Intravenous rehydration in paediatric gastroenteritis

BMJ 2011; 343 doi: https://doi.org/10.1136/bmj.d7083 (Published 17 November 2011) Cite this as: BMJ 2011;343:d7083
  1. Alan L Nager, director, emergency and transport medicine
  1. 1Children’s Hospital Los Angeles, Los Angeles, CA 90027, USA
  1. nager{at}chla.usc.edu

Overall, the evidence points to it being efficacious and safe

The rehydration of dehydrated children can be seriously challenging. Many factors need to be taken into account when choosing the most appropriate route and method of rehydration, including the setting, equipment, personnel, skill level, volume of patients, and available resources. Fortunately, in the emergency department, all types of rehydration—including oral, nasogastric, and intravenous—should be feasible.

Clinicians have to decide how much fluid to give, the rate of administration, and under what circumstances (level of dehydration) fluid should be given. Larger volumes of fluid given over a shorter period of time are increasingly being recommended.1

In the linked randomised controlled trial (doi:10.1136/bmj.d6976), Freedman and colleagues assessed whether rapid intravenous rehydration improved hydration and clinical outcomes in children with gastroenteritis aged 3 months to 11 years. Patients were randomised to receive 60 ml/kg (rapid) or 20 ml/kg (standard) over one hour. The authors concluded that patients had no clinical benefit from rapid intravenous rehydration over standard treatment and that its use should be reconsidered.2

All studies should be rational, prudent, “pragmatic,” and scientifically based. Freedman and colleagues justify their study because previous research has highlighted safety concerns with intravenous …

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