Ask the Pharmacist

Q: My son has some kind of virus and I’m worried that he might be getting dehydrated from the diarrhea. He hates the taste of Pedialyte and Gastrolyte. Is there anything else I can give him?

A: Every year in Canada, there are about 7,000 hospitalizations, 27,000 Emergency Room (ER) visits and some 56,000 physician visits mainly as a result of dehydration just from the rotavirus alone.

When you add all the other possible illnesses and causes that can produce dehydration in children, you can clearly see that this is a major source of ill health in kids (one of the most common causes of mortality and sickness) and a significant drag upon the economy (the treatment of such is estimated to cost the health care system $17-million per year at a minimum).

This is regrettable as many cases of dehydration can be prevented long before they become serious, by being cognizant of the causes and symptoms and initiating preventative measures at home before the situation turns into an emergency.
Dehydration is simply an excessive loss of water in the body. This can lead to a host of other problems, such as changes in the levels of a number of electrolytes (most notably potassium and sodium), as well as the potential for the body to become too acidic, a condition known as metabolic acidosis.

If left untreated for too long, it can lead to permanent damage to assorted organs (most commonly the kidney; with the brain, heart and skin also being at substantial risk) and be potentially fatal.

Kids can become dehydrated far faster than adults due to their rapid turnover of body fluids, and the younger the child, the quicker the onset and the greater the risks. Dehydration is usually caused by prolonged diarrhea or vomiting but can also be induced by being exposed to hot temperatures for too long, vigorous exercise, certain medications (mainly water pills/diuretics), and some medical conditions such as kidney disease.

The key to dehydration treatment is to prevent it in the first place as rehydrating your child can be challenging. Rehydration is also not nearly as simple as giving your child more fluids to drink since plain water, without the proper amounts of electrolytes, can cause sodium and potassium levels to plummet; whereas, juice contains large amounts of sugar which can significantly worsen diarrhea. As well, over-hydration can be as serious as dehydration and require urgent medical attention.

In general, the younger the child, the more careful the rehydration process should be. So, in order to prevent dehydration, you must first be aware of the signs that it may be developing.

The initial symptoms, not surprisingly, are thirst and a decreased urine output which will become darker in colour. Note, if your child is exhibiting these symptoms, he/she is already somewhat dehydrated. Later-developing symptoms include a mouth that feels sticky to the touch, sunken eyes, irritability and decreased tears.

Symptoms that indicate that significant dehydration has already occurred include your child appearing to be drowsy, limp or cold; a mouth that feels dry; eyes that are very sunken and an inability to produce tears.

Another way of assessing the level of dehydration is through body weight. As soon as your child exhibits vomiting or diarrhea, it is a great idea to get an exact current weight. A loss weight of five per cent or less is a sign of mild dehydration; a loss of five to 10 per cent, moderate dehydration; and it’s determined to be severe if the loss is any greater than 10 per cent.

There are a number of different rating systems that can help indicate when it is time to seek immediate medical attention. Calling Telehealth Ontario, your local pharmacy or perhaps your physician’s office, can help guide your decision.

There are a number of rehydration solutions available commercially such as the two mentioned in the article above that provide the proper amounts of electrolytes, sugar per volume of liquid. They are all excellent choices and are considered the so-called first line in prevention.

However, for some parents, they may not be suitable due to their taste (often not great, although the “freezie pops” version is often preferred by many youngsters), price (they can cost more than $8 per litre), and lack of stability (once mixed or opened they go bad within days).

Recent evidence from ERs indicates that half-strength apple juice (i.e. mixed apple juice mixed half-and-half with water) seems to work as well as the commercial products and doesn’t appear to worsen diarrhea.

After choosing a rehydration product, the next issue to address is timing. Rehydration should start as soon as vomiting or diarrhea occurs. Start with one teaspoon (five mL) every five minutes, then increase as tolerated.

For kids who are already showing the initial signs of mild dehydration, try 60-120 mL of fluid after each bout of diarrhea or vomiting for kids who weigh less than 10 kilograms (22 pounds) or 120 to -240 mL for heavier kids.

Of course, some children should be referred to the ER regardless of hydration state, such as a sick child who is less than six months of age, or weighs eight kilograms, or older kids who are spiking a fever greater than 39 degrees Celsius.

For more information about this or any other health-related questions, contact the pharmacists at Gordon Pharmasave, Your Health and Wellness Destination. Also check the website at www.gordon-pharmasave.com/ and the Facebook page at www.facebook.com/GordonPharmasave/?fref=ts