Intravenous Dextrose during Outpatient Rehydration in Pediatric Gastroenteritis

Levy, Jason A.; Bachur, Richard G.

doi:10.1111/j.1553-2712.2007.tb02015.x

Cited by 9 publications

(2 citation statements)

References 26 publications

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“…Nevertheless, we probably enrolled some children with mild dehydration. The inclusion of this group enhances the pragmatic nature of this trial as our study population is similar to those included in other intravenous rehydration studies in developed countries,41 42 43 44 and hence are candidates for rapid intravenous rehydration. Furthermore, subgroup analysis did not show a trend towards increased benefit in children with more severe dehydration.…”

Section: Discussionmentioning

confidence: 99%

Rapid versus standard intravenous rehydration in paediatric gastroenteritis: pragmatic blinded randomised clinical trial

Freedman

Parkin

Willan

et al. 2011

BMJ

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Objective To determine if rapid rather than standard intravenous rehydration results in improved hydration and clinical outcomes when administered to children with gastroenteritis.Design Single centre, two arm, parallel randomised pragmatic controlled trial. Blocked randomisation stratified by site. Participants, caregivers, outcome assessors, investigators, and statisticians were blinded to the treatment assignment.Setting Paediatric emergency department in a tertiary care centre in Toronto, Canada.Participants 226 children aged 3 months to 11 years; complete follow-up was obtained on 223 (99%). Eligible children were aged over 90 days, had a diagnosis of dehydration secondary to gastroenteritis, had not responded to oral rehydration, and had been prescribed intravenous rehydration. Children were excluded if they weighed less than 5 kg or more than 33 kg, required fluid restriction, had a suspected surgical condition, or had an insurmountable language barrier. Children were also excluded if they had a history of a chronic systemic disease, abdominal surgery, bilious or bloody vomit, hypotension, or hypoglycaemia or hyperglycaemia.Interventions Rapid (60 mL/kg) or standard (20 mL/kg) rehydration with 0.9% saline over an hour; subsequent fluids administered according to protocol.Main outcome measures Primary outcome: clinical rehydration, assessed with a validated scale, two hours after the start of treatment. Secondary outcomes: prolonged treatment, mean clinical dehydration scores over the four hour study period, time to discharge, repeat visits to emergency department, adequate oral intake, and physician's comfort with discharge. Data from all randomised patients were included in an intention to treat analysis.Results 114 patients were randomised to rapid rehydration and 112 to standard. One child was withdrawn because of severe hyponatraemia at baseline. There was no evidence of a difference between the rapid and standard rehydration groups in the proportions of participants who were rehydrated at two hours (41/114 (36%) v 33/112 (30%); difference 6.5% (95% confidence interval −5.7% to 18.7%; P=0.32). The results did not change after adjustment for weight, baseline dehydration score, and baseline pH (odds ratio 1.8, 0.90 to 3.5; P=0.10). The rates of prolonged treatment were similar (52% rapid v 43% standard; difference 8.9%, 21% to −5%; P=0.19). Although dehydration scores were similar throughout the study period (P=0.96), the median time to discharge was longer in the rapid group (6.3 v 5.0 hours; P=0.03).Conclusions There are no relevant clinical benefits from the administration of rapid rather than standard intravenous rehydration to haemodynamically stable children deemed to require intravenous rehydration.Trail registration Clinical Trials NCT00392145.

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Section: Discussionmentioning

confidence: 99%

Rapid versus standard intravenous rehydration in paediatric gastroenteritis: pragmatic blinded randomised clinical trial

Freedman

Parkin

Willan

et al. 2011

BMJ

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“…47 It has also been demonstrated that the rate of re-presentation admissions is significantly lower in children who have glucose administered on their first presentation with gastroenteritis, independent of the volume of fluid administered. 48 These outcomes are unlikely to be because of glucose causing an improvement in hydration, but because of an effect on improving acid-base state by reversing ketosis. Further research to examine this relationship in a larger cohort is warranted.…”

Section: Box 2 Case 2: Ketoacidosis Without Hypoglycaemiamentioning

confidence: 99%

Review article: Accelerated starvation of childhood: Have I judged ketones?

Millar

Harding

2019

Emerg Medicine Australasia

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Acute ketosis is an important physiological mechanism to prevent irreversible neurological damage from hypoglycaemia during starvation, and represents a significant metabolic stress. A cohort of children adapt to relatively short periods of reduced caloric intake by generating large quantities of ketone bodies. When excessive, the gastrointestinal symptoms of starvation ketosis such as nausea and pain may create a vicious cycle that delays spontaneous resolution. The presence of ketones can be dismissed as a normal feature of childhood metabolism, sometimes even when extreme. A broader understanding of this process under the banner of ‘accelerated starvation of childhood’ is helpful for clinicians managing acute illness in children. We advocate that children less than 7 years of age with a history suggestive of accelerated starvation of childhood should be screened by emergency clinicians for ketosis using a simple and cheap bedside capillary test, even if glucose levels are greater than 2.6 mmol/L. Identification and appropriate management of ketosis may alleviate the distressing gastrointestinal symptoms associated with many minor illnesses, and potentially prevent hypoglycaemia in some children. Appropriate advice to carers may be helpful to prevent further episodes. Illustrative case examples from our own practice are provided.

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Clinical Practice: Nausea and vomiting in acute gastroenteritis: physiopathology and management

et al. 2017

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Well-designed investigations suggest that antagonists of the type 3 serotonin receptor, most frequently oral ondansetron, reduce the rate of vomiting, improve the tolerance of oral rehydration, and reduce the need for intravenous rehydration. What is Known: • Although children with gastroenteritis habitually have vomiting, current recommendations do not focus on the correction of this symptom. What is New: • Recently acquired evidence supports the prescription of ondansetron, an antagonist of the type 3 serotonin receptor, to increase the success rate of oral rehydration therapy.

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Intravenous Dextrose during Outpatient Rehydration in Pediatric Gastroenteritis

Abstract: Background: Rapid intravenous (IV) rehydration in the emergency department (ED) is required for certain children with acute gastroenteritis (AGE).

Cited by 9 publications

References 26 publications

Rapid versus standard intravenous rehydration in paediatric gastroenteritis: pragmatic blinded randomised clinical trial

Rapid versus standard intravenous rehydration in paediatric gastroenteritis: pragmatic blinded randomised clinical trial

Review article: Accelerated starvation of childhood: Have I judged ketones?

Clinical Practice: Nausea and vomiting in acute gastroenteritis: physiopathology and management

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