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[Fast intravenous rehydration with 90 mmol/L of sodium in dehydrated children with diarrhea]
F C Ferrero1, M F Ossorio, L E Voyer
14a. Cátedra de Pediatría, Universidad de Buenos Aires, Hospital General de Niños Pedro de Elizalde, Argentina.
Insights
Rapid intravenous rehydration (RIR) effectively treated moderate dehydration in infants when oral rehydration therapy (ORT) was not feasible. This safe and well-tolerated method facilitated early hospital discharge for pediatric patients.
Area of Science:
- Pediatrics
- Emergency Medicine
- Clinical Nutrition
Context:
- Infants with moderate dehydration often require alternative rehydration strategies.
- Oral rehydration therapy (ORT) may be contraindicated or ineffective in some cases.
- Rapid intravenous rehydration (RIR) offers a potential solution for these challenging pediatric cases.
Purpose:
- To evaluate the safety and efficacy of rapid intravenous rehydration (RIR) in infants with moderate dehydration.
- To assess the tolerance and outcomes of RIR in a pediatric population.
- To determine if RIR facilitates early hospital discharge.
Summary:
- Twenty-two infants with moderate dehydration, unresponsive or intolerant to ORT, received RIR using a standard solution (90 mmol/L sodium, 111 mmol/L glucose).
- RIR was administered at 15-20 mL/kg/hour until complete rehydration, requiring an average of 89.5 mL/kg over 5.1 hours.
- All infants achieved rehydration (6.5% weight gain), tolerated early refeeding, and showed improved acid-base balance without hypernatremia, suggesting RIR is safe and effective.
Impact:
- RIR is a well-tolerated and effective treatment for moderate dehydration in infants when ORT fails or is contraindicated.
- This rehydration method can lead to positive clinical outcomes, including improved acid-base status and successful refeeding.
- Successful RIR may enhance the possibility of early hospital discharge for pediatric patients, optimizing resource utilization.
Abstract:
Twenty-two infants with moderate dehydration due to diarrhea in whom oral rehydration therapy (ORT) was contraindicated or who failed to respond to this method of therapy were treated with rapid intravenous rehydration (RIR). Clinical signs of dehydration without shock allowed us to estimate 5% to 10% of weight loss. Patients were 11 days to 19 months old, and 9 of them were undernourished. A standard solution containing 90 mmol/L sodium, 80 mmol/L chloride, 30 mmol/L bicarbonate, 20 mmol/L potassium and 111 mmol/L glucose was used for all patients. The IV infusion was maintained until the rehydration was completed at a rate of 15 to 20 mL/kg/hour. Complete rehydration was successfully achieved in all patients. A total of 89.5 +/- 25.0 mL/kg (mean +/- SD) was needed and the duration of the IV infusion was 5.1 +/- 1.6 hours. Weight gain achieved was 6.5 +/- 1.6%. None of the patients developed hypernatremia following treatment. The initial base deficit, -9.5 +/- 6.6, was reduced to -3.5 +/- 2.9. All of the patients tolerated refeeding immediately after completion of the IV infusion. Our study suggests that this modality of rehydration is well tolerated, safe and effective and enhances the possibility of an early hospital discharge.