Oral rehydration therapy in emergency departments

Abstract

Objective: To describe the management of acute diarrhea in emergency departments with emphasis on the type of hydration and exploring factors associated with prescription of oral rehydration therapy vs. intravenous rehydration therapy for children with dehydration that is not severe. Methods:This was a descriptive study conducted from January to May of 2008 observing case management of children with non-severe dehydration due to acute diarrhea at two emergency units (A and B) in Recife, Brazil. Emergency unit B is affiliated to a teaching hospital. The primary variables were: 1) type of hydration prescribed, 2) associations with the characteristics of the children and emergency department (A or B).Results: A total of 166 children took part in the study. The rates of prescription of oral rehydration therapy were similar at both services (32.2 vs. 31.6% for A and B, respectively, p = 0.93) and were lower for cases with moderate dehydration (17.6%) compared with mild dehydration (35.6%) (p = 0.07). Neither service had a dedicated oral rehydration room.Conclusions: Most children were given intravenous rehydration therapy, especially those with moderate dehydration, without differences according type of service: whether a teaching institution or healthcare provider only.J Pediatr (Rio J). 2011;87(2):175-179: Emergency medical services, fluid therapy, gastroenteritis, child. ResumoObjetivo: Descrever o manejo da diarreia aguda na emergência, explorando fatores associados à prescrição da terapia de reidratação oral (TRO) versus terapia de reidratação venosa (TRV) para crianças com desidratação não grave.Métodos: Estudo descritivo conduzido de janeiro a maio de 2008 em duas unidades de emergência em Recife (PE), A e B, sendo a emergência B vinculada a um hospital-escola, com observação do manejo de crianças com desidratação não grave por diarreia aguda. As principais variáveis foram: 1) tipo de hidratação prescrito; 2) associação com características das crianças e local.Resultados: Cento e sessenta e seis crianças participaram do estudo. A indicação de TRO foi semelhante nos dois serviços (32,2 versus 31,6% em A e B, respectivamente, p = 0,93) e menor para os casos com desidratação moderada (17,6%) em relação à forma leve (35,6%), p = 0,07. Não havia sala de reidratação oral nos serviços. Conclusões:A maioria das crianças não fez uso de TRO, principalmente aquelas com desidratação moderada, não havendo diferença em relação ao tipo de serviço, assistencial ou de ensino.J Pediatr (Rio J). 2011;87(2):175-179: Serviços médicos de emergência, terapia de reidratação oral, gastroenterite, criança.

Strong community-based health systems and national governance predict improvement in coverage of oral rehydration solution (ORS): a multilevel longitudinal model

“…care [13][14][15]; and, (4) education among medical professionals and/or caregivers [9,10,13,[17][18][19][20][21][22][23][24][25]. Although the studies identify predictors of ORS use across several countries, generalizable knowledge about the predictors of ORS use globally is limited, and systematic literature reviews have highlighted this gap in knowledge [3,13,14].…”

Disease Control Priorities, Third Edition (Volume 2): Reproductive, Maternal, Newborn, and Child Health

“…Parental expectations of treatment are also influenced by previous experience. For example, Brazilian physicians recommend intravenous fluids for most children with moderate dehydration, which sends the wrong message to caregivers about professionals' trust in the efficacy of ORS (Costa and Silva 2011). Community-based initiatives, such as home visits by community health workers, and community-based delivery mechanisms have increased the use of ORS by an average of 160 percent, with an 80 percent increase in the use of zinc-ORS, as well as a 75 percent reduction in antibiotic use (Das, Lassi, and others 2013).…”