Rapid Intravenous Rehydration Therapy in Children With Acute Gastroenteritis

A Systematic Review

Toaimah, Fatihi Hassan Soliman MB, BCh, MSc, MD; Mohammad, Hala Mohammad Fathi MB, BCh, MSc, MD

From the *Division of Pediatric Emergency Medicine, Department of Pediatrics, Hamad Medical Corporation, Doha; and †Department of Clinical Pediatrics, Weill Cornell Medical College, Al Rayyan, Qatar; and ‡Department of Pediatrics, Zagazig University Hospital, Zagazig; and §Department of Clinical Pharmacology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt.

Disclosure: The authors declare no conflict of interest.

Reprints: Fatihi Hassan Soliman Toaimah, MB, BCh, MSc, MD, Division of Pediatric Emergency Medicine, Department of Pediatrics, Hamad Medical Corporation, Doha 3050, Qatar (e-mail:[email protected]).

Pediatric Emergency Care32(2):p 131-135, February 2016. |DOI:10.1097/PEC.0000000000000708

Abstract

Background

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.

Method

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.

Results

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.

Conclusions

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.