Diluted APPLE JUICE for mild dehydration in kids
As a community pharmacist, parents may ask you about using apple juice for dehydration in kids. We usually discourage using juice, sports drinks, water, broths, or soda for dehydration because of concerns they may not replace lost electrolytes and the sugar in some products can worsen diarrhea. But commercial electrolyte solutions (ORS, Pedialyte, etc) may be less convenient due to bad taste.
Recent evidence suggests giving half-strength apple juice in the emergency room followed by fluids at home works at least as well as electrolyte solutions for mild dehydration in kids with gastroenteritis. And the juice doesn't seem to cause more diarrhea. Consider diluted apple juice an alternative to commercial electrolyte solutions for kids with gastroenteritis and mild dehydration to help replace fluids and prevent more serious dehydration. But continue to refer kids with more severe symptoms (no tears, dry mouth, lack of urination, etc).
Tell parents to start rehydration promptly if kids have diarrhea or vomiting, dehydration can progress quickly in young kids. Advise them to start by giving about 5 mL every 5 minutes, then increasing slowly as tolerated. For mild dehydration, suggest giving 60 to 120 mL of fluids after each bout of diarrhea or vomiting for kids under 10 kg or 120 to 240 mL for heavier kids. Discourage using homemade solutions, especially in young kids. Mixing or dosing errors could lead to serious electrolyte problems.
References
- King CK, Glass R, Bresee JS, Duggan C; Centers for Disease Control and Prevention. Managing acute gastroenteritis among children: oral rehydration, maintenance, and nutritional therapy. MMWR Recomm Rep. 2003 Nov 21;52(RR-16):1-16.
- 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 May 10;315(18):1966-74.