Salt-containing fluids, such as World Health Organization Oral Rehydration Solution (WHO ORS), commercially available ORS (e.g., Drip Drop, Ceralyte), or homemade ORS solution (see below), can be given by mouth or nasogastric tube (NGT) when IV fluids are unavailable.    

Protocol

1. Start enteral resuscitation as soon as tactically feasible using rule of 10s to determine initial fluid rate.

2. Monitor vital signs and urine output hourly (with Foley if available)

3. Titrate fluids based on urine output similar to IV-based resuscitation covered above

4. Give at least 100 mL/hr of enteral resuscitation for the first 48 hours.

5. Ensure adequate pain control and anti-nausea therapy throughout resuscitation.

6. Handling GI discomfort and GI intolerance

7. When to augment enteral resuscitation with IV fluids or switch to IV fluid resuscitation

Homemade ORS solution recipe:2

  1. 1 L clean water (sterile water is not necessary)
  2. Stir in ½ level teaspoon of salt (or 4 grams)
  3. Stir in 6 level teaspoons of sugar (or 20 grams)

*Shock: SBP <90 or absent radial pulses.

References

  1. Jones, IF; Nakarmi, K; Wild, HB, et al. Enteral resuscitation: a field-expedient treatment strategy for burn shock during wartime and in other austere settings. Eur. Burn J. 2024, 5, 23-37.
  2. Anonymous. Oral rehydration solutions: Made at home. Mother and child health and education trust, Rehydration Project.