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The number of children younger than 5 years who die after diarrheal diseases worldwide has dropped with the support of WHO and UNICEF from more than 3 million annually in 1980 to 500 000 in 2015. Oral rehydration solutions made a crucial contribution to reducing the death rate, at 36.2% (1). Rehydration therapy of dehydrated infants and toddlers, using hypotonic oral rehydration solution—as is recommended worldwide—has proved successful and is lifesaving.

Clean water is available everywhere in Germany; 10 packets of electrolyte-glucose powder to prepare 2 liters of oral rehydration solution cost between €2.50 and €5.80. The sachets are available without prescription, last for many years, and should be stocked in every household and during travel/trips/journeys. Improvised preparations for rehydration are error-prone; the incorrect composition can be fatal in younger children.

The treatment of diarrheal dehydration should not be confused with its prevention. A sufficiently high fluid intake (including tea with sugar and salt or diluted apple juice drinks) and an age-appropriate diet should be provided at home at disease onset and continued even if signs of dehydration are lacking. This is consistent with the approach recommended in our review article (Figure) (2). In the randomized trial cited by Dr Nolte (diluted apple juice versus electrolyte solution), 68% of participating children were not experiencing dehydration and 67.4% received ondansetron for vomiting (3). A significant effect regarding defined parameters for therapeutic failure was seen in older children only (<24 months: apple juice 23.9% versus electrolyte solution 24.1%). This study was considered during guideline development, but owing to the study design it did not factor in the recommendations for giving oral rehydration therapy for infants and children with mild to moderate dehydration (4). The evidence based treatment of diarrheal dehydration with oral rehydration solutions is practical and saves lives.

DOI: 10.3238/arztebl.m2021.0032

On behalf of the authors
Prof. Dr. med. Carsten Posovszky
Universitätsklinikum Ulm
Klinik für Kinder- und Jugendmedizin
carsten.posovszky@uniklinik-ulm.de

Prof. Dr. med. Sibylle Koletzko
LMU Klinikum der Universität München
Kinderklinik und Kinderpoliklinik
im Dr. von Haunerschen Kinderspital

Conflict of interest statement
Both authors participated in the development of the German S2k guideline on acute infectious gastroenteritis in infancy, childhood, and adolescence.

Prof. Koletzko has served as a paid consultant for Boehringer Ingelheim and has received lecture honoraria from Hipp.

Prof. Posovszky states that he has no conflict of interest.

1.
Black R, Fontaine O, Lamberti L, et al.: Drivers of the reduction in childhood diarrhea mortality 1980–2015 and interventions to eliminate preventable diarrhea deaths by 2030. J Glob Health 2019; 9: 020801 CrossRef MEDLINE PubMed Central
2.
Posovszky C, Buderus S, Claßen M, Lawrenz B, Keller KM, Koletzko S: Acute infectious gastroenteritis in infancy and childhood. Dtsch Arztebl Int 2020; 117: 615–24 VOLLTEXT
3.
Freedman SB, Willan AR, Boutis K, Schuh S: Effect of dilute apple juice and preferred fluids vs electrolyte maintenance solution on treatment failure among children with mild gastroenteritis: a randomized clinical trial. JAMA 2016; 315: 1966–74 CrossRef MEDLINE
4.
Posovszky C, Backendorf V, Buderus S, et al.: S2k-Leitlinie „Akute infektiöse Gastroenteritis im Säuglings-, Kindes- und Jugendalter“ – AWMF Registernummer 068–003. Z Gastroenterol 2019; 57: 1077–118.
1. Black R, Fontaine O, Lamberti L, et al.: Drivers of the reduction in childhood diarrhea mortality 1980–2015 and interventions to eliminate preventable diarrhea deaths by 2030. J Glob Health 2019; 9: 020801 CrossRef MEDLINE PubMed Central
2.Posovszky C, Buderus S, Claßen M, Lawrenz B, Keller KM, Koletzko S: Acute infectious gastroenteritis in infancy and childhood. Dtsch Arztebl Int 2020; 117: 615–24 VOLLTEXT
3.Freedman SB, Willan AR, Boutis K, Schuh S: Effect of dilute apple juice and preferred fluids vs electrolyte maintenance solution on treatment failure among children with mild gastroenteritis: a randomized clinical trial. JAMA 2016; 315: 1966–74 CrossRef MEDLINE
4.Posovszky C, Backendorf V, Buderus S, et al.: S2k-Leitlinie „Akute infektiöse Gastroenteritis im Säuglings-, Kindes- und Jugendalter“ – AWMF Registernummer 068–003. Z Gastroenterol 2019; 57: 1077–118.

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