Related Experiment Videos
Outpatient rapid intravenous rehydration to correct dehydration and resolve vomiting in children with acute
1Department of Pediatric Emergency Medicine, Children's Health Care-St Paul, Minnesota, USA.
Insights
Outpatient rapid intravenous rehydration effectively corrects dehydration and resolves vomiting in children with acute gastroenteritis. Most children tolerated oral fluids post-treatment, indicating a safe and effective outpatient management strategy.
Area of Science:
- Pediatric Emergency Medicine
- Gastroenterology
- Clinical Hydration Therapy
Background:
- Acute gastroenteritis is a common cause of dehydration in children.
- Vomiting associated with gastroenteritis can lead to significant fluid loss and electrolyte imbalances.
- Effective rehydration strategies are crucial for managing pediatric patients with gastroenteritis.
Purpose of the Study:
- To evaluate the efficacy of rapid intravenous (IV) rehydration in an outpatient setting.
- To assess the ability of rapid IV rehydration to correct dehydration and resolve vomiting in children.
- To identify predictors of successful oral fluid tolerance after outpatient IV rehydration.
Main Methods:
- Prospective cohort study of 58 children (6 months to 13 years) with mild to moderate dehydration and acute gastroenteritis.
- Administered 20-30 mL/kg isotonic crystalloid IV over 1-2 hours, followed by oral fluids.
- Assessed tolerance to oral fluids, hospital admission criteria, and post-discharge outcomes via telephone follow-up.
Main Results:
- All patients showed improved hydration after rapid IV rehydration.
- 72% of patients tolerated oral fluids and were discharged; 28% required admission for continued IV therapy.
- Children with a serum bicarbonate concentration >13 mEq/L were more likely to tolerate oral fluids (P = .001).
- 85% of discharged patients required no further medical evaluation within 24-48 hours.
Conclusions:
- Outpatient rapid IV rehydration is a safe and effective treatment for selected children with mild to moderate dehydration from gastroenteritis.
- Serum bicarbonate concentration can help predict oral fluid tolerance post-rehydration.
- Most children successfully managed as outpatients demonstrated sustained tolerance to oral fluids.
Study Objective:
To determine the efficacy of outpatient rapid i.v. rehydration in correcting dehydration and resolving vomiting in children with mild to moderate dehydration resulting from acute gastroenteritis.
Methods:
We carried out a prospective cohort study in an urban children's hospital. A convenience sample of 58 children aged 6 months to 13 years, with acute gastroenteritis and clinically estimated dehydration of 5% to 10% body weight, was assembled. All patients had been vomiting for less than 48 hours, had vomited at least five times in the 24 hours preceding presentation, and had metabolic acidosis (serum bicarbonate concentration, 18 mEq/L or less). Each patient received an i.v. infusion of 20 to 30 mL/kg isotonic crystalloid solution over 1 to 2 hours, followed by the oral administration of 1 to 3 ounces of clear fluid. Patients who subsequently vomited were admitted for continued i.v. fluid therapy. Patients who tolerated oral fluid were discharged; their caregivers were contacted by telephone 24 to 48 hours after discharge.
Results:
All patients had improved hydration status after rapid i.v. rehydration. Sixteen patients (28%) did not tolerate oral fluids after rapid i.v. rehydration and were admitted; 11 of these patients had a serum bicarbonate concentration of 13 mEq/L or less. The other 42 patients (72%) tolerated oral fluids after rapid i.v. rehydration and were discharged; 41 of these patients had a serum bicarbonate concentration greater than 13 mEq/L. The frequency of serum bicarbonate concentration of 13 mEq/L or less on presentation was significantly greater (P = .001) in patients requiring hospitalization than in those discharged from the emergency department after rapid i.v. rehydration. Of 40 patients whose caregivers were contacted after discharge, 34 (85%) required no further medical evaluation or treatment for any reason, including inadequate hydration; 29 of these patients vomited no more than once. Six of the discharged patients (15%) required further medical evaluation and were admitted; four had recurrent vomiting and dehydration, two had not vomited but were dehydrated as a result of diarrheal fluid loss or inadequate oral fluid intake.
Conclusion:
Outpatient rapid i.v. rehydration is safe and effective in correcting dehydration and resolving vomiting in selected children with acute gastroenteritis and mild to moderate dehydration. In our study, most children who presented with a serum bicarbonate concentration greater than 13 mEq/L tolerated oral fluids after rapid i.v. rehydration and were further managed as outpatients without complications. By contrast, most children with a serum bicarbonate concentration of 13 mEq/L or less usually did not tolerate oral fluids after rapid i.v. rehydration and required more prolonged i.v. fluid therapy. All discharged patients, regardless of their serum bicarbonate concentration, demonstrated the ability to tolerate orally administered fluid.