Obtaining intravenous access to treat dehydrated infants and youths can be a challenge for the everyday hospitalist. One alternative is subcutaneous rehydration. Interim results from the Increased Flow Utilizing Subcutaneously-Enabled Pediatric Rehydration I (INFUSE) study presented at the recent American College of Emergency Physicians meeting in Boston suggests subcutaneous rehydration as a viable alternative in children with mild to moderate dehydration.
Complete study results were published in the October issue of Pediatrics (doi:10.1542/peds.2008-3588).
"The study included 51 children admitted to emergency rooms throughout the country who were given Hylenex (hyaluronidase human injection-Baxter)," says Sharon Mace, MD, director of pediatric education and quality improvement at the Cleveland Clinic. Hylenex is a purified preparation of the hyaluronidase enzyme; after being administered subcutaneously, it facilitates the infusion of subcutaneous
fluids. "The majority of the patients were able to be given subcutaneous fluids and then sent home," Dr. Mace adds. "In 86% of patients, the catheter was successfully placed on the first attempt. This contrasts to other studies suggesting that the success rate for IV placement in young children is 50% at best."
Shawn L. Ralston, MD, a pediatric hospitalist at the University of Texas Health Sciences Center in San Antonio, notes that most of the time the question of access already has been addressed in the ED. However, there is a subset of medically complex patients in which subcutaneous rehydration is a useful technique to consider.
"The great thing for the hospitalist is that subcutaneous rehydration is almost always one-stick," Dr. Ralston says. "We also find that after rehydration the kids are able to soon begin taking nutrition and water by mouth again."
According to Dr. Mace, only such minor adverse events as swelling and redness at the injection site were observed. No allergic responses were noticed.