Rehydration In Children Research Articles

Sports drinks effect on salivary volume and pH in children after exercise: a randomized clinical study.

The aim of this study was to examine the sports' related oral health behavior and the effect of sports drinks on the salivary volume and acidity of 6 to 14 years old children. Sixty-eight children with a median age of 8 years old from Waterford Tennis Association camp participated in the study. Each child was randomly assigned to either the control group that consumed water or the experimental group that consumed a sports drink. Salivary volume and acidity were measured for all groups before exercise, right after exercise and after consuming the rehydrating agent. Salivary volume was measured by dripping into a pre-measured (mL) plastic medicine cup while salivary acidity was measured using an electric pH meter with 0.01 sensitivity. Oral health behavior did not differ between the two groups. No statistically significant difference was detected in the salivary volume before and after exercise. A statistically significant increase (P=0.005) was found in the salivary volume before (1.73ml) and after re-hydration (2.92ml) regardless of the drink consumed (P=0.813). Salivary pH increased significantly (P=0.012) before (7.06) and after exercise (7.73), and dropped significantly (P=0.001) after the consumption of the rehydration drink (6.63) among the same group. The pH decrease was greater in the sports drink group (P=0.013). No difference in the children's salivary volume was found between the two groups. However, consumption of sports drinks reduces significantly salivary pH and thus, water should be the drink of choice for rehydration in children.

Proctoclysis for rehydration in children – A scoping review and a pilot survey among medical doctors

Although proctoclysis (enema) is a historically proven, safe and cost-effective rehydration method that needs little training for users and can effectively replace intravenous hydration in different care settings, it is an uncommon choice for hydration in children with fever and is often missing in official guidelines. To evaluate the usefulness of proctoclysis, this study provides a scoping review of the existing literature. The matched literature was labelled in 5 categories, identifying 6 indication fields that are emphasized in the literature on rectal rehydration. The analysis showed that proctoclysis is mostly used in the context of diagnostic procedures, constipation or in the treatment of a gastrointestinal disease. It is also described as a quick, safe and cost-effective intervention for fluid replacement in emergency, critical care or resource-scarce settings. There are also socio-cultural variations in its use Additionally, we performed a survey on attitudes and experience of medical doctors towards proctoclysis based on a semi-structured questionnaire. In the survey, we analysed the experience of 35 medical doctors from 8 countries. Although we found a general acceptance of enema as beneficial in both hospitalized patients and in home care, doctors expressed the need for more experience with enema and the need for more education materials in order to effectively perform the procedure. Based on our findings, we suggest that further research is necessary examining the attitude towards proctoclysis among parents, nurses and doctors. Enema can have a considerable clinical advantage during home care for gastroenteritis or other infectious diseases with fever to prevent insufficient oral fluid intake resulting in a negative fluid balance. Risks and safety issues are rare and should be considered. However, due to its low level of social acceptability in order to reduce refusal rate, more education is necessary for both medical providers and parents.

The problem of dehydration in pediatrics

Dehydration syndrome often complicates the course of various diseases in children. The article covers the main pathological conditions that are accompanied by fluid loss, such as infectious diarrhea, cyclic vomiting syndrome, non-diabetic ketosis and ketoacidosis. The pathophysiological mechanisms that lead to water and electrolyte loss are described, as well as methods for correcting dehydration in pediatrics. We presented the results of a clinical study of Reogel, which was used for oral rehydration in children with acute infectious diarrhea receiving inpatient treatment. According to the results of this observation, we did not find a significant difference in the duration of the main clinical symptoms of the disease, such as diarrhea, vomiting and dehydration symptoms, as well as the frequency and duration of parenteral rehydration between groups of children receiving Reogel and standard oral rehydration. The results of this study give grounds to consider Reogel as an alternative to traditional oral rehydration in children with infectious diarrhea, accompanied by mild and moderate dehydration.

