BNF for Children 2011-2012

BNFC 2011–2012 9.2.1 Oral preparations for fluid and electrolyte imbalance 459Sodium supplementation in neonates. By mouthPreterm neonate 2 mmol/100 mL of formula feedor 3–4 mmol/100 mL of breast milk, consult dieticianSodium replacement. By mouthChild 1 month–18 years according to requirements,generally 1–2 mmol/kg daily in divideddoses, higher doses may be needed in severedepletionChronic renal loss. By mouthChild 1 month–18 years 1–2 mmol/kg daily individed doses, adjusted according to requirementsSlow Sodium c (HK Pharma)Tablets, m/r, sodium chloride 600 mg (approx.10 mmol each of Na + and Cl ). Net price 100-tab pack= £6.05. Label: 25Capsules available from ‘special-order’ manufacturers or specialistimporting companies, see p. 809Extemporaneous formulations available seeExtemporaneous Preparations, p. 6Oral rehydration therapy (ORT)Diarrhoea in children is usually self-limiting, however, inchildren under 6 months of age, and more particularly inthose under 3 months, symptoms of dehydration may beless obvious and there is a risk of rapid and severedeterioration. Intestinal absorption of sodium and wateris enhanced by glucose (and other carbohydrates).Replacement of fluid and electrolytes lost through diarrhoeacan therefore be achieved by giving solutionscontaining sodium, potassium, and glucose or anothercarbohydrate such as rice starch.Oral rehydration solutions should:. enhance the absorption of water and electrolytes;. replace the electrolyte deficit adequately and safely;. contain an alkalinising agent to counter acidosis;. be slightly hypo-osmolar (about 250 mmol/litre) toprevent the possible induction of osmotic diarrhoea;. be simple to use in hospital and at home;. be palatable and acceptable, especially to children;. be readily available.It is the policy of the World Health Organization (WHO)to promote a single oral rehydration solution but to useit flexibly (e.g. by giving extra water between drinks oforal rehydration solution to moderately dehydratedinfants).Oral rehydration solutions used in the UK are lower insodium (50–60 mmol/litre) than the WHO formulationsince, in general, patients suffer less severe sodium loss.Rehydration should be rapid over 3 to 4 hours (except inhypernatraemic dehydration in which case rehydrationshould occur more slowly over 12 hours). The patientshould be reassessed after initial rehydration and if stilldehydrated rapid fluid replacement should continue.Once rehydration is complete further dehydration isprevented by encouraging the patient to drink normalvolumes of an appropriate fluid and by replacing continuinglosses with an oral rehydration solution; ininfants, breast-feeding or formula feeds should beoffered between oral rehydration drinks.For intravenous rehydration see section 9.2.2.ORAL REHYDRATION SALTS (ORS)Licensed use Dioralyte c Relief not licensed for usein children under 3 monthsIndication and doseFluid and electrolyte loss in diarrhoea see notesabove. By mouthChild 1 month–1 year 1–1½ times usual feedvolumeChild 1–12 years 200 mL after every loosemotionChild 12–18 years 200–400 mL after every loosemotionUK formulationsNote After reconstitution any unused solution should be discardedno later than 1 hour after preparation unless stored in arefrigerator when it may be kept for up to 24 hours.Dioralyte c (Sanofi-Aventis)Oral powder, sodium chloride 470 mg, potassiumchloride 300 mg, disodium hydrogen citrate 530 mg,glucose 3.56 g/sachet, net price 6-sachet pack =£2.25, 20-sachet pack (black currant- or citrus-flavouredor natural) = £6.72Note Reconstitute 1 sachet with 200 mL of water (freshlyboiled and cooled for infants); 5 sachets reconstituted with1 litre of water provide Na + 60 mmol, K + 20 mmol, Cl60 mmol, citrate 10 mmol, and glucose 90 mmolDioralyte c Relief (Sanofi-Aventis)Oral powder, sodium chloride 350 mg, potassiumchloride 300 mg, sodium citrate 580 mg, cooked ricepowder 6 g/sachet, net price 6-sachet pack (apricot-,black currant- or raspberry-flavoured) = £2.50, 20-sachet pack (apricot-flavoured) = £7.13Note Reconstitute 1 sachet with 200 mL of water (freshlyboiled and cooled for infants); 5 sachets when reconstitutedwith 1 litre of water provide Na + 60 mmol, K + 20 mmol, Cl50 mmol and citrate 10 mmol; contains aspartame (section9.4.1)Electrolade c (Actavis)Oral powder, sodium chloride 236 mg, potassiumchloride 300 mg, sodium bicarbonate 500 mg, anhydrousglucose 4 g/sachet (banana-, black currant-,lemon and lime-, or orange-flavoured). Net price 6-sachet (plain or multiflavoured) pack = £1.33, 20-sachet (single- or multiflavoured) pack = £4.99Note Reconstitute 1 sachet with 200 mL of water (freshlyboiled and cooled for infants); 5 sachets when reconstitutedwith 1 litre of water provide Na + 50 mmol, K + 20 mmol, Cl40 mmol, HCO 3 30 mmol, and glucose 111 mmolWHO formulationOral Rehydration Salts (Non-proprietary)Oral powder, sodium chloride 2.6 g, potassiumchloride 1.5 g, sodium citrate 2.9 g, anhydrous glucose13.5 g. To be dissolved in sufficient water to produce1 litre (providing Na + 75 mmol, K + 20 mmol, Cl –65 mmol, citrate 10 mmol, glucose 75 mmol/litre)Note Recommended by the WHO and the United NationsChildren’s Fund but not commonly used in the UK9 Nutrition and blood