Treatment of dehydration in children with SAM (without shock)

Give oral rehydration solution as follows, in amounts based on the child’s weight:

How often to give ORS* Amount to Give
Every 30 minutes for first 2 hours 5 ml/kg weight
Alternate hours for up to 10 hours 5-10 ml/kg**

* Reduced osmolarity ORS is used ; add 15 ml of potassium chloride to one litre ORS (15 ml contains 20 mmol/L of potassium)

** The amount offered should be based on child’s willingness to drink and amount of ongoing losses in stool.

Starter diet is given in alternate hours (eg. 2, 4, 6) with reduced osmolarity ORS (eg. 3, 5, 7) until the child is rehydrated.

Signs to check every half hour for the first two hours, then hourly:

  • Respiratory rate
  • Pulse rate
  • Urine frequency
  • Stool or vomit frequency
  • Signs of hydration

Signs of over hydration:

  • Increased respiratory rate and pulse. (Both must increase to consider it a problem –increase of pulse by 15 & respiratory rate by 5)
  • Jugular veins engorged
  • Puffiness of eye

Stop ORS if any of the above mentioned signs appear.


Signs of improved hydration status (any 3 of the following):-

  • Child is no longer thirsty
  • Child is less lethargic
  • Slowing of respiratory and pulse rates from previous high rate
  • Skin pinch is less slow
  • Child has tears

If diarrhoea continues after rehydration, give ORS after each loose stool to replace ongoing losses:-

  • For children less than 2 years, give approximately 50 ml after each loose stool
  • For children 2 years and older, give 100 ml after each loose stool

Breast feeding is continued with increased frequency if the child is breastfed.