| Extracellular fluid restoration in dehydration: a critique of rapid versus slow. | |
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MedLine Citation:
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PMID: 10454776 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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We compared current recommendations for treatment of severe dehydration by World Health Organization physicians and by the American Academy of Pediatrics Committee on Pediatric Gastroenterology with those in general textbooks of pediatrics, written mostly by pediatric nephrologists. The former