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This article has a correction. Please see:

Intravenous rehydration of children with gastroenteritis: which solution is better? - August 01, 2007

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Intravenous rehydration of children with gastroenteritis: which solution is better?

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A safe solution
Stephen D Playfor
Published on: 22 March 2016
Added glucose to intravenous fluids for rehydration of children with gastroenteritis- Authors reply
kristen a neville
Published on: 22 March 2016

Published on: 22 March 2016
A safe solution
- Stephen D Playfor, Consultant Paediatric Intensivist
Dear Editor,
The letter from Sanchez-Bayle and colleagues (1) partially describing a study into the administration of hypotonic intravenous fluids adds little to the safety of children receiving intravenous fluids. The deaths of at least 50 children attributable to the administration of hypotonic intravenous fluids in clinical settings associated with increased circulating levels of antidiuretic hormone have been de...
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Dear Editor,
The letter from Sanchez-Bayle and colleagues (1) partially describing a study into the administration of hypotonic intravenous fluids adds little to the safety of children receiving intravenous fluids. The deaths of at least 50 children attributable to the administration of hypotonic intravenous fluids in clinical settings associated with increased circulating levels of antidiuretic hormone have been described; typically these are previously healthy children with gastroenteritis or in the postoperative phase following minor surgical procedures (2). At least six or seven children have died in the UK in this manner within the last five years (3), with the deaths of some of these children currently being investigated by the Police Service of Northern Ireland.
Whilst the routine prescription of hypotonic intravenous fluids may be safe if the volumes administered are very tightly restricted and with close plasma electrolyte and fluid balance monitoring, the sad fact is that, around the world, we have demonstrated that in clinical practice we are unable to administer these fluids in such a manner, resulting in the needless deaths of previously healthy children.
Furthermore, there is absolutely no advantage in routinely administering a fluid with tonicity below that of 0.45% saline, and certain high-risk groups, such as those with established hyponatraemia, gastroenteritis or in the postoperative state, should only ever receive isotonic fluids. The use of isotonic fluids such as sodium chloride 0.9% with glucose 5% will adequately deal with ‘maintenance’ glucose requirements in the majority of children.
Given the clear dangers associated with the routine administration of the most hypotonic intravenous fluids, and given the clear lack of advantage in their use, I am surprised that Sanchez-Bayle’s study was granted ethical approval. Deaths due to this mechanism are rare and I will be interested to see how many thousands of children these authors intend to study to demonstrate the safety of sodium chloride 0.3% with glucose 5% in this setting.
SD Playfor
References:
1. Sanchez-Bayle M, Alonso-Ojembarrena A, Cano-Fernandez J. Intravenous rehydration of children with gastroenteritis: which solution is better? Arch Dis Child 2006; 91: 716.
2. Moritz ML, Ayus JC. Preventing neurological complications from dysnatremias in children. Pediatr Nephrol 2005; 20:1687-1700.
3. Playfor SD. Fatal iatrogenic hyponatraemia. Arch Dis Child 2003; 88: 646-647.
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Conflict of Interest:
None declared.
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Published on: 22 March 2016
Added glucose to intravenous fluids for rehydration of children with gastroenteritis- Authors reply
- kristen a neville, doctor
- Other Contributors:
  Charles F Verge, Andrew R Rosenberg, Matthew W OMeara, Jan L Walker
Dear Editor,
The letter from Sanchez-Bayle and colleagues(1) states that the administration of hypotonic saline to children with gastroenteritis is not, in their hands, associated with an increased risk of hyponatraemia. This is in sharp contrast to our findings,(2,3) and those of others, showing that the risk is real. Unfortunately the data provided by Sanchez- Boyle is insufficient for analysis and we look for...
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Dear Editor,
The letter from Sanchez-Bayle and colleagues(1) states that the administration of hypotonic saline to children with gastroenteritis is not, in their hands, associated with an increased risk of hyponatraemia. This is in sharp contrast to our findings,(2,3) and those of others, showing that the risk is real. Unfortunately the data provided by Sanchez- Boyle is insufficient for analysis and we look forward to their findings being published in full.
On the other hand, we also concluded from our studies that any isotonic solution used should contain added glucose. In two studies of children with gastroenteritis (n=154) we have documented a 4% rate of hypoglycaemia (blood glucose concentration <2.6mmol/L) at presentation.(2,3) In both studies the hypoglycaemia responded to the 2.5% dextrose content of the intravenous fluid prescribed at either the slower or rapid rehydration rate. Much of the recent literature on isotonic versus hypotonic saline solutions for children ignores the need for glucose and we welcome this focus.
Kristen A Neville, Charles F Verge, Andrew R Rosenberg, Matthew W O’Meara, Jan L Walker
References:
1. Sanchez-Bayle M, Alonso-Ojembarrena A, Cano-Fernandez J. Intravenous rehydration of children with gastroenteritis: which solution is better? Archives of Disease in Childhood.91(8):716, 2006.
2. Neville KA, Verge CF, O'Meara MW, Walker JL. High antidiuretic hormone levels and hyponatremia in children with gastroenteritis. Pediatrics.116(6):1401-7, 2005.
3. Neville KA, Verge CF, Rosenberg AR, O'Meara MW, Walker JL. Isotonic is better than hypotonic saline for intravenous rehydration of children with gastroenteritis: a prospective randomised study. Archives of Disease in Childhood.91(3):226-32, 2006.
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Conflict of Interest:
None declared.
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