You are here

Article Text

Article menu
Download PDFPDF
Archimedes
Rehydration strategies in infants and children with acute gastroenteritis refusing or not tolerating an oral fluid challenge
  1. Benjamin Clay1,
  2. Benjamin Gordon Fisher2
  1. 1 School of Clinical Medicine, University of Cambridge, Cambridge, UK
  2. 2 Department of Paediatrics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
  1. Correspondence to Benjamin Clay, School of Clinical Medicine, University of Cambridge, Cambridge, UK; bjc61{at}cam.ac.uk

https://doi.org/10.1136/archdischild-2023-326449

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    Scenario

    A 4-year-old girl is brought to the children’s emergency department (ED) with a 3-day history of diarrhoea and non-bilious vomiting, and a 36-hour history of poor fluid intake with reduced urine output (less than half her usual volumes). She complains of mild epigastric pain but has had no fevers. Her older brother has had similar symptoms in recent days. She shows clinical signs of moderate dehydration including dry mucous membranes, reduced skin turgor, capillary refill time of 2–3 seconds and mild tachycardia. She has not tolerated attempts at oral rehydration with water from her parents at home, nor with oral rehydration solution (ORS) from staff in the ED. You diagnose acute gastroenteritis. Your options for providing rehydration in the department are via nasogastric (NG) tube or intravenous (IV) cannula. Your colleagues differ in opinion regarding the best strategy to achieve an optimal clinical outcome and minimise patient discomfort. The child’s mother is hesitant to permit NG tube insertion due to its potential to cause significant distress to her child.

    Structured clinical question

    In infants and children with mild or moderate dehydration due to acute gastroenteritis who refuse or cannot tolerate oral fluid intake (patient), does the use of IV fluids (intervention) compared with NG fluids (control) lead to faster clinical resolution and/or reduced patient distress (outcome)?

    Search

    The MEDLINE and Embase databases were searched from their inception up to 18 September 2023 with the strategy: (dehydrat*) AND (child* OR paediatric* OR paediatric*) AND (NG OR nasogastric) AND (IV OR intravenous) AND (rehydrat* OR fluid*) .

    The search was limited to English language and the age groups: infant and child (0–18 years). The full text of all returned articles was screened for the following inclusion criteria: (1) NG and IV rehydration were directly compared; (2) patients were diagnosed with acute gastroenteritis; (3) the study was …

    View Full Text

    Footnotes

    • X @benclaymed

    • Contributors BC formulated the topic, performed the literature review and drafted the initial manuscript. Both BC and BGF contributed to the interpretation of the results and revision of the manuscript for important intellectual content and approved the final version of the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.