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Assessment and treatment of diarrhoea
Treatment Plan C: for patients with severe dehydration
Follow the arrows. If the answer is “yes” go across. If “no” go down.
Can you give intravenous Yes Start IV fluids immediately. If the patient can drink,
(IV) fluids immediately? give ORS by mouth while the drip is set up. Give
100 ml/kg Ringer’s Lactate Solution (or if not
available normal saline), divided as follows:
Age Firstgive Then give
30 ml/kg in: 70 ml/kg in:
Infants
(under 12 months) 1 hour* 5 hours
Older 30minutes* 2½ hours
No * Repeat once if radial pulse is still very weak or non-
detectable.
Is IV treatment available
nearby Yes Reassess the patient every 1-2 hours. If
(within 30 minutes)? hydration is not improving, give the IV drip
more rapidly.
Also give ORS (about 5 ml/kg/hour) as soon
as the patient can drink: usually after 2-4
hours (infants) or 1-2 hours (older patients).
After 6 hours (infants) or 3 hours (older
patients), evaluate the patient using the
assessment chart. Then choose the
appropriate Plan (A, B or C) to continue
treatment.
Send the patient immediately for IV
treatment.
If the patient can drink, provide the mother
with ORS solution and show her how to give it
during the trip to receive IV treatment.
No
Are you trained to use a Yes Start rehydration by tube with ORS solution:
naso-gastric tube (NG) for give 20 ml/kg/hour for 6 hours (total of
120 ml/kg).
rehydration? Reassess the patient every 1-2 hours:
if there is repeated vomiting or increased
No abdominal distension, give the fluid more slowly.
Can the patient drink? if hydration is not improved after 3 hours, send
the patient for IV therapy.
No After 6 hours, reassess the patient and
Urgent: send the patient choose the appropriate treatment plan.
for IV or NG treatment.
Yes Start rehydration by mouth with ORS
solution, giving 20 ml/kg/hour for 6 hours
(total of 120 ml/kg).
Reassess the patient every 1-2 hours:
if there is repeated vomiting, give the fluid more
slowly - if hydration is not improved after 3 hours
send the patient for IV therapy.
After 6 hours, reassess the patient and choose
the appropriate treatment plan.
NB: If possible, observe the patient for at least six hours after rehydration to be sure the mother
can maintain hydration giving ORS solution by mouth. If the patient is over two years old and there
is cholera in your area, give an appropriate oral antibiotic after the patient is alert.
321
Treatment Plan C: for patients with severe dehydration
Follow the arrows. If the answer is “yes” go across. If “no” go down.
Can you give intravenous Yes Start IV fluids immediately. If the patient can drink,
(IV) fluids immediately? give ORS by mouth while the drip is set up. Give
100 ml/kg Ringer’s Lactate Solution (or if not
available normal saline), divided as follows:
Age Firstgive Then give
30 ml/kg in: 70 ml/kg in:
Infants
(under 12 months) 1 hour* 5 hours
Older 30minutes* 2½ hours
No * Repeat once if radial pulse is still very weak or non-
detectable.
Is IV treatment available
nearby Yes Reassess the patient every 1-2 hours. If
(within 30 minutes)? hydration is not improving, give the IV drip
more rapidly.
Also give ORS (about 5 ml/kg/hour) as soon
as the patient can drink: usually after 2-4
hours (infants) or 1-2 hours (older patients).
After 6 hours (infants) or 3 hours (older
patients), evaluate the patient using the
assessment chart. Then choose the
appropriate Plan (A, B or C) to continue
treatment.
Send the patient immediately for IV
treatment.
If the patient can drink, provide the mother
with ORS solution and show her how to give it
during the trip to receive IV treatment.
No
Are you trained to use a Yes Start rehydration by tube with ORS solution:
naso-gastric tube (NG) for give 20 ml/kg/hour for 6 hours (total of
120 ml/kg).
rehydration? Reassess the patient every 1-2 hours:
if there is repeated vomiting or increased
No abdominal distension, give the fluid more slowly.
Can the patient drink? if hydration is not improved after 3 hours, send
the patient for IV therapy.
No After 6 hours, reassess the patient and
Urgent: send the patient choose the appropriate treatment plan.
for IV or NG treatment.
Yes Start rehydration by mouth with ORS
solution, giving 20 ml/kg/hour for 6 hours
(total of 120 ml/kg).
Reassess the patient every 1-2 hours:
if there is repeated vomiting, give the fluid more
slowly - if hydration is not improved after 3 hours
send the patient for IV therapy.
After 6 hours, reassess the patient and choose
the appropriate treatment plan.
NB: If possible, observe the patient for at least six hours after rehydration to be sure the mother
can maintain hydration giving ORS solution by mouth. If the patient is over two years old and there
is cholera in your area, give an appropriate oral antibiotic after the patient is alert.
321
