Safe oral rehydration of hypertonic dehydration

Area of Science:

• Pediatrics
• Gastroenterology
• Emergency Medicine

Background:

• Severe hypernatremic dehydration in infants, often caused by acute gastroenteritis, traditionally requires intravenous fluid resuscitation.
• Oral rehydration solutions (ORS) are widely used for milder dehydration, but their efficacy in severe cases with hypernatremia is less established.

Purpose of the Study:

• To evaluate the safety and efficacy of oral glucose electrolyte solution for rehydrating infants with severe hypernatremic dehydration.
• To compare the rate of natremia decrease and incidence of seizures with oral versus intravenous rehydration methods.

Main Methods:

• Eighteen infants with severe hypernatremic dehydration were treated with an oral glucose electrolyte solution (60 mmol sodium/L) at a mean rate of 120 ml/kg/24 h.
• Plasma sodium levels and occurrence of seizures were monitored throughout the treatment period.
• Outcomes were compared to a historical group of 26 infants treated intravenously for similar conditions.

Main Results:

• All 18 infants were safely treated with oral therapy alone, with no observed convulsions during treatment.
• The mean decrease in natremia was 0.32 mmol/L/h, which is comparable to or favorable compared to intravenous treatment outcomes.
• No other adverse effects were noted during the oral rehydration process.

Conclusions:

• Oral glucose electrolyte solutions, administered at a slow rate (e.g., 120 ml/kg/24 h), can effectively and safely replace intravenous fluids in most infants with severe hypernatremic dehydration.
• A slow decrease in plasma sodium (less than 0.5 mmol/L/h) appears crucial in preventing seizures during rehydration therapy.
• This study supports the expanded use of oral rehydration therapy in pediatric emergency settings for severe hypernatremic dehydration.