Значение оральной регидратации в терапии ротавирусной инфекции у детей

Rotavirus infection (RVI) has always been one of the urgent problems in healthcare causing significant economic and social damage. Correction of water-electrolyte disorders is pivotal for RVI therapy. The severity of the dehydration largely determines the overall severity of the disease. It is often challenging to choose the most effective rehydration solution; therefore, inadequate choice is the most common treatment error in patients with acute intestinal infections. Objective. To assess the efficacy of oral rehydration in children with acute gastroenteritis caused by rotavirus treated in an outpatient department. Patients and methods. This retrospective, open-label, case-control study included 100 children with RVI treated in 2021–2022. They were divided into three groups. In group I, patients received water or self-made solutions for rehydration; in group II, patients received oral rehydration therapy (ORT) with different commercial solutions; in group III, patients received Nestle ReHydra. We evaluated the severity and duration of RVI symptoms, including diarrhea, vomiting, abdominal pain, flatulence, general symptoms of intoxication, and signs of exicosis. Results. The lowest duration of diarrhea, vomiting, flatulence, and bloating was observed in group III. The duration of RVI symptoms in children receiving low osmolar ORT was 1.2-1.4 times lower than in those who did not receive this therapy. We found that low osmolar ORTs are the most effective agents to treat dehydration in children. Oral rehydration with ready-touse ORTs is preferable, because they can be rapidly prepared and administered and prevent mistakes associated with drug preparation. Conclusion. Oral rehydration with low osmolar ORT in children with RVI increases the efficacy of outpatient treatment, reduce the duration of clinical symptoms, and decrease the risks of severe dehydration that requires inpatient treatment. Key words: acute intestinal infections, dehydration, low osmolar solutions, diarrhea, oral rehydration

Differential diagnosis of infectious watery diarrhea (view from time immemorial to the present). Modern approaches to rehydration

Today, as in ancient times, diarrhea (loss of water and electrolytes along with stool) accompanies many pathological conditions in humans. The pathophysiology of various types of diarrhea has been studied, which made it possible to optimize therapeutic approaches and save the lives of many people. The most dangerous conditions occur in young patients with osmotic and exudative types of diarrhea, as they result in exicosis within a short time. In arriving at a diagnosis, rehydration therapy should be started as soon as possible. The article presents the historical aspects associated with the global pandemics of cholera. The history of the creation of solutions for intravenous and oral rehydration is covered. The authors presented tables for calculating fluid losses and the required volume of solutions for oral or parenteral administration. The modern requirements for rehydration solutions and the principles of rehydration in children are presented. Oral rehydration is particularly problematic for young children due to the limited range of drugs and requirements for the composition of solutions used in pediatrics. According to the recommendations of the World Health Organization and ESPGHAN, clinical recommendations of the Russian Federation, low-osmolar solutions should be used. When complex solutions containing probiotic and zinc are used, the therapy compliance increases. A rehydration solution, which contains a weighted amount of salt for the preparation of a low-osmolar solution, as well as the probiotic L. reuteri DSM 17938 at least 1 billion of viable bacteria and zinc sulphate 0.004 g is one of the latest solutions. The results of studies of this solution are provided.

The Effect of Dehydration on the Development of Endothelial Dysfunction in Young Athletes: a Comparative Analysis of the Effectiveness of a New Honey Isotonic Drink and Standard Means of Restoring Hydro-Electrolytic Balance

Aim of the research. To prove the effectiveness of using isotonic honey drink “Gold F25 IsoDrink Light” (IsoDrink-L) based on the study of the hydration process and endothelial function in young athletes. Materials and methods. A randomized controlled study was performed in young athletes under the age of 18 years. Athletes of the main group (n = 40) consumed IsoDrink-L for a month; athletes of the control group (n = 34) consumed water and isotonic drink “X”. A bioimpedance-based device was used to determine the total amount of water, the absolute and relative proportions of intra- and extracellular water, as well as the ratio of extracellular water to the total amount of water. Hematocrit, specific gravity and color of morning urine, samples with reactive hyperemia and hyperventilation in the brachial artery, including the determination of the endothelial sensitivity index were assessed. Results. All athletes had dehydration in the form of extracellular dehydration, cellular hyperhydration, “blood thickening”, hyponatremia, increased specific gravity and urine color, as well as endothelial dysfunction. All symptoms disappeared after using IsoDrink-L for 1 month. No dynamics was observed in the control group, where 95 % of the athletes took water and 5 % – isotonic drink “X”. ROC analysis showed that the endothelial sensitivity index with a sensitivity of 95.8 % and a specificity of 99.4 % detects endothelial dysfunction. The canonical correlation coefficient between the set of hydration-dependent and endothelium-dependent signs was R = 0.71 (p < 0.0001). We established the danger of uncontrolled water consumption for rehydration in young athletes, as well as the high efficiency of isotonic honey drink and the evidence for its use for the correction of dehydration and endothelial dysfunction. A low awareness of athletes, doctors and coaches about the importance of using effective methods of rehydration in children’s sports was revealed. Conclusion. It was found that water imbalance in young athletes directly or indirectly contributes to the development of endothelial dysfunction, thereby increasing cardiovascular risk. Original approaches to the development of honey isotonic drink for young athletes with proven hydrating and endothelium-protective properties are proposed.

