Intravenous Dextrose for Children With Gastroenteritis and Dehydration: A Double-Blind Randomized Controlled Trial

Levy, Jason A.; Bachur, Richard G.; Monuteaux, Michael C.; Waltzman, Mark L.

doi:10.1016/j.annemergmed.2012.08.007

Cited by 20 publications

(31 citation statements)

References 16 publications

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“…Children with acute gastroenteritis and dehydration are often found to have low serum bicarbonate concentrations and anion gap acidosis . Studies around serum bicarbonate have shown that it may be useful to assess degree of dehydration, it can predict success of oral rehydration therapy, and it can determine patient disposition .…”

Section: Discussionmentioning

confidence: 99%

“…In a previous study we found that children with gastroenteritis and dehydration have elevated serum ketones . Metabolic acidosis from ketonemia may contribute to ongoing nausea, vomiting, and malaise.…”

mentioning

confidence: 81%

“…This was a secondary analysis of a registered (ClinicalTrials.gov #NCT01343758) prospective, double‐blind, randomized controlled clinical trial investigating the use of an IV dextrose bolus for children with symptoms of gastroenteritis and dehydration requiring IV fluids . The study was approved by the hospital institutional review board.…”

Section: Methodsmentioning

confidence: 99%

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Value of Point-of-care Ketones in Assessing Dehydration and Acidosis in Children With Gastroenteritis

et al. 2013

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Section: Discussionmentioning

confidence: 99%

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confidence: 81%

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Value of Point-of-care Ketones in Assessing Dehydration and Acidosis in Children With Gastroenteritis

et al. 2013

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“…Previously, it has been observed that children with gastroenteritis treated with i.v. glucose–containing fluids have more rapid reduction of ketone levels than those treated with normal saline, and a non‐significant trend towards reduction in admission rate . It has also been demonstrated that the rate of re‐presentation admissions is significantly lower in children who have glucose administered on their first presentation with gastroenteritis, independent of the volume of fluid administered .…”

Section: Methodsmentioning

confidence: 99%

“…glucose-containing fluids have more rapid reduction of ketone levels than those treated with normal saline, and a non-significant trend towards reduction in admission rate. 47 It has also been demonstrated that the rate of re-presentation admissions is significantly lower in children who have glucose administered on their first presentation with gastroenteritis, independent of the volume of fluid administered. 48 These outcomes are unlikely to be because of glucose causing an improvement in hydration, but because of an effect on improving acid-base state by reversing ketosis.…”

Section: Box 2 Case 2: Ketoacidosis Without Hypoglycaemiamentioning

confidence: 99%

Review article: Accelerated starvation of childhood: Have I judged ketones?

Millar

Harding

2019

Emerg Medicine Australasia

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Acute ketosis is an important physiological mechanism to prevent irreversible neurological damage from hypoglycaemia during starvation, and represents a significant metabolic stress. A cohort of children adapt to relatively short periods of reduced caloric intake by generating large quantities of ketone bodies. When excessive, the gastrointestinal symptoms of starvation ketosis such as nausea and pain may create a vicious cycle that delays spontaneous resolution. The presence of ketones can be dismissed as a normal feature of childhood metabolism, sometimes even when extreme. A broader understanding of this process under the banner of ‘accelerated starvation of childhood’ is helpful for clinicians managing acute illness in children. We advocate that children less than 7 years of age with a history suggestive of accelerated starvation of childhood should be screened by emergency clinicians for ketosis using a simple and cheap bedside capillary test, even if glucose levels are greater than 2.6 mmol/L. Identification and appropriate management of ketosis may alleviate the distressing gastrointestinal symptoms associated with many minor illnesses, and potentially prevent hypoglycaemia in some children. Appropriate advice to carers may be helpful to prevent further episodes. Illustrative case examples from our own practice are provided.

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Balanced crystalloid solutions versus 0.9% saline for treating acute diarrhoea and severe dehydration in children

Flórez

Sierra

Pérez‐Gaxiola

2023

Cochrane Database of Systematic Reviews

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Background Although acute diarrhoea is a self‐limiting disease, dehydration may occur in some children. Dehydration is the consequence of an increased loss of water and electrolytes (sodium, chloride, potassium, and bicarbonate) in liquid stools. When these losses are high and not replaced adequately, severe dehydration appears. Severe dehydration is corrected with intravenous solutions. The most frequently used solution for this purpose is 0.9% saline. Balanced solutions (e.g. Ringer's lactate) are alternatives to 0.9% saline and have been associated with fewer days of hospitalization and better biochemical outcomes. Available guidelines provide conflicting recommendations. It is unclear whether 0.9% saline or balanced intravenous fluids are most effective for rehydrating children with severe dehydration due to diarrhoea. Objectives To evaluate the benefits and harms of balanced solutions for the rapid rehydration of children with severe dehydration due to acute diarrhoea, in terms of time in hospital and mortality compared to 0.9% saline. Search methods We used standard, extensive Cochrane search methods. The latest search date was 4 May 2022. Selection criteria We included randomized controlled trials in children with severe dehydration due to acute diarrhoea comparing balanced solutions, such as Ringer's lactate or Plasma‐Lyte with 0.9% saline solution, for rapid rehydration. Data collection and analysis We used standard Cochrane methods. Our primary outcomes were 1. time in hospital and 2. mortality. Our secondary outcomes were 3. need for additional fluids, 4. total amount of fluids received, 5. time to resolution of metabolic acidosis, 6. change in and the final values of biochemical measures (pH, bicarbonate, sodium, chloride, potassium, and creatinine), 7. incidence of acute kidney injury, and 8. adverse events. We used GRADE to assess the certainty of the evidence. Main results Characteristics of the included studies We included five studies with 465 children. Data for meta‐analysis were available from 441 children. Four studies were conducted in low‐ and middle‐income countries and one study in two high‐income countries. Four studies evaluated Ringer's lactate, and one study evaluated Plasma‐Lyte. Two studies reported the time in hospital, and only one study reported mortality as an outcome. Four studies reported final pH and five studies reported bicarbonate levels. Adverse events reported were hyponatremia and hypokalaemia in two studies each. Risk of bias All studies had at least one domain at high or unclear risk of bias. The risk of bias assessment informed the GRADE assessments. Primary outcomes Compared to 0.9% saline, the balanced solutions likely result in a slight reduction of the time in hospital (mean difference (MD) −0.35 days, 95% conf...

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Intravenous Dextrose for Children With Gastroenteritis and Dehydration: A Double-Blind Randomized Controlled Trial

Cited by 20 publications

References 16 publications

Value of Point-of-care Ketones in Assessing Dehydration and Acidosis in Children With Gastroenteritis

Value of Point-of-care Ketones in Assessing Dehydration and Acidosis in Children With Gastroenteritis

Review article: Accelerated starvation of childhood: Have I judged ketones?

Balanced crystalloid solutions versus 0.9% saline for treating acute diarrhoea and severe dehydration in children

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