Rapid Intravenous Rehydration Therapy in Children With Acute Gastroenteritis

Toaimah, Fatihi Hassan Soliman; Mohammad, Hala M.F.

doi:10.1097/pec.0000000000000708

Cited by 16 publications

(16 citation statements)

References 12 publications

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“…Potential weaknesses include the possibility of undetected unpublished work, non-inclusion of non-English studies and the heterogeneity in identified studies precluding a formal meta-analysis to augment the systematic review. Another review has recently been published with similar conclusions for management of AGE in emergency rooms in high income (HMIC) settings [ 22 ]. However, our review sought to address the global burden of disease and treatment challenges for AGE rehydration and, given the paucity of data, we can only conclude that robust trials are long overdue.…”

Section: Discussionmentioning

confidence: 97%

Rapid intravenous rehydration of children with acute gastroenteritis and dehydration: a systematic review and meta-analysis

et al. 2018

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BackgroundThe World Health Organization (WHO) recommends rapid intravenous rehydration, using fluid volumes of 70-100mls/kg over 3–6 h, with some of the initial volume given rapidly as initial fluid boluses to treat hypovolaemic shock for children with acute gastroenteritis (AGE) and severe dehydration. The evidence supporting the safety and efficacy of rapid versus slower rehydration remains uncertain.MethodsWe conducted a systematic review of randomised controlled trials (RCTs) on 11th of May 2017 comparing different rates of intravenous fluid therapy in children with AGE and moderate or severe dehydration, using standard search terms. Two authors independently assessed trial quality and extracted data. Non-RCTs and non-English articles were excluded. The primary endpoint was mortality and secondary endpoints included adverse events (safety) and treatment efficacy.Main resultsOf the 1390 studies initially identified, 18 were assessed for eligibility. Of these, 3 studies (n = 464) fulfilled a priori criteria for inclusion; most studied children with moderate dehydration and none were conducted in resource-poor settings. Volumes and rates of fluid replacement varied from 20 to 60 ml/kg given over 1-2 h (fast) versus 2-4 h (slow). There was substantial heterogeneity in methodology between the studies with only one adjudicated to be of high quality. There were no deaths in any study. Safety endpoints only identified oedema (n = 6) and dysnatraemia (n = 2). Pooled analysis showed no significant difference between the rapid and slow intravenous rehydration groups for the proportion of treatment failures (N = 468): pooled RR 1.30 (95% CI: 0.87, 1.93) and the readmission rates (N = 439): pooled RR 1.39 (95% CI: 0.68, 2.85).ConclusionsDespite wide implementation of WHO Plan C guideline for severe AGE, we found no clinical evaluation in resource-limited settings, and only limited evaluation of the rate and volume of rehydration in other parts of the world. Recent concerns over aggressive fluid expansion warrants further research to inform guidelines on rates of intravenous rehydration therapy for severe AGE.Electronic supplementary materialThe online version of this article (10.1186/s12887-018-1006-1) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 97%

Rapid intravenous rehydration of children with acute gastroenteritis and dehydration: a systematic review and meta-analysis

et al. 2018

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“…Refer to the correction of dehydration using a large volume of fluids over a relatively shorter time (50-60 ml/kg/hour). Ultra-rapid IV rehydration may be associated with electrolyte abnormalities and longer hospital stay or delayed discharge and therefore is not recommended [29,30].…”

Section: Rapid Large-volume IV Rehydrationmentioning

confidence: 99%

Dehydration

Toaimah¹,

Manthattil²

2020

Perspective of Recent Advances in Acute Diarrhea

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Dehydration is one of the common presentations to the general practice or emergency departments (EDs) in children having acute gastroenteritis (AGE). Assessing the severity of dehydration remains a challenge among physicians, and the dehydration scales currently available are inaccurate. The correct assessment of dehydration is the basis for proper management of acute diarrhea in children. Rapid oral rehydration therapy (ORT) over 3-4 hours remains the cornerstone treatment of AGE with dehydration. It is advisable to reserve intravenous (IV) rehydration therapy for patients with severe dehydration and for those who fail ORT. Rapid standardvolume (20 ml/kg/hour) IV bolus of isotonic solution for 1-4 hours followed by oral fluid intake or maintenance IV fluids seems to be adequate for most cases requiring IV rehydration. A minority of patients may be presented with complications due to diarrheal dehydration, such as dyselectrolytemia, which requires careful calculation of fluids and electrolytes with slow correction approach.

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“…Eine weitere prospektiv randomisierte Studie zeigte weder für die Verwendung von Ringer-Laktat noch einer 0,9 %igen NaCl-Lösung bei schwer dehydrierten Kindern eine Entwicklung von Hyper-oder Hyponatriämien [128]. [129,130]. Die Autoren empfehlen eine Rehydration mit 20 ml/kg/h über 1 bis 4 Stunden gefolgt von oraler Hydrierung bzw.…”

Section: Ii28 Empfehlungunclassified

S2k-Leitlinie „Akute infektiöse Gastroenteritis im Säuglings-, Kindes- und Jugendalter“ – AWMF Registernummer 068-003

et al. 2019

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Leitlinie der Gesellschaft für pädiatrische Gastroenterologie und Ernährung (GPGE) gemeinsam mit der Deutschen Gesellschaft für Kinder-und Jugendmedizin (DGKJ), dem Berufsverband der Kinder-und Jugendärzte (BVKJ), der Deutschen Gesellschaft für pädiatrische Infektiologie (DGPI), der österreichischen Gesellschaft für Kinder-und Jugendheilkunde (ÖGKJ), der Deutschen Gesellschaft für Gastroenterologie, Verdauungs-und Stoffwechselstörungen (DGVS), dem Arbeitskreis "Krankenhaus & Praxishygiene" der AWMF und der Deutschen Gesellschaft für Pflegewissenschaft e. V. (DGPW)

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Rapid Intravenous Rehydration Therapy in Children With Acute Gastroenteritis

Abstract: Standard volume IV rehydration for 1 to 4 hours followed by oral hydration or maintenance IV fluids seems sufficient for most children with gastroenteritis requiring IV fluid administration. However, more evidence is needed to establish an optimal IV rehydration regimen.

Cited by 16 publications

References 12 publications

Rapid intravenous rehydration of children with acute gastroenteritis and dehydration: a systematic review and meta-analysis

Rapid intravenous rehydration of children with acute gastroenteritis and dehydration: a systematic review and meta-analysis

Dehydration

S2k-Leitlinie „Akute infektiöse Gastroenteritis im Säuglings-, Kindes- und Jugendalter“ – AWMF Registernummer 068-003

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