Effect of Rehydration With Normal Saline Versus Ringer Lactate on Serum Sodium Level of Children With Acute Diarrhea and Severe Dehydration: A Randomized Controlled Trial

To demonstrate the equivalence of Normal Saline (NS) and Ringer Lactate (RL) for change in serum sodium levels during correction of severe dehydration in children with acute diarrhea based on World Health Organization (WHO) plan C. Equivalence randomized control trial. Pediatric diarrhea unit of a tertiary care hospital from May, 2016 to April, 2017. 72 children of 1-12 years with acute diarrhea and severe dehydration were enrolled. Children with dysentery, severe acute malnutrition, severe anemia, meningitis, and known surgical and systemic diseases were excluded. RL (n=36) or NS (n=36) were used as per WHO plan C. Blood samples were drawn before intravenous fluid correction and 3 h post-intervention. Mean change in serum sodium level from the baseline between the RL and NS groups. 70 children (35 in each group) completed the study. The difference in mean serum sodium levels from baseline in RL and NS groups were 1.4 (4.5) mEq/L and 2.1(4.9) mEq/L, respectively (P=0.58). Both RL and NS are equivalent in terms of change in serum sodium from baseline for intravenous rehydration in children with acute diarrhea and severe dehydration.

Clinical and laboratory efficacy of hypoosmolar solution for oral rehydration in children with intestinal infections

There is a high incidence of acute intestinal infections in the Russian Federation. Children rapidly develop clinical manifestations of acute intestinal infections. The severity and outcome of the disease are largely determined by the dehydration syndrome. The article presents the results of the effectiveness of oral rehydration in 2 groups of children with acute intestinal infection from 3 months to 7 years old, treated with hypoosmolar glucose-saline solution “Gastrolit with chamomile extract” (n=215) or “Rehydron” (n=188) in the complex treatment of intestinal infections with the dehydration syndrome of I or II degree. The groups were comparable by sex, age, clinical manifestations of the disease. It was found that “Gastrolit with chamomile extract” eliminates water-electrolyte disorders, relieves metabolic acidosis and has anti-inflammatory, antiseptic and antispasmodic effect on the intestine and relieves symptoms of dehydration faster than “Rehydron” in children with acute intestinal infection.

P067: Ondansetron and rehydration in pediatric gastroenteritis

Introduction: Gastroenteritis (GE) is one of the most common causes of emergency room visits, especially in pediatrics. The Canadian Paediatric Society and Choosing Wisely have issued high-grade recommendations to physicians working in the Emergency Department. It suggests, trying oral ondansetron followed by oral rehydration before installing venous rehydration in children with GE with adequate hydration or mild to moderate dehydration. This quality of medical care evaluation aims to determine if these recommendations were being applied for children aged 6 months to 12 years, with adequate hydration status or mild to moderate dehydration, who presented to the Chicoutimi emergency room between November 2016 and November 2018. Methods: Practice conformity was assessed according to two explicit criteria: prescription of oral ondansetron and appropriate mean of rehydration. A data collection tool was created and files were reviewed by investigators after standardization. Several secondary outcomes were assessed, including, among others, duration of symptoms, the number of vomiting and diarrhea. The hydration status was measured according to the capillary refill, feeling of skin to the touch, condition of buccal mucosa, tears, heart rate and mental status. These variables were analyzed to understand their impact on practice conformity. We excluded cases in which there was infections needing antibiotics, hypoglycemia, hemodynamic instability, no vomiting in the last 24 hours, convulsions and history of diabetes. Results: A total of 270 patient files were analyzed, 181 of which were included. Oral ondansetron was tried in 49 % of children. Rehydration was adequate in 55% of cases. The hydration level was written in 18% of files and the hydration status noted by the emergency room physician overestimated the dehydration score in 16% of cases. When hydration status was well assessed, adequate rehydration was observed in 63% of cases, while ondansetron was attempted in only 44% of cases. Conclusion: Use of oral ondansetron and adequate mean of rehydration to treat children aged 6 months to 12 years with GE in Chicoutimi emergency department is suboptimal. The difficulty of adequate dehydration assessment may be one of the causes. Concerted dehydration assessment grid and a group prescription for the administration of ondansetron during the nurse triage may constitute potential solutions.

