours
- C Oral rehydration solution (ORS) 50-100 mL/kg over 3-4 hours ✓
- D IV 0.45% NaCl + 5% dextrose at maintenance rate
Correct answer: C. Oral rehydration solution (ORS) 50-100 mL/kg over 3-4 hours
Explanation
WHO and IAP guidelines recommend oral rehydration therapy (ORT) as the first-line treatment for mild-to-moderate dehydration without signs of severe dehydration or shock. ORS 50-100 mL/kg over 3-4 hours (for moderate dehydration) is safe, effective, cost-efficient, and reduces IV complications. IV boluses are reserved for severe dehydration (>10%) with shock. Normal saline boluses risk hyperchloremic acidosis. Hypernatremia (Na 145) here is borderline but ORS corrects this safely by providing a balanced glucose-electrolyte solution. Hypotonic IV fluids risk hyponatremia.
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.