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A Novel Approach for the Administration of Medications and Fluids in Emergency Scenarios and Settings
Published on: November 9, 2016
Alternative rehydration methods: a systematic review and lessons for resource-limited care
Shada Rouhani1, Laura Meloney, Roy Ahn
1Harvard Affiliated Emergency Medicine Residency Program, Brigham and Women's Hospital and Massachusetts General Hospital, Boston, MA 02114, USA. srouhani@partners.org
Pediatrics
|February 16, 2011
Summary
Nasogastric rehydration is effective for moderate-to-severe dehydration, and intraosseous rehydration is a viable alternative when IV access is difficult. Further research is needed for other non-oral, non-IV methods in pediatric dehydration management.
Area of Science:
- Pediatric emergency medicine
- Global child health
- Fluid and electrolyte balance
Background:
- Dehydration is a leading cause of child mortality globally, especially in resource-limited settings.
- Oral and intravenous (IV) rehydration are established treatments for non-severe dehydration.
- Effectiveness of alternative rehydration methods in children remains less understood.
Purpose of the Study:
- To systematically review the effectiveness of non-oral and non-intravenous rehydration techniques in pediatric patients.
- To compare alternative rehydration methods beyond oral and IV routes.
Main Methods:
- Searched Medline, Cochrane, Global Health, Embase, and CINAHL databases up to December 2009.
- Included human pediatric studies on intraosseous (IO), nasogastric (NG), intraperitoneal (IP), subcutaneous (hypodermoclysis), and rectal (proctoclysis) rehydration.
- Focused on studies reporting effectiveness or complications.
Main Results:
- Identified 38 relevant articles: 12 on NG, 16 on IO, 7 on IP, 3 on subcutaneous, and 0 on rectal rehydration.
- Nasogastric (NG) rehydration demonstrated effectiveness comparable to IV for moderate-to-severe dehydration.
- Intraosseous (IO) rehydration was found effective and accessible, though based on limited randomized trials.
- Intraperitoneal (IP) and subcutaneous rehydration showed some potential benefits but lacked robust evidence.
Conclusions:
- Nasogastric (NG) rehydration is recommended as a second-line therapy after oral rehydration, particularly in resource-limited areas.
- Intraosseous (IO) rehydration is a practical alternative when intravenous access is challenging.
- Further research is necessary to validate intraperitoneal (IP) and subcutaneous rehydration for pediatric use.
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