Single-dose Intravenous Ondansetron in Children with Gastroenteritis: A Randomized Controlled Trial

To evaluate the efficacy of ondansetron for the treatment of vomiting and thus reducing the need for intravenous (IV) rehydration in children with gastroenteritis. Double-blind, placebo-controlled, randomized trial. Pediatric ward of An Giang General Hospital, South Vietnam, between December 2013 and June 2014. 61 inpatient children (age 11-60 mo) suffering from gastroenteritis with vomiting. Exclusion criteria were: underlying chronic conditions, immunodeficiency, malnutrition or history of allergy to ondansetron. Single bolus of IV ondansetron at a dose of 0.2 mg/kg or placebo. Proportion of patients who needed IV rehydration, proportion of patients with cessation of vomiting, amount of oral rehydration solution intake, duration of diarrhea and the length of hospital stay. After drug administration, 22 (73%) of the 30 patients in the ondansetron group had complete cessation of vomiting compared with 7 (23%) of the 31 patients in the placebo group (RR 0.32; 95% CI 0.16 to 0.63, P<0.001). 3 (10%) patients in the ondansetron group required IV rehydration as compared with 12 (39%) in the placebo group (RR 0.51; 95% CI 0.33 to 0.79, P=0.009). The median amount of oral rehydration solution intake in 24 hours was significantly greater in the ondansetron group (450 mL vs 350 mL, P=0.019).The duration of diarrhea and the length of hospital stay were not different between the two groups. In hospitalized children having gastro-enteritis associated with emesis, ondansetron is effective in the cessation of episodes of vomiting and in lowering the rates of IV rehydration, without reducing the duration of diarrhea and hospital stay.

118 Predictors of intravenous rehydration in children with acute gastroenteritis in the United States and Canada

Abstract Background Although oral rehydration therapy is recommended for children with acute gastroenteritis (AGE) with none to some dehydration, intravenous (IV) rehydration is still commonly administered to these children in high-income countries. IV rehydration is associated with pain, anxiety, and emergency department (ED) revisits in children with AGE. Objectives We sought to better understand the factors associated with IV rehydration in children with AGE in order to inform knowledge translation strategies. Design/Methods This was a planned secondary analysis of the Pediatric Emergency Research Canada (PERC) and Pediatric Emergency Care Applied Research Network (PECARN) randomized, controlled trials of oral probiotics in children with AGE-associated diarrhea. Eligible children were aged 3–48 months and reported &amp;gt;3 watery stools in a 24-hour period. The primary outcome was administration of IV rehydration at the index ED visit. We used mixed-effects logistic regression model to explore univariable and multivariable relationships between IV rehydration and a prioririsk factors. Results From the parent study sample of 1848 participants, 1846 had data available for analysis: mean (SD) age of 19.1 ± 11.4 months, 45.4% females. 70.2% (1292/1840) vomited within 24 hours of the index ED visit and 34.1% (629/1846) received ondansetron in the ED. 13.0% (240/1846) were administered IV rehydration at the index ED visit, and 3.6% (67/1842) were hospitalized. Multivariable predictors of IV rehydration were Clinical Dehydration Scale (CDS) score [compared to none: mild to moderate (OR: 8.1, CI: 5.5–11.8); severe (OR: 45.9, 95% CI: 20.1–104.7), P&amp;lt;0.001], ondansetron in the ED (OR: 1.8, CI: 1.2–2.6, P=0.003), previous healthcare visit for the same illness [compared to no prior visit: prior visit with no IV (OR: 1.9, 95% CI: 1.3–2.9); prior visit with IV (OR: 10.5, 95% CI: 3.2–34.8), P&amp;lt;0.001], and country [compared to Canada: US (OR: 4.1, CI: 2.3–7.4, P&amp;lt;0.001]. Significantly more participants returned to the ED with symptoms of AGE within 3 days if IV fluids were administered at the index visit [30/224 (13.4%) versus 88/1453 (6.1%), P&amp;lt;0.001]. Conclusion Higher CDS scores, antiemetic use, previous healthcare visits and country were independent predictors of IV rehydration which was also associated with increased ED revisits. Knowledge translation focused on optimizing the use of antiemetics (i.e. for those with dehydration) and reducing the geographic variation in IV rehydration use may improve the ED experience and reduce ED-revisits.

