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Published on: November 9, 2016
Comparison of ultrarapid and rapid intravenous hydration in pediatric patients with dehydration
1Department of Pediatrics, Division of Emergency and Transport Medicine, Children's Hospital Los Angeles, University of Southern California and the Keck School of Medicine, Los Angeles, CA, USA. anager@chla.usc.edu
Insights
Ultrarapid intravenous (IV) hydration for 1 hour is a safe and effective alternative to standard 3-hour IV hydration for pediatric acute gastroenteritis. This faster method improves emergency department efficiency.
Area of Science:
- Pediatric Emergency Medicine
- Gastroenterology
- Critical Care
Background:
- Acute gastroenteritis is a common cause of dehydration in children.
- Moderate dehydration often requires intravenous (IV) fluid resuscitation.
- Current IV hydration protocols can be time-consuming.
Purpose of the Study:
- To compare the efficacy of ultrarapid (1-hour) versus standard (3-hour) IV hydration in pediatric patients with acute gastroenteritis and moderate dehydration.
- To assess the impact on rehydration success, patient outcomes, and emergency department throughput.
Main Methods:
- A randomized pilot study involving pediatric patients (3-36 months) with moderate dehydration after failing oral rehydration.
- Patients received either ultrarapid (50 mL/kg over 1 hour) or standard (50 mL/kg over 3 hours) normal saline infusion.
- Outcomes included rehydration success, return visits, hospital admissions, and laboratory values.
Main Results:
- No significant difference in rehydration success or serious complications between groups.
- Ultrarapid hydration showed a trend towards fewer treatment failures and hospitalizations.
- Both hydration methods were well-tolerated with similar laboratory results.
Conclusions:
- Ultrarapid IV hydration is a potentially efficacious alternative to standard 3-hour hydration for pediatric gastroenteritis.
- This approach may improve emergency department efficiency and patient flow.
- Further research is warranted to confirm these preliminary findings.
Objective:
The purpose of this study is to test the efficacy of ultrarapidly infused vs rapidly infused intravenous (IV) hydration in pediatric patients with acute gastroenteritis and moderate dehydration.
Methods:
Patients 3 to 36 months, with vomiting and/or diarrhea and moderate dehydration, were eligible. Subjects were randomly assigned "ultra" (50 mL/kg normal saline for 1 hour) vs "standard" (50 mL/kg normal saline for 3 hours) after failing an oral fluid challenge. Subjects were weighed and had serum electrolyte testing, and urine was obtained before/after IV hydration. Input/output and vital signs were tabulated hourly during the study. Subjects were discharged after fulfilling specified criteria. A follow-up questionnaire was completed 24 hours after discharge. Comparison data included success and timing of rehydration, number of patients who returned and/or were admitted, output during the rehydration period, laboratory differences, and serious complications.
Results:
Eighty-eight of 92 subjects completed the study: 45 ultra and 43 standard. Four patients failed treatment (1 ultra and 3 standard), were hospitalized, and excluded from the study. Groups were similar regarding sex, days of symptoms, episodes of vomiting/diarrhea before treatment, capillary refill time, tears, and vital signs and laboratory results. No subject had evidence of serious complications. Ninety-one percent of subjects completed the follow-up questionnaire. Seven ultra and 6 standard subjects returned. Six ultra subjects received oral fluid, one received IV fluid, and all were discharged. Five standard subjects received oral fluid, one received IV fluid, and all were discharged.
Conclusion:
Based on this pilot study, ultrarapid hydration for 1 hour preliminarily appears to be an efficacious alternative to standard rapid hydration for 3 hours and improves emergency department throughput time.
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