Mild gastroenteritis? Try dilute apple juice!

Among children with mild gastroenteritis and minimal dehydration, initial oral hydration with dilute apple juice followed by preferred fluids is more beneficial than providing electrolyte maintenance solution, a large study in a pediatric emergency department (ED) found.

The 647 study participants, who were aged 6 to 60 months, were divided into an intervention group that received half-strength apple juice and a control group that was given an apple-flavored electrolyte maintenance solution. After discharge, the apple juice group was instructed to drink whatever fluids they wished, while the electrolyte maintenance solution group replaced fluids with electrolyte maintenance solution.

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At follow-up, fewer children in the apple juice/preferred fluids group received intravenous (IV) rehydration (Freedman SB, et al. JAMA. 2016;315[18]:1966-1974).

Commentary: Dilute apple juice or other liquids were not only as good as electrolyte solution in this study, they were better. Perhaps IV hydration and admission were more common in the electrolyte solution group because parents had to purchase the solution after ED discharge, while those in the dilute apple juice arm of the study could be given any fluid available at home. It is important to note that this study included only patients aged at least 6 months and only those with mild dehydration; 81% of the enrolled patients had dehydration scores of 0 or 1 on an 8-point scale. Diarrhea leading to life-threatening dehydration and electrolyte disturbances is a real and scary thing, even in developed countries. Dilute apple juice may be fine for mildly dehydrated children, but in moderate to severe diarrhea I will stick with electrolyte solution. —Michael G Burke, MD

Ms Freedman is a freelance medical editor and writer in New Jersey. Dr Burke, section editor for Journal Club, is chairman of the Department of Pediatrics at Saint Agnes Hospital, Baltimore, Maryland. The editors have nothing to disclose in regard to affiliations with or financial interests in any organizations that may have an interest in any part of this article.