LO34: Predictors of intravenous rehydration in children with acute gastroenteritis in the United States and Canada

Introduction: Although oral rehydration therapy is recommended for children with acute gastroenteritis (AGE) with none to some dehydration, intravenous (IV) rehydration is still commonly administered to these children in high-income countries. IV rehydration is associated with pain, anxiety, and emergency department (ED) revisits in children with AGE. A better understanding of the factors associated with IV rehydration is needed to inform knowledge translation strategies. Methods: This was a planned secondary analysis of the Pediatric Emergency Research Canada (PERC) and Pediatric Emergency Care Applied Research Network (PECARN) randomized, controlled trials of oral probiotics in children with AGE-associated diarrhea. Eligible children were aged 3-48 months and reported &amp;gt; 3 watery stools in a 24-hour period. The primary outcome was administration of IV rehydration at the index ED visit. We used mixed-effects logistic regression model to explore univariable and multivariable relationships between IV rehydration and a priori risk factors. Results: From the parent study sample of 1848 participants, 1846 had data available for analysis: mean (SD) age of 19.1 ± 11.4 months, 45.4% females. 70.2% (1292/1840) vomited within 24 hours of the index ED visit and 34.1% (629/1846) received ondansetron in the ED. 13.0% (240/1846) were administered IV rehydration at the index ED visit, and 3.6% (67/1842) were hospitalized. Multivariable predictors of IV rehydration were Clinical Dehydration Scale (CDS) score [compared to none: mild to moderate (OR: 8.1, CI: 5.5-11.8); severe (OR: 45.9, 95% CI: 20.1-104.7), P &amp;lt; 0.001], ondansetron in the ED (OR: 1.8, CI: 1.2-2.6, P = 0.003), previous healthcare visit for the same illness [compared to no prior visit: prior visit with no IV (OR: 1.9, 95% CI: 1.3-2.9); prior visit with IV (OR: 10.5, 95% CI: 3.2-34.8), P &amp;lt; 0.001], and country [compared to Canada: US (OR: 4.1, CI: 2.3-7.4, P &amp;lt; 0.001]. Significantly more participants returned to the ED with symptoms of AGE within 3 days if IV fluids were administered at the index visit [30/224 (13.4%) versus 88/1453 (6.1%), P &amp;lt; 0.001]. Conclusion: Higher CDS scores, antiemetic use, previous healthcare visits and country were independent predictors of IV rehydration which was also associated with increased ED revisits. Knowledge translation focused on optimizing the use of antiemetics (i.e. for those with dehydration) and reducing the geographic variation in IV rehydration use may improve the ED experience and reduce ED-revisits.

Oral Rehydration in Children with Acute Diarrhoea and Moderate Dehydration-Effectiveness of an ORS Tolerance Test.

