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Rapid Intravenous Rehydration Therapy in Children With Acute Gastroenteritis: A Systematic Review
Fatihi Hassan Soliman Toaimah1, Hala Mohammad Fathi Mohammad
1From the *Division of Pediatric Emergency Medicine, Department of Pediatrics, Hamad Medical Corporation, Doha; and †Department of Clinical Pediatrics, Weill Cornell Medical College, Al Rayyan, Qatar; and ‡Department of Pediatrics, Zagazig University Hospital, Zagazig; and §Department of Clinical Pharmacology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt.
Insights
Rapid intravenous (IV) rehydration for pediatric gastroenteritis does not appear superior to standard methods. Standard IV fluid administration appears sufficient, with rapid rehydration potentially leading to longer discharge times and higher readmission rates.
Area of Science:
- Pediatric Emergency Medicine
- Gastroenterology
- Clinical Trials
Background:
- Intravenous (IV) rehydration is a common emergency department treatment for pediatric gastroenteritis.
- Current practices in IV fluid volume and rate vary significantly.
- This review assesses the efficacy of rapid IV rehydration versus standard methods in children.
Purpose of the Study:
- To compare the effectiveness of rapid IV rehydration with standard IV rehydration in children diagnosed with gastroenteritis.
- To analyze outcomes such as successful rehydration, oral fluid tolerance, time to discharge, and emergency department revisits.
Main Methods:
- Systematic literature search of MEDLINE, EMBASE, and CENTRAL databases (up to 2014).
- Inclusion of randomized controlled trials (RCTs) evaluating rapid IV rehydration in pediatric gastroenteritis.
- Analysis of data from 3 eligible RCTs involving 464 participants.
Main Results:
- Successful rehydration and oral fluid tolerance rates (69%-100%) were similar between rapid and standard IV rehydration groups.
- Rapid IV rehydration was associated with potentially longer time-to-discharge (2-6 hours) compared to standard methods (2-5 hours).
- Higher emergency department revisit rates were observed in the rapid IV rehydration group (3%-16%) versus standard (5%-14%).
Conclusions:
- Standard volume IV rehydration (1-4 hours) followed by oral or maintenance IV fluids is generally sufficient for children with gastroenteritis.
- Current evidence does not support the superiority of rapid, large-volume IV rehydration (60 mL/kg/h) over standard rates (20 mL/kg/h).
- Further research is required to determine an optimal IV rehydration protocol for pediatric gastroenteritis.
Background:
Rapid intravenous (IV) rehydration is commonly used for the management of pediatric gastroenteritis in the emergency department. The current practice shows wide variation in the volume and rate of rapid IV hydration. The aim of this review was to assess the efficacy of rapid IV rehydration compared with standard method in children with gastroenteritis.
Method:
MEDLINE (1946-2014), EMBASE (1974-2014), and CENTRAL via the Cochrane Library (Issue 8, 2014) were systematically searched to identify eligible studies. Inclusion criteria were randomized controlled trials of rapid IV rehydration in children with gastroenteritis.
Results:
A total of 1513 articles were retrieved, and our inclusion criteria were met by 3 studies, with a total of 464 participants. The percentage of children who were successfully rehydrated and tolerated oral fluids at 2 to 4 hours after starting IV fluid therapy ranged from 69% to 100% in both rapid IV rehydration and standard method. Time to discharge ranged from 2 to 6 hours (rapid rehydration) versus 2 to 5 hours (standard rehydration). Emergency department revisits ranged from 3% to 16% (rapid rehydration) versus 5% to 14% (standard). Summarized results suggested that rapid IV rehydration may be associated with longer time-to-discharge and higher readmission rates. The new evidence fails to demonstrate superiority of large-volume (60 mL/kg/h) over standard (20 mL/kg/h) IV rehydration.
Conclusions:
Standard volume IV rehydration for 1 to 4 hours followed by oral hydration or maintenance IV fluids seems sufficient for most children with gastroenteritis requiring IV fluid administration. However, more evidence is needed to establish an optimal IV rehydration regimen.
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