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The administration of rapid intravenous fluid is the current practice for acute gastroenteritis, but does it actually lead to better outcomes?
The current practice of administering rapid intravenous fluid (IVF) to children with acute gastroenteritis does not result in either early discharge or reduced likelihood of a revisit to the emergency department (ED). These were the primary findings of a retrospective study conducted with 284 patients ranging from infants to adolescents who had received a diagnosis of acute gastro- enteritis and moderate dehydration at an ED in Saudi Arabia. Investigators divided patients into 2 groups: those receiving IVF in 2 boluses of 40 mL/kg and those given less than 40 mL/kg. A comparison of outcomes found that the 2 groups did not differ significantly in discharge rate at 4 hours, admission to the ward, or rate of ED revisits. On the other hand, patients who presented with only vomiting/diarrhea were less likely than other patients to revisit the ED, whereas patients with an increased CO2 level and anion gap were more likely to return within 1 week of being discharged.
Thoughts from Dr. Farber
Even these children, with moderate dehydration, did not benefit from aggressive IV rehydration. I’m also not sure they needed the IV at all. We should continue to move more and more toward oral rehydration in children if they are willing to drink, using ondansetron if needed for vomiting.
1. Almutairi MK, Al-Saleh AM, Qadrah BH, Sarhan NT, Alshehri NA, Shaheen NA. Outcomes and predictors of early emergency department discharge among children with acute gastroenteritis and moderate dehydration. Int J Pediatr Adolesc Med. Published online March 11, 2021. doi:10.1016/j.ijpam.2021.03.003