Oral rehydration solution (ORS) is the mainstay of treatment of acute watery diarrhoea, but it is underutilized in many hospitals, resulting in children with moderate degrees of dehydration being unnecessarily hospitalized and receiving intravenous fluids. We aimed to assess the utility of an ORS tolerance test on initial presentation to an emergency department, and determine the volume of ORS a child with diarrhoea and moderate dehydration needed to tolerate to be successfully managed at home. One hundred and twenty-nine children with acute watery diarrhoea and moderate dehydration were given ORS and observed in a Children's Emergency Department (CED) over a period of 2-4 h. Patients were admitted, kept in the CED for further management or discharged, based on the assessment of oral intake and the clinical judgement of the treating health workers. Seventy-nine (61.2%) patients tolerated ORS well. They drank a median [interquartile range (IQR)] of 24.4 ml (IQR 12.5-28.8) ml/kg, were judged to have passed the ORS test and were discharged to continue oral rehydration treatment at home. At follow-up on days 2 and 5, 63/79 (79.7%) children had improved, were adequately hydrated and the diarrhoea had reduced. Sixteen of the 79 (20.3%) failed oral home treatment, with persisting diarrhoea, vomiting, hypokalaemia and/or weakness. The 63 who succeeded had tolerated a median of 25.8 (IQR 18.4-30.0) ml/kg of ORS in the CED, whilst the 16 who failed oral home treatment had tolerated 11.1 (IQR 9.1-23.0) ml/kg ORS (p < 0.001).

Effect of Intravenous Ondansetron on the QT Interval of Patients' Electrocardiograms

Ondansetron improves the success of oral rehydration in children with gastroenteritis. In postoperative adults, ondansetron has been shown to prolong the corrected QT (QTc). The aim of the study was to evaluate the effect of ondansetron on the QT at peak effect and at 1-hour postpeak effect in pediatric patients. This was an observational study looking at patients aged 6 months to 18 years receiving intravenous ondansetron for nausea, vomiting, or the inability to take fluids in the emergency department. Patients had electrocardiogram performed at baseline, at ondansetron's peak effect, and 1 hour postpeak effect. A paired samples Student t test compared QTc change at peak effect to zero. Peak effect of intravenous ondansetron is 3 minutes. One hundred patients were included. Fifty-five percent of patients were female with a mean age of 8.3 years. The mean (range) baseline QTc was 435 (388 to 501) milliseconds. The mean (range) change in QTc at peak effect of ondansetron was 3 (-40 to 65) milliseconds (P = 0.072). The change in QTc 1-hour postpeak effect of ondansetron was 3 (-43 to 45) milliseconds (P = 0.082). No change at peak effect or 1-hour postpeak effect was clinically significant. Ondansetron does not affect the QTc of pediatric patients receiving the medication for nausea, vomiting, or inability to take fluids in the emergency department. No changes in the QTc are clinically significant. To date, there have been no studies evaluating the effect of ondansetron in this acutely ill population; therefore, a larger study should be completed to confirm these data.

Use of the drug Rehydron Bio in the complex therapy of rotavirus infection

Objective: to study efficiency of using the drug Rehydron Bio in the treatment of rotavirus infection (RVI) in children.Materials and methods. The study included 58 children aged from 3 to 8 years, who were treated in Odesa City Clinical Infectious Diseases Hospital because of RVI. Patients of the main group (n = 26) received basic therapy that included that included low lactose diet, intestinal antiseptic nifuroxazide in the age medium therapeutic dose, chelators and enzymes.. For the purpose of oral rehydration main group of patients received the drug Rehydron Bio that produced by «Orion Corporation» (Finland) rate 3–6 days. The control group included 32 children who, along with basic treatment for oral rehydration used rehydron, sweetened tea and degassed mineral water. During hospitalization patients conducted a comprehensive survey, which included an objective review of clinical and biochemical blood and urine.Results. During the using of the drug Rehydron Bio, the necessity for infusion therapy for rehydration aim occurred significantly less often, which confirms its high efficiency. Conclusion. Use of the drug Rehydron Bio for the purpose of oral rehydration in children with rotavirus infection contributed to the rapid improvement of the patient, eliminating the symptoms of toxicity, and dehydration, reduced the need for the appointment of infusion therapy, which indicates its high efficiency and give an opportunity to recommend the drug for oral rehydration in patients with viral diarrhea.

Gelatin Tannate for Acute Childhood Gastroenteritis: A Randomized, Single-Blind Controlled Trial.

