concentration of 2% to 2.5% Soda, juice, popsicles, and soups are inappropriate rehydration solutions in dehydrated infants and children and should be discouraged as they not have the appropriate glucose-to-sodium ratio and are not absorbed as easily as electrolyte solutions Studies have evaluated half strength apple juice (mixed with water) as an alternate therapy as compared to ORT and have found fewer treatment failures most likely secondary to patient taste preference In developing countries, the addition of zinc supplementation in patients older than months of age with diarrhea has been shown to have improved outcomes however current evidence does not show a benefit in wellnourished children in settings with low prevalence of zinc deficiency TABLE 22.4 ONDANSETRON DOSING FOR GASTROENTERITIS Patient weight (kg) Dose 8–15 >15–30 >30 2-mg orally disintegrating tablet (½ tablet) 4-mg orally disintegrating tablet 8-mg orally disintegrating tablet The amount of fluid to be administered is dependent on the degree of dehydration Mild dehydration reflects up to 5% weight loss, so 5% of the child’s body weight (50 mL/kg) should be administered as small-volume frequent feeds Moderate dehydration represents up to 10% weight loss, so 10% of the child’s weight (100 mL/kg) should be administered An easy rule of thumb to remember is that a mildly dehydrated patient can receive mL/kg every minutes and a moderately dehydrated patient can receive mL/kg every minutes As the child tolerates the feeds, the volume can be increased as well as the frequency The rehydration should be completed over a 4-hour time frame ( Fig 22.2 ) ORT has been shown to be equivalent to IV fluid therapy in terms of rehydration efficacy and it has been shown that it takes less time to institute therapy with ORT (i.e., teach the parents how to administer the fluids) than to start an IV line in a child, and there is less staff time involved in administering care to these patients as well as shorter ED stays There are a significant number of patients with gastroenteritis who will be unable to perform ORT and will subsequently require alternative methods for rehydration Nasogastric (NG) tube use is an acceptable alternative as it has been shown to be as effective as IV hydration They are relatively easy to