Treatment of diarrheal dehydration.

In a paper on fluid therapy of rehydration, the rehydration fluid advocated by Speretto et al, N/2 saline, is approximately 60% of the tonicity of their children's plasma with respect to sodium. Thus, their data show a weight gain over a 3-hour reparation period of about 60% of the fluid administered. Administering a half normal solution leaves a severely dehydrated child still dehydrated. In addition, the potassium deficits are exacerbated and acidosis is only slowly corrected. The author of this letter recommends for rapid rehydration, the use of a balanced solution with a range of electrolyte content (in mEq/liter) as follows: Na, 100 to 130; K, 10 to 15; HCO3, 20 to 30. Children should take oral fluids and food within a few hours after rehydration. A 2nd paper on fluid therapy of rehydration by Nichols and Soriano contains practical, conceptual, physiological and historical fallacies. The practical fallacy is their theoretical critique of an approach that is already successful, and documented worldwide. The conceptual fallacy is their argument for individualized therapy and management based on average stool electrolyte concentration. The physiologic fallacy is their assumption that less sodium content (30 mEq/liter), is safer than more sodium content (90 mEq/liter), while the historical fallacy is their objection of the nutritional inadequacy of oral rehydration fluids.