Oral rehydration therapy is the recommended treatment for acute childhood gastroenteritis. The aim of this study was to assess the efficacy and safety of gelatin tannate plus oral rehydration compared with oral rehydration alone. We conducted a multicenter, parallel, randomized, controlled, single-blind, prospective, open-label trial. A central randomization center used computer generated tables to allocate treatments. The study was performed in two medical centers in Italy. Sixty patients 3-72months of age with acute gastroenteritis were recruited (median age 18months; age range 3-66months): 29 received an oral rehydration solution (ORS) and 31 an ORS plus gelatin tannate (ORS+G). The primary outcome was the number of bowel movements 48 and 72h after initiating treatment. Secondary outcomes were: duration of diarrhea, stool characteristics and adverse events. No patient was lost at follow-up. No significant difference in the number of bowel movements after 48h was reported (2.7±1.3 ORS+G; 3.2±0.8 ORS; p=0.06), although the ORS+G group showed a significant improvement in stool consistency (3.7±1.0 vs. 4.3±0.8; p=0.005). At 72h, a significant reduction in bowel movements was reported in the ORS+G group compared with the ORS group (1.0±1.4 vs. 2.0±1.7; p=0.01). Mean duration of diarrhea was significantly lower in the ORS+G group than in the ORS only group (76.8±19.2 vs. 108±24.0h; p<0.0001). No adverse events were reported. Gelatin tannate added to oral rehydration in children with acute diarrhea was associated with a significant decrease in bowel movements at 72h, with an early improvement in the stool consistency and shorter disease duration. NCT02644200-Gelatin Tannate as Treatment for Acute Childhood Gastroenteritis ( https://www.clinicaltrials.gov ).

Ondansetron Oral Dissolve Tab vs. Oral Solution in Children Presenting to the Emergency Department with Gastroenteritis

BackgroundOndansetron is often used in the emergency department (ED) to promote oral rehydration in children with acute gastroenteritis (AGE), yet medication solutions administered orally may be poorly tolerated in this population. ObjectivesWe compared the tolerability of ondansetron oral dissolve tab (ODT) to oral solution (OS) in children presenting to the ED with AGE. MethodsUsing alternate-day controlled clinical trial design, children aged 3 months to 10 years received either ondansetron ODT or OS. Our primary outcome was early vomiting (within 15 min of drug administration). The secondary outcome was intravenous (i.v.) fluid administration. ResultsThere were 462/534 eligible children who met study criteria. Demographics, severity, and duration of illness were similar between groups. Using intention-to-treat analysis, early vomiting occurred in 8/209 ODT vs. 19/253 OS children (3.8% vs. 7.5%; odds ratio [OR] 0.49; 95% confidence interval [CI] 0.18–1.21). Using as-treated analysis, 6/222 (2.7%) children receiving ODT experienced early vomiting, compared with 21/221 (9.5%) of the OS group (OR 0.26; 95% CI 0.09–0.70). The proportion of children discharged without i.v. fluids was not different (intention-to-treat: ODT = 91.4% (191/209), OS = 94.1% (238/253), OR 1.49, 95% CI 0.69–3.28; as-treated: ODT = 92.3% (205/222), OS = 93.2% (206/221), OR 0.88, 95% CI 0.40–1.93). ConclusionsUsing a conservative intention-to-treat analysis, we found that children presenting to an ED with AGE did not have statistically less early vomiting with ondansetron ODT as compared with OS. However, our as-treated analysis demonstrates that children receiving ondansetron ODT experienced early vomiting approximately one-third as often as those receiving OS. The rate of i.v. fluid administration was no different between groups regardless of the type of analysis used.

A randomized trial of Plasma-Lyte A and 0.9% sodium chloride in acute pediatric gastroenteritis.

