What Discharge Instructions Should I Give? Oral Rehydration, Zinc Supplementation, Diet, Probiotics, and Antimotility Medications

  • Alexa R. Gale
  • Matthew WilsonEmail author


For mild to moderate dehydration, oral rehydration therapy (ORT) delivers replacement of fluids and electrolytes in a safe, cost-effective manner. In a meta-analysis of 16 studies of 1545 children in 11 countries, oral rehydration was associated with fewer major adverse events (relative risk 0.36, 95% confidence interval, 0.14–0.89) and shorter hospital stays (mean 21 h; 95% CI, 8–35 h) compared to IV hydration. In the United States, oral rehydration solutions include Pedialyte, Infalyte, or WHO oral rehydration solutions. In 2004, WHO and United Nation’s Children fund (UNICEF) recommended zinc supplementation for acute diarrhea in children <5 years of age. Patients should no longer be limited to bananas, rice, applesauce, and toast as has been promoted in the past, but instead a healthy diet should be encouraged to promote enterocyte recovery.


Diarrhea Dehydration Abdominal pain Antibiotics ORT 


  1. 1.
    Binder HJ, Brown I, Ramakrishna BS, Young GP. Oral rehydration therapy in the second decade of the twenty-first century. Curr Gastroenterol Rep. 2014;16(3):376.CrossRefGoogle Scholar
  2. 2.
    Churgay CA, Aftab Z. Gastroenteritis in children: part I. Diagn Am Fam Physician. 2012;85(11):1059–62.Google Scholar
  3. 3.
    Hahn S, Kim S, Garner P. Reduced osmolarity oral rehydration solution for treating dehydration caused by acute diarrhea in children. Cochrane Database Sys Rev. 2002;1:CD002847.Google Scholar
  4. 4.
    Muskiwa A, Vomink J. Oral rehydration salt solution for treating cholera: <270 mOsm/L solutions vs > 310 mOsm/L solutions. Cochrane Database Sys Rev. 2009;2:CD003754.Google Scholar
  5. 5.
    Fonseca BK, Holdgate A, Craig JC. Enteral vs intravenous rehydration therapy for children with gastroenteritis: a meta-analysis of randomized controlled trials. Arch Pediatr Adolesc Med. 2004;158(5):483–90.CrossRefGoogle Scholar
  6. 6.
    Hartling L, Bellemare S, Wiebe N, Russell K, Klassen TP, Craig W. Oral versus intravenous rehydration caused by acute diarrhea in children. Cochrane Database Syst Rev. 2006;3:CD004390.Google Scholar
  7. 7.
    Pillow MT, Porter E, Hostetler MA, ACEP. Now focus on: current management of gastroenteritis in children. ACEP News. 2008:9.Google Scholar
  8. 8.
    Lamberti LM, Walker CL, Chan KY, Jian WY, Black RE. Oral zinc supplementation for the treatment of acute diarrhea in children: a systematic review and meta-analysis. Nutrients. 2013;5(11):4715–40.CrossRefGoogle Scholar
  9. 9.
    Gregorio G, Dans L, Silvestre M. Early versus delayed refeeding for children with acute diarrhea. Cochrane Database Sys Rev. 2011;7:CD007296.Google Scholar
  10. 10.
    Shane AL, Mody RK, Crump JA, Tarr PI, Steiner TS, Kotloff K, Langley JM, et al. 2017 Infectious Diseases Society of America clinical practice guidelines for the diagnosis and management of infectious diarrhea. Clin Infect Dis. 2017;65(12):e45–80.CrossRefGoogle Scholar
  11. 11.
    Allen SJ, Martinez EG, Gregorio GV, Dans LF. Probiotics for treating acute infectious diarrhoea. Cochrane Database Syst Rev. 2010;11:CD003048.Google Scholar
  12. 12.
    Wu PE, Juurlink DN. Clinical Review: loperamide toxicity. Ann Emerg Med. 2017;70(2):245–52.CrossRefGoogle Scholar
  13. 13.
    Riddle MS, Connor BA, Beeching NJ, DuPont HL, Hamer DH, Kozarsky P, et al. Guidelines for the prevention and treatment of travelers’ diarrhea: a graded expert panel report. J Travel Med. 2017;24(suppl_1):S63–80.CrossRefGoogle Scholar
  14. 14.
    Koo HL, Koo DC, Musher DM, DuPont HL. Antimotility agents for the treatment of Clostridium difficile diarrhea and colitis. Clin Infect Dis. 2009;48(5):598–605.CrossRefGoogle Scholar

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Georgetown University School of Medicine, MedStar Washington Hospital Center, Department of Emergency MedicineWashington, DCUSA

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