Oral rehydration without added bicarbonate for childhood gastroenteritis.

Abstract

All children admitted to the Departments of Child Health and Pharmacy University Hospital of Wales Cardiff with gastroenteritis during 1 year were studied prospectively. Oral rehydration was carried out with a solution containing sodium 34 mmol(mEq)/1 potassium 20 mmol(mEq)/1 chloride 54 mmol(mEq)/1 glucose 183 mmol/1(3.2 g/100 ml). The solutions were prepared and sterilized by the hospital pharmacy and supplied in sealed 500 ml glass bottles. During 1 year 50 boys and 40 girls under 5 were admitted for gastroenteritis to this unit which serves a population of about 250000. 10 were under 1 month 48 from 1 to 12 months and 32 under 5 years of age. 4 breast fed infants were admitted none of whom required intravenous fluids. 82 children were managed with oral rehydration fluids alone. None had received similar standard solutions at home. 8 were givev intravenous fluids within 2 hours of admission 1 of whom was given intravenous bicarbonate. None of those managed with oral fluids required sodium bicarbonate supplements or intravenous fluids. After rehydration standard formula or low lactose feeding was resumed. On admission the mean serum electrolyte concentrations and blood gases were: sodium 137 mmou/1 range 122-164 mmol; potassium 4.2 mmol/1 range 3.3-5.1 mmol/1; urea 6.4 mmol/1 (38.4 mg/100 ml) range 1-12 mmol/1 (6.72 mg/100 ml); pH 7.4 range 7.3-7.47; carbon dioxide pressure 4.1 kPa (31 mmHg) range 2.5-5.4 kPa (9-41 mmHg); standard bicarbonate 21 mmol/(mEq)/1 range 16-24 mmol/1; base deficit 4 mmol(mEq)/1 range 0-9 mmol/1. Serum sodium concentration was over 150 mmol/1 in 2 children and under 125 mmol/1 in another 2. Various pathogenic bacteria and viruses were detected. 50% of the children were home within 4 days and 78% within 1 week. No obvious neurological damage or deaths occurred. The use of sterile prepacked solutions stored at 4 degrees Celsius after opening minimizes the problem of bacterial growth. It is suggested that in Britain and probably other developed countries childhood gastroenteritis can be treated advantageously with a sterile prepacked oral rehydration solution that is free of bicarbontate.