In a toddler with dehydration due to gastroenteritis, what is the recommended rehydration strategy?

• A. Oral rehydration solution alone for all dehydration.
• B. IV fluids for all dehydration.
• C. Oral rehydration solution (ORS) with 50 mL/kg over 4 hours for mild-moderate dehydration; IV fluids for severe dehydration.
• D. No fluids.

Answer: (C)

The main idea is matching rehydration method to how dehydrated the child is. For mild to moderate dehydration from gastroenteritis, oral rehydration solution is preferred because it restores fluids and electrolytes safely without IV access. The recommended amount is about 50 mL per kilogram of body weight over roughly 4 hours, with ongoing feeding as tolerated. If dehydration is severe—signs like lethargy, poor skin turgor with rapid capillary refill, or shock—then IV fluids are needed, typically starting with isotonic saline or lactated Ringer’s, given as 20 mL/kg boluses and reassessed.

In this scenario, using oral rehydration solution at 50 mL/kg over 4 hours for mild to moderate dehydration, with IV fluids reserved only for severe dehydration, fits best. The other options fail because they either ignore severity (oral rehydration for all cases), treat all dehydration with IV regardless of severity, or provide no fluids at all, which would be dangerous.