Plasmalyte versus saline solution for rapid rehydration in gastroenteritis: prospective observational study

General recommendations suggest using physiological saline solution (PSS) in the guidelines for rapid intravenous rehydration (RIR) in children with dehydration secondary to acute gastroenteritis, although the use of a balanced crystalloid solution, such as Plasmalyte (PLA), could be more beneficial since its composition is more similar to plasma.

Single-center prospective and observational study with two treatment groups. The sample consisted of patients aged 3 months to 13 years with mild to moderate dehydration in whom RIR was indicated based on the SEUP guideline, who visited the pediatric emergency department (PED) of a tertiary care hospital. A total of 40mL/kg of solution (PLA or PSS, at the discretion of the physician in charge) supplemented with 2.5% glucose was administered over 2h. We collected data on clinical and laboratory variables before and after RIR, length of stay, need for readmission and adverse events.

A total of 169 patients (50.9% male; median age, 40 months) completed the study. Of these, 49.1% received PLA. The group that received PLA showed greater improvement in bicarbonate levels (3.7mmol/L vs 1.4mmol/L; P < .001) and a lower increase in chloride levels (0.9mmol/L vs 4.1mmol/L; P < .001). There were no differences in clinical dehydration scales, length of stay in PED or need for readmission. No serious adverse events were observed.

The use of PLA in the RIR protocol was effective and safe, showing greater recovery of bicarbonate with lesser elevation of chloride levels compared to the use of PSS. However, we did not find differences in clinical outcomes.