The letter from Eisenhut¹ questions the benefits of intravenous rehydration of children with gastroenteritis with normal saline (NS) because of the possibility of hyperchloraemic acidosis and suggests that Ringer’s lactate or an equivalent solution might offer advantages over NS.

Our study of 102 children with gastroenteritis judged to need intravenous fluids, compared plasma and urinary electrolyte changes after randomisation to receive either 0.9% saline+2.5% dextrose (NS, n = 51) or 0.45% saline+2.5% dextrose (N/2, n = 51).² The infusion rate was at the discretion of the treating physician according to either a rapid replacement protocol (RRP; 10 ml/kg/h for 4 h) or a standard replacement protocol (SRP; replacement of estimated percent dehydration over 24 h).

Data on acidosis and plasma concentrations of chloride were not presented in our original manuscript² but are available in all children. At baseline, the children were normochloraemic (mean+SD chloride 100.4±3.4 mmol/l) with a raised anion gap. Mean bicarbonate (a surrogate for acidosis) was low (17.8±3.0 mmol/l). Ninety …