Appendix 2. Assessment and treatment of diarrhoea
a  Evaluation of dehydration (adapted from the WHO)
Mental status 
Normal, awake 
Agitated, irritable 
Lethargic or unconscious 
Radial pulse 
Easily palpable 
Palpable (possibly rapid) 
Difficult to palpate (weak) or absent 
Eyes 
Normal 
Sunken 
Sunken 
Skin pinch 
Disappears rapidly 
Disappears slowly (< 2 seconds) 
Disappears very slowly (> 2 seconds) 
Thirst 
Drinks normally 
Thirsty, drinks avidly 
Incapable or drinks very little 

↓ 
↓ 
↓ 
Notes:
– Sunken eyes are a sign of dehydration (loss of soft tissue volume causing eyes to sink into their orbits) but may be a normal feature in some children.
Ask the mother if the child’s eyes are the same as usual or are more sunken than usual.
– Skin pinch: this test evaluates the loss of skin elasticity due to a decrease in water content. The slower the skin pinch disappears, the greater the degree of dehydration.
Skin pinch is assessed by pinching the skin of the abdomen between the thumb and forefinger, without twisting. In the elderly, this sign is not as reliable, as normal aging diminishes skin elasticity. In these patients, checking skin pinch can be done on the chest below the clavicle.
– Thirst is not always a good indicator of dehydration. Severely dehydrated patients and the elderly may not feel thirsty, even in the presence of clear signs of dehydration. The objective is to determine if the patient is able to drink, rather than the level of thirst. If the patient drinks normally or avidly, then oral rehydration is indicated and is likely to succeed. Those who have difficulty drinking will require close surveillance as they risk failing oral therapy, necessitating a change in protocol (e.g. switching to IV rehydration).
b  Prevention of dehydration in children and adults (ORS, Plan A)
Administer oral rehydration solution (ORS) after each loose stool, until diarrhoea ceases, as below:
Age 
Amount of ORS 
Under 2 years 
50100 ml (10 to 20 teaspoons) after each loose stool 
2 to 10 years 
100200 ml (½ to 1 glass) after each loose stool 
Over 10 years 
at least 200250 ml (at least 1 glass) after each loose stool 
c  Treatment of some dehydration in children and adults (ORS, Plan B)
Weight 
Age 
Total volume of ORS 
Volume of ORS per hour 

3 to < 4 kg 
0 to < 1 month 
230 ml 
60 ml per hour for 4 hours 
4 to < 5 kg 
1 to < 2 months 
300 ml 
75 ml per hour for 4 hours 
5 to < 6 kg 
2 to < 3 months 
400 ml 
100 ml per hour for 4 hours 
6 to < 7 kg 
3 to < 4 months 
480 ml 
120 ml per hour for 4 hours 
7 to < 8 kg 
4 to < 7 months 
550 ml 
140 ml per hour for 4 hours 
8 to < 9 kg 
7 to < 10 months 
600 ml 
150 ml per hour for 4 hours 
9 to < 10 kg 
10 to < 12 months 
700 ml 
180 ml per hour for 4 hours 
10 to < 13 kg 
1 to < 2 years 
800 ml 
200 ml per hour for 4 hours 
13 to < 15 kg 
2 to < 3 years 
1000 ml 
250 ml per hour for 4 hours 
15 to < 17 kg 
3 to < 4 years 
1200 ml 
300 ml per hour for 4 hours 
17 to < 19 kg 
4 to < 5 years 
1400 ml 
350 ml per hour for 4 hours 
19 to < 21 kg 
5 to < 6 years 
1600 ml 
400 ml per hour for 4 hours 
21 to < 24 kg 
6 to < 7 years 
1600 ml 
400 ml per hour for 4 hours 
24 to < 27 kg 
7 to < 8 years 
1800 ml 
450 ml per hour for 4 hours 
27 to < 30 kg 
8 to < 9 years 
2000 ml 
500 ml per hour for 4 hours 
30 to < 32 kg 
9 to < 10 years 
2200 ml 
550 ml per hour for 4 hours 
32 to < 35 kg 
10 to < 11 years 
2400 ml 
600 ml per hour for 4 hours 
35 to < 39 kg 
11 to < 12 years 
2800 ml 
700 ml per hour for 4 hours 
39 to < 44 kg 
12 to < 13 years 
3200 ml 
800 ml per hour for 4 hours 
44 to < 50 kg 
13 to < 14 years 
3600 ml 
900 ml per hour for 4 hours 
≥ 50 kg 
≥ 14 years 
4000 ml 
1000 ml per hour for 4 hours 
≥ 75 kg 
6000 ml 
1500 ml per hour for 4 hours 
If the patient wants to drink more than prescribed, give more ORS.