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Randomised controlled trial comparing oral and intravenous rehydration therapy in children with diarrhoea
1Department of Gastroenterology, Royal Children's Hospital, Parkville, Victoria, Australia.
Insights
Oral rehydration is a safe and effective treatment for moderate dehydration in children with gastroenteritis. This study found oral rehydration comparable to intravenous methods with fewer serious complications.
Area of Science:
- Pediatrics
- Gastroenterology
- Infectious Diseases
Background:
- Gastroenteritis is a common cause of dehydration in children.
- Moderate dehydration requires effective and safe rehydration strategies.
- Oral rehydration therapy (ORT) is a widely recommended intervention.
Purpose of the Study:
- To evaluate the effectiveness of oral rehydration in children with moderate dehydration.
- To compare complications between oral and intravenous rehydration treatments.
- To assess the safety and efficacy of ORT in pediatric gastroenteritis.
Main Methods:
- Randomized controlled trial involving 111 children aged 3-36 months.
- Comparison of oral rehydration fluid (given orally or via nasogastric tube) versus intravenous rehydration.
- Outcomes included rehydration success/failure, vomiting, stool frequency, and time to rehydration.
Main Results:
- Oral rehydration failed in 3.8% of children; intravenous treatment had no failures.
- Vomiting was significantly more common in the oral rehydration group (52% vs. 22%).
- No significant difference in stool frequency; no serious complications reported for either group.
Conclusions:
- Oral rehydration is a safe and effective treatment for moderately dehydrated children with gastroenteritis.
- ORT offers a viable alternative to intravenous therapy in this population.
- Further research may explore strategies to mitigate vomiting during ORT.
Objective:
To determine the effectiveness of oral rehydration in children with moderate dehydration caused by gastroenteritis, and to compare the complications of oral and intravenous treatment.
Design:
Randomised controlled trial.
Setting:
Emergency department and infectious diseases ward in a large urban teaching hospital.
Patients:
111 children aged 3-36 months who had been previously healthy, had had diarrhoea for seven days or less, had clinical signs of dehydration, and were not in shock. Six children were withdrawn because the diagnosis was incorrect (four in oral group, two in intravenous group) and one (oral group) was withdrawn at her parents' request.
Interventions:
Oral rehydration fluid was given by mouth or nasogastric tube, or both to 52 children. The remaining 52 received intravenous rehydration fluids but were allowed to drink.
Main Outcome Measures:
Success or failure of rehydration. Number of times child vomited or passed stool after starting treatment. Time taken to rehydrate.
Results:
Oral treatment failed in two children (failure rate 3.8%, upper 95% confidence limit 11.6%) and intravenous treatment in none. Vomiting was more common in the oral group (p less than 0.01): 26 of 50 children (52%) in the oral group and 11 of 50 (22%) in the intravenous group vomited during rehydration. There was no significant difference between the two treatment groups in the number of stools passed during rehydration (p = 0.09). None of the children had serious complications of treatment.
Conclusion:
Rehydration by mouth or nasogastric tube is a safe and effective treatment for moderately dehydrated children with gastroenteritis.