urgent question for any doctors pharmacists

[ledger]

my 18 month old daughter was sent to the local hospital today by our doctors. She has gastro enteritus (sp ?). She has been vomiting for 2 days and can't even keep water down. She also has diorhea (how do you spell that word).

The peadiatrician told my wife to give her "Dioralyte", but the instructions for her age are unclear. My wife went to one chemist, I went to another and we have had been told 1-1.5 sachets a day by one, and as many as she likes by another.

My concern is about giving her too much salt. Can anyone tell me how many of these she should have a day and in what concentration ?.

[craigw]

I'd phone nhs direct if i were you, 118 500 with have their number

[vixpy1]

Julian64 is your man.

[mechsympathy]

I'd call the paediatrician you saw. Get the hospital switchboard to page them.


>>>Edit: Although, if you've ever tasted dioralyte you'll be surprised if you can get half a sachet down her (or him, can't remember. Sorry.)

>> Edited by mechsympathy on Friday 11th February 15:35

[viggen114]

Hope this helps you, its from BNF

ORAL REHYDRATION SALTS (ORS)

Indications: fluid and electrolyte loss in diarrhoea, see notes above

Dose: according to fluid loss, usually 200-400mL solution after every loose motion; infant 1-1½ times usual feed volume; child 200mL after every loose motion

Dioralyte® (Rhône-Poulenc Rorer)
Effervescent tablets, sodium chloride 117mg, sodium bicarbonate 336mg, potassium chloride 186mg, citric acid anhydrous 384mg, anhydrous glucose 1.62g. Net price 10-tab pack (blackcurrant- or citrus-flavoured) =£1.42
Dose: reconstitute 2 tablets with 200 mL of water (only for adults and for children over 1 year)
Note. Ten tablets when reconstituted with 1 litre of water provide Na+ 60 mmol, K+ 25mmol, Cl- 45mmol, citrate 20mmol, and glucose 90 mmol

Oral powder, sodium chloride 470mg, potassium chloride 300 mg, disodium hydrogen citrate 530 mg, glucose 3.56g/sachet, net price 6-sachet pack = £2.02, 20-sachet pack (blackcurrant- or citrus-flavoured or natural) = £5.68
Dose: reconstitute one sachet with 200mL of water (freshly boiled and cooled for infants)
Note. Five sachets reconstituted with 1 litre of water provide Na+ 60 mmol, K+ 20mmol, Cl- 60mmol, citrate 10mmol, and glucose 90 mmol

[Mannginger]

mechsympathy said:

I'd call the paediatrician you saw. Get the hospital switchboard to page them. >>>Edit: Although, if you've ever tasted dioralyte you'll be surprised if you can get half a sachet down her (or him, can't remember. Sorry.) >> Edited by mechsympathy on Friday 11th February 15:35

I concur - my experience led me to have the smallest amount of water possible to dissolve the sachet and then lots of normal water to drink and get rid of the taste.

Re the amount I'm not able to say I'm afraid.

Phil

[Plotloss]

Similar effect can be achieved with a cup of water, a spoon of sugar and a pinch of salt.

[ledger]

viggen114 said:

Hope this helps you, its from BNF Dose: according to fluid loss, usually 200-400mL solution after every loose motion; infant 1-1½ times usual feed volume; child 200mL after every loose motion

this is the bit I'm unclear on. She has a mixture of cows milk and normal food as her daily diet. We don't really monitor how much milk she has (we used to before she moved to solids).

So how much should we give her ?, before she was weened she used to drink in excess of 21oz per day, does that mean we can give her up to 32oz of dioralyte in 24 hrs.

Thanks for all the replies, I'm sure after all this she will refuse to drink it anyway. Bloody kids they are a worry :-)

[Plotloss]

At 18 months they should drink about a pint of milk a day...

[stone]

Getting her to drink it may be the hardest part!

[glocko]

ledger said:

She also has diorhea (how do you spell that word).

Get a pen....

S


H


I


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getting labcoat

[lunarscope]

stone said:

Getting her to drink it may be the hardest part!

A few drops of undiluted ribena should help.

[KingRichard]

I had Gastro Entiritus (again... sp?) before christmas... Its not fun, hope the little mites ok

I cured it by dosing up on imodium, it enabled me to 'retain' some of the water I drank... although I wasn't suffering from vomiting. There might be something similar suitable for nippers.

I'd get onto NHS direct they are always top banana

[nubbin]

Electrolade is a bit more palatable, but use the strong flavours (Blackcurrant is best).

However, try it yourself first and ask "Would I drink this if I was vomiting?" The answer will be no.

Then use flat Lucozade, water, dilute fruit squash, or anything really.

The problem in Gastre-enteritis is Potassium loss mainly from diarrhoea, but in the short term i.e 2-3 days, this is rarely clinically significant.

If in doubt, ring your GP for a bit of advice, or ring the Paediatric ward - Paeds. nurses are usually better able than average to give sound advice.

[Julian64]

Hi

Sorry to hear about your littl'un. Gp's rarely (hopefully) send mites to hospital with gastroenteritis unless they are pretty concerned about dehydration on examination. So your mite must be pretty poorly.

Dioralyte, electolade both very similar. Mix them with the specified amout of water and bobs your uncle. You do NOT need to worry about salt poisoning. I have never seen an over dioralyted child. Both electrolade and dioralyte are designed to mimic the concentration of body fluids.

If you add to this that your child is dehydrated and likely refusing much to drink then it makes it an impossible combination to get too much into her/him.

Good advice from Nubbin but I would avoid lucozade. We used to have a lot of parents bring this into hospital to treat their own children but left standing orders with the nurses that it be thrown out. It contains a horrendously large amount of sugar rendering it fairly hypertonic and therefore counterproductive for rehydration.

Two further points. difficulty in getting fluids into a child can sometimes be temperature related. A hot child will feel dizzy and sick, so remember to cool and calpol, which can often make them tolerate fluids better.

Second, Your GP has been worried enogh to have already sent your child to hospital. Children can dehydrate quite fast because they have few reserves to call on. SO DON'T ASSUME YOUR DOCTOR KNOWS YOU HAVN'T BEEN ADMITTED TO HOSPITAL. He may not know you are back at home. As a GP if I have been worried enough about the state of a child to send to hospital they get admitted cos this is what our consultants agreed upon. If not I would wanna see them regularly until they are getting better, and am sure your doc is similar, so call him.

[ledger]

thanks for all of the advise posted on this thread. Hopefully she will stop being sick soon and be able to keep fluids down.

Now I just need to work out how to get the smell of vomit out of every carpet in the house, back seat of the car, her car seat etc etc :-). I can feel a "shake and vac" weekend looming.

Though you have to admire her timing, vomiting for England a couple of days after our washing machine breaks and 5 days before the new one is due to be delivered :-)

[wedge girl]

ledger said:

Now I just need to work out how to get the smell of vomit out of every carpet in the house, back seat of the car, her car seat etc etc :-). I can feel a "shake and vac" weekend looming.

Now that I can help with, Fabreeze, much better and easier to use than Shake and Vac

Hope your little one feels well soon.