BackgroundCompare the efficacy and safety of Plasma-Lyte A (PLA) versus 0.9 % sodium chloride (NaCl) intravenous (IV) fluid replacement in children with moderate to severe dehydration secondary to acute gastroenteritis (AGE).MethodsProspective, randomized, double-blind study conducted at eight pediatric emergency departments (EDs) in the US and Canada (NCT#01234883). The primary outcome measure was serum bicarbonate level at 4 h. Secondary outcomes included safety and tolerability. The hypothesis was that PLA would be superior to 0.9 % NaCl in improvement of 4-h bicarbonate. Patients (n = 100) aged ≥6 months to <11 years with AGE-induced moderate-to-severe dehydration were enrolled. Patients with a baseline bicarbonate level ≤22 mEq/L formed the modified intent to treat (mITT) group.ResultsAt baseline, the treatment groups were comparable except that the PLA group was older. At hour 4, the PLA group had greater increases in serum bicarbonate from baseline than did the 0.9 % NaCl group (mean ± SD at 4 h: 18 ± 3.74 vs 18.0 ± 3.67; change from baseline of 1.6 and 0.0, respectively; P = .004). Both treatment groups received similar fluid volumes. The PLA group had less abdominal pain and better dehydration scores at hour 2 (both P = .03) but not at hour 4 (P = 0.15 and 0.08, respectively). No patient experienced clinically relevant worsening of laboratory findings or physical examination, and hospital admission rates were similar. One patient in each treatment group developed hyponatremia. Four patients developed hyperkalemia (PLA:1, 0.9 % NaCl:3).ConclusionIn comparison with 0.9 % NaCl, PLA for rehydration in children with AGE was well tolerated and led to more rapid improvement in serum bicarbonate and dehydration score.Trial registrationNCT#01234883 (Registration Date: November 3, 2010).Electronic supplementary materialThe online version of this article (doi:10.1186/s12887-016-0652-4) contains supplementary material, which is available to authorized users.

Rapid Intravenous Rehydration Therapy in Children With Acute Gastroenteritis: A Systematic Review.

Rapid intravenous (IV) rehydration is commonly used for the management of pediatric gastroenteritis in the emergency department. The current practice shows wide variation in the volume and rate of rapid IV hydration. The aim of this review was to assess the efficacy of rapid IV rehydration compared with standard method in children with gastroenteritis. MEDLINE (1946-2014), EMBASE (1974-2014), and CENTRAL via the Cochrane Library (Issue 8, 2014) were systematically searched to identify eligible studies. Inclusion criteria were randomized controlled trials of rapid IV rehydration in children with gastroenteritis. A total of 1513 articles were retrieved, and our inclusion criteria were met by 3 studies, with a total of 464 participants. The percentage of children who were successfully rehydrated and tolerated oral fluids at 2 to 4 hours after starting IV fluid therapy ranged from 69% to 100% in both rapid IV rehydration and standard method. Time to discharge ranged from 2 to 6 hours (rapid rehydration) versus 2 to 5 hours (standard rehydration). Emergency department revisits ranged from 3% to 16% (rapid rehydration) versus 5% to 14% (standard). Summarized results suggested that rapid IV rehydration may be associated with longer time-to-discharge and higher readmission rates. The new evidence fails to demonstrate superiority of large-volume (60 mL/kg/h) over standard (20 mL/kg/h) IV rehydration. Standard volume IV rehydration for 1 to 4 hours followed by oral hydration or maintenance IV fluids seems sufficient for most children with gastroenteritis requiring IV fluid administration. However, more evidence is needed to establish an optimal IV rehydration regimen.

Assessment of effectiveness of nonspecific antidiarrheal agents in reducing the need for intravenous rehydration in children with acute diarrhea

Background: In clinical practice, nonspecific antidiarrheals are most commonly used by clinicians along with routine treatment to hasten the recovery and to give psychological reassurance. This study was conducted to assess the effectiveness of nonspecific antidiarrheal agents in reducing the need for intravenous rehydration in children with acute diarrhea. Materials and Methods: This was a prospective, observational study done in clinical settings for a period of 3 years at two pediatric clinics and at a tertiary care hospital. Children were divided into 5 treatment groups (viz, control, racecadotril, Mebarid, Diarex and loperamide) at the discretion of the pediatrician. One questionnaire was provided to parents to record the details about the course of diarrhea. Parents were sensitized to report any episode of complication or need for intravenous fluids. Results: The unscheduled need for intravenous fluids due to dehydration was significantly higher in control group compared to other groups {Control: 7.37%, Racecadotril : 1.71% Mebarid: 2.4%, Diarex: 0%, Loperamide : 0%)}. Conclusion: Present study suggests that use of nonspecific antidiarrheals may decrease the need for admission for intravenous fluids in children with acute diarrhea.