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Other Pediatric Literature of Interest


 

1. Bender B, Skae C, Ozuah P. Oral rehydration therapy: the clear solution to fluid loss. Contemp Pediatr. 2005;22:72-6.

Acute diarrhea leads to more than 1.5 million outpatient visits, 200,000 hospital visits, and 300 deaths per year in the United States. Oral rehydration therapy (ORT) is the preferred approach to treat mild to moderate dehydration due to acute gastroenteritis that includes diarrhea and vomiting. Mild dehydration is defined as a fluid deficit of less than 3%–5%, moderated dehydration is 5%–10%, and severe dehydration is greater than 9%–10%.

The practice of oral rehydration can be traced back more than 150 years. Studies have shown that more than 90% of children can be successfully rehydrated orally and that these children have a lower complication rate than those treated with IV fluids. The key to successful rehydration is to use the appropriate rehydration fluid. These fluids include Pedialyte, Enfalyte, Rehydralyte, or any other “lyte” fluid. Parents should be discouraged from using soda, juice, and chicken broth, because these liquids can cause electrolyte abnormalities.

There are 2 components of ORT: rehydration and maintenance. For rehydration, a child should receive 50–100 ml/kg of oral rehydration solution over a 3–4 hour period. Replacement fluids are estimated at 10 mL/kg for each stool and 2 mL/kg for each episode of vomiting. The most important consideration in successfully rehydrating a child who is vomiting is to offer a small volume frequently. ORT should start with one teaspoon every 1–2 minutes. Severely dehydrated children should receive IV fluid boluses until perfusion and mental status is normal, and then ORT can be initiated.

Treatment of ORT remains widely underused. Stated barriers include lack of convenience, inadequately trained staff , children’s unwillingness to take the solution, parents and staff preference for IV therapy, lower reimbursement for ORT, cost of ORT to parents, extended length of stay in the emergency department compared with IV therapy, and persistent vomiting that prevents administration of ORT. Recent data show that in the emergency department ORT actually requires less time than IV therapy and is less painful. In addition, the data showed that parents were more satisfied with the ED visit when ORT was used. ORT is less expensive than IV therapy. Children who refuse oral rehydration solution are usually not dehydrated and therefore do not crave the high salt concentration found in oral rehydration solutions.

  1. Concise Reviews of Pediatric Infectious Diseases: Treatment of community-associated methicillinresistant Staphylococcus aureus infections. Pediatr Infect Dis J. 2005;24:45760.

Supplements

Supplement to Pediatric Critical Care Medicine. 2005;6. This supplement is devoted to sepsis in infants and children.

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