Clinical Impact of Rapid Intravenous Rehydration With Dextrose Serum in Children With Acute Gastroenteritis

Sendarrubias, Marta; Carrón, Marta; Molina, Juan Carlos; Marañón, Rafael; Mora, Andrea

doi:10.1097/pec.0000000000001064

Cited by 7 publications

(16 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The two included trials 18,19 were similar in size and the demographics of enrolled patients. Both trials were performed in the ED and enrolled healthy children with acute gastroenteritis needing IV rehydration as determined by the treating clinician.…”

Section: Study Characteristics and Robmentioning

confidence: 99%

“…20 The control solution in both studies was 0.9% saline (NS). The intervention group in Levy et al 18 received 5% dextrose in NS (D5NS), whereas Sendarrubias et al 19 used 2.5% dextrose in NS (SGNS). Each trial gave a 20 mL/kg bolus of study fluid, with further hydration determined by the treating clinician.…”

Section: Study Characteristics and Robmentioning

confidence: 99%

“…Each trial gave a 20 mL/kg bolus of study fluid, with further hydration determined by the treating clinician. The primary outcome in both RCTs appeared to be need for hospitalization, though no outcome was specified as primary by Sendarrubias et al 19 Both studies also reported return visits, change in dehydration scores, and laboratory end points. Further characteristics of each study, including specific inclusion and exclusion criteria, can be found in Table 1.…”

Section: Study Characteristics and Robmentioning

confidence: 99%

“…Although patients and interventions were very similar between studies, the RoB of the two trials was discrepant, with Levy et al 18 at generally low RoB and Sendarrubias et al 19 at high RoB. Details are summarized in Table 2.…”

Section: Study Characteristics and Robmentioning

confidence: 99%

“…The study by Sendarrubias et al 19 was an open label trial with unclear methods for randomization and allocation concealment. Other RoB was also rated as high because the study was stopped early after an interim analysis revealed a much lower than expected between-group difference in hospital admissions.…”

Section: Study Characteristics and Robmentioning

confidence: 99%

See 4 more Smart Citations

Does the addition of dextrose to IV crystalloid therapy provide clinical benefit in acute dehydration? A systematic review and meta-analysis

Grigsby

Herron

Hunter

2019

CJEM

View full text Add to dashboard Cite

ObjectivesIntravenous dextrose aids in the resolution of ketosis in dehydrated patients not tolerating oral glucose and is often recommended in this clinical scenario. Our aim was to determine whether the addition of dextrose to intravenous rehydration solutions results in decreased hospital admissions or other clinically important benefits among dehydrated children or adults.MethodsMEDLINE, EMBASE, Web of Science, SCOPUS, and the Cochrane Library were searched by a medical librarian from inception through November 2017. The inclusion criteria were randomized controlled trials comparing dextrose containing intravenous solutions with intravenous solutions without dextrose in patients being treated for dehydration, and not already hospitalized.ResultsThe database and bibliographies search identified 1,472 unique citations. Only two trials (N = 333) met the inclusion criteria. Both compared normal saline with solutions of dextrose in normal saline. There was no statistically significant difference in admission rates (relative risk = 0.83; 95% confidence interval = 0.62 to 1.10) or revisits (relative risk = 0.54; 95% confidence interval = 0.24 to 1.22). Heterogeneity was low (I2 = 0). No other outcome results were eligible for pooling, but neither study found differences in any clinical outcomes. No adverse events were reported in either trial.ConclusionsThe addition of dextrose to intravenous saline has not been shown to improve clinical outcomes in dehydrated children presenting to the emergency department with gastroenteritis, but the confidence intervals around the estimate of effect are wide and include the possibility of substantial benefit.

show abstract

Section: Study Characteristics and Robmentioning

confidence: 99%

Section: Study Characteristics and Robmentioning

confidence: 99%

Section: Study Characteristics and Robmentioning

confidence: 99%

Section: Study Characteristics and Robmentioning

confidence: 99%

Section: Study Characteristics and Robmentioning

confidence: 99%

See 3 more Smart Citations

Does the addition of dextrose to IV crystalloid therapy provide clinical benefit in acute dehydration? A systematic review and meta-analysis

Grigsby

Herron

Hunter

2019

CJEM

View full text Add to dashboard Cite

show abstract

Balanced crystalloid solutions versus 0.9% saline for treating acute diarrhoea and severe dehydration in children

Flórez

Sierra

Pérez‐Gaxiola

2023

Cochrane Database of Systematic Reviews

View full text Add to dashboard Cite

Background Although acute diarrhoea is a self‐limiting disease, dehydration may occur in some children. Dehydration is the consequence of an increased loss of water and electrolytes (sodium, chloride, potassium, and bicarbonate) in liquid stools. When these losses are high and not replaced adequately, severe dehydration appears. Severe dehydration is corrected with intravenous solutions. The most frequently used solution for this purpose is 0.9% saline. Balanced solutions (e.g. Ringer's lactate) are alternatives to 0.9% saline and have been associated with fewer days of hospitalization and better biochemical outcomes. Available guidelines provide conflicting recommendations. It is unclear whether 0.9% saline or balanced intravenous fluids are most effective for rehydrating children with severe dehydration due to diarrhoea. Objectives To evaluate the benefits and harms of balanced solutions for the rapid rehydration of children with severe dehydration due to acute diarrhoea, in terms of time in hospital and mortality compared to 0.9% saline. Search methods We used standard, extensive Cochrane search methods. The latest search date was 4 May 2022. Selection criteria We included randomized controlled trials in children with severe dehydration due to acute diarrhoea comparing balanced solutions, such as Ringer's lactate or Plasma‐Lyte with 0.9% saline solution, for rapid rehydration. Data collection and analysis We used standard Cochrane methods. Our primary outcomes were 1. time in hospital and 2. mortality. Our secondary outcomes were 3. need for additional fluids, 4. total amount of fluids received, 5. time to resolution of metabolic acidosis, 6. change in and the final values of biochemical measures (pH, bicarbonate, sodium, chloride, potassium, and creatinine), 7. incidence of acute kidney injury, and 8. adverse events. We used GRADE to assess the certainty of the evidence. Main results Characteristics of the included studies We included five studies with 465 children. Data for meta‐analysis were available from 441 children. Four studies were conducted in low‐ and middle‐income countries and one study in two high‐income countries. Four studies evaluated Ringer's lactate, and one study evaluated Plasma‐Lyte. Two studies reported the time in hospital, and only one study reported mortality as an outcome. Four studies reported final pH and five studies reported bicarbonate levels. Adverse events reported were hyponatremia and hypokalaemia in two studies each. Risk of bias All studies had at least one domain at high or unclear risk of bias. The risk of bias assessment informed the GRADE assessments. Primary outcomes Compared to 0.9% saline, the balanced solutions likely result in a slight reduction of the time in hospital (mean difference (MD) −0.35 days, 95% conf...

show abstract

Recommendation document on rapid intravenous rehydration in acute gastroenteritis

Mora-Capín

López-López

Guibert-Zafra

et al. 2022

Anales de Pediatría (English Edition)

View full text Add to dashboard Cite

Clinical Impact of Rapid Intravenous Rehydration With Dextrose Serum in Children With Acute Gastroenteritis

Abstract: Our results enabled us to conclude that there were no significant differences in hospital admission or return visits to the emergency department between children with dehydration secondary to acute gastroenteritis.

Cited by 7 publications

References 15 publications

Does the addition of dextrose to IV crystalloid therapy provide clinical benefit in acute dehydration? A systematic review and meta-analysis

Does the addition of dextrose to IV crystalloid therapy provide clinical benefit in acute dehydration? A systematic review and meta-analysis

Balanced crystalloid solutions versus 0.9% saline for treating acute diarrhoea and severe dehydration in children

Recommendation document on rapid intravenous rehydration in acute gastroenteritis

Contact Info

Product

Resources

About