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Hypernatremic diarrheal dehydration treated with oral glucose-electrolyte solution containing 90 or 75 mEq/L of
C Guzmán1, D Pizarro, B Castillo
1Department of Medicine, Hospital Nacional de Niños, San José, Costa Rica.
Insights
Oral rehydration solutions with 90 or 75 mEq/L sodium are safe and effective for treating hypernatremic dehydration in infants. This method successfully reduced serum sodium levels without adverse neurological effects.
Area of Science:
- Pediatrics
- Clinical Nutrition
- Emergency Medicine
Background:
- Hypernatremic dehydration in infants presents a significant clinical challenge.
- Effective rehydration strategies are crucial to prevent neurological complications.
Purpose of the Study:
- To evaluate the safety and efficacy of two different oral rehydration solutions (ORS) in treating hypernatremic dehydration in infants.
- To compare the outcomes of using WHO-recommended ORS (90 mEq/L Na+) versus Pedialyte-RS (75 mEq/L Na+).
Main Methods:
- A study of 27 infants with hypernatremic dehydration (serum Na+ ≥ 150 mEq/L).
- Infants were randomized into two groups: Group A received WHO-recommended ORS (90 mEq/L Na+), and Group B received Pedialyte-RS (75 mEq/L Na+).
- Solutions were administered orally in a volume equivalent to twice the estimated fluid deficit.
Main Results:
- Both ORS formulations effectively reduced serum sodium levels within 24-48 hours.
- Mean serum sodium decreased from approximately 156 mEq/L to 144 mEq/L in both groups.
- No infants experienced seizures or persistent central nervous system dysfunction.
Conclusions:
- Slow oral administration of ORS containing either 90 mEq/L or 75 mEq/L sodium is a safe and effective treatment for hypernatremic dehydration in infants.
- These findings support the use of oral rehydration as a primary therapeutic approach in this condition.
Abstract:
Of 33 infants with hypernatremic dehydration (serum Na+ of greater than or equal to 150 mEq/L) 7 were excluded, 6 because severe alteration of the level of consciousness or shock precluded oral rehydration and 1 because he was given glucose-electrolyte solution plus water. We studied the remaining 27 infants. Twenty (group A) were treated with the World Health Organization-recommended oral rehydration solution (90 mEq/L Na+) and seven (group B) were treated with Pedialyte-RS (Abbott Laboratories Ltd.; 75 mEq/L Na+). The rehydrating solutions were administered in a volume equivalent to twice the clinically estimated fluid deficit. Initial serum sodium was 156.7 +/- 0.9 mEq/L for group A and 155.8 +/- 1.8 mEq/L for group B (mean +/- SEM). The mean time to achieve rehydration was 14.3 and 16.6 h for groups A and B, respectively. Twenty-four hours after commencing oral rehydration, serum Na+ had decreased to 144.8 +/- 1.8 mEq/L for group A and 144.5 +/- 0.9 mEq/L for group B. In two patients in group A, the serum Na+, which, had not decreased to less than 150 mEq/L at 24 h, did so at 48 h. Only in one case (group A) did the serum Na+ increase. This patient had high stool output and failed to become rehydrated after 24 h of unsuccessful oral rehydration. None of the patients had seizures or persistent CNS dysfunction. We conclude that the slow administration of oral rehydration solutions containing either 90 or 75 mEq/L Na+ is a safe and effective treatment of hypernatremic dehydration.