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Intravenous dextrose during outpatient rehydration in pediatric gastroenteritis
Jason A Levy1, Richard G Bachur
1Division of Emergency Medicine, Children's Hospital Boston, Harvard Medical School, Boston, MA, USA. jason.levy@childrens.harvard.edu
Insights
Higher IV dextrose doses in children with acute gastroenteritis and dehydration are linked to fewer return visits requiring admission. This finding suggests optimal dextrose administration may improve outcomes and reduce hospital readmissions.
Area of Science:
- Pediatric Emergency Medicine
- Gastroenterology
- Clinical Nutrition
Background:
- Acute gastroenteritis (AGE) in children often necessitates intravenous (IV) rehydration in emergency departments (ED).
- Understanding factors influencing return visits with admission (RVA) is crucial for optimizing pediatric care.
Purpose of the Study:
- To investigate the association between IV dextrose administration and RVA in children with AGE and dehydration.
- To identify other clinical, laboratory, and treatment parameters linked to RVA.
Main Methods:
- A case-control study involving children aged 6 months to 6 years with AGE and dehydration receiving IV rehydration.
- Cases were defined as patients with RVA within 72 hours; controls had no RVA.
- Analysis focused on IV dextrose amount and other clinical/treatment factors.
Main Results:
- Children with RVA received significantly less IV dextrose (399 mg/kg) compared to controls (747 mg/kg).
- No IV dextrose increased RVA odds by 3.9 times; each 500 mg/kg increase in dextrose reduced RVA likelihood by 1.9 times.
- Shorter symptom duration (≤1 day) was associated with higher RVA likelihood.
Conclusions:
- Increased IV dextrose administration is associated with a reduced incidence of return visits requiring admission in pediatric AGE.
- Dextrose dosage appears to be a significant factor in preventing readmission for dehydrated children with gastroenteritis.
Background:
Rapid intravenous (IV) rehydration in the emergency department (ED) is required for certain children with acute gastroenteritis (AGE).
Objectives:
To determine whether the amount of IV dextrose administered is related to a return visit with admission (RVA) in children with AGE and dehydration, and to determine which clinical, laboratory, and treatment parameters are associated with an RVA.
Methods:
The investigators performed a case control study of children aged 6 months to 6 years who presented to an urban ED with AGE and dehydration and who received IV rehydration before discharge from the ED. Dehydration was defined a priori on the basis of parameters used in prior studies. Cases were defined as those patients who had an RVA within 72 hours of an original visit for ongoing symptoms. Controls were defined as those patients who met inclusion criteria who did not have an RVA. The authors studied whether the amount of IV dextrose administered at the initial visit was related to an RVA as well as which other clinical and treatment parameters were associated with an RVA.
Results:
A total of 56 cases and 112 controls were studied. Patients who had an RVA received significantly less IV dextrose (mean: 399 mg/kg vs. 747 mg/kg, p < 0.001) than those who did not have an RVA. Patients who received no IV dextrose had 3.9 times greater odds of having a return visit with admission than those who received some dextrose. Controlling for fluid volume, the amount of dextrose administered remained statistically significant by logistic regression; for every 500 mg/kg of IV dextrose administered, the patient was 1.9 times less likely to have an RVA. Patients with length of symptoms less than or equal to one day were more likely to have an RVA than were those with symptom length of two or more days. No other historical or physical exam findings or laboratory parameters (including mean serum bicarbonate) were associated with a return visit requiring admission.
Conclusions:
Administration of larger amounts of IV dextrose is associated with reduced return visits requiring admission in children with gastroenteritis and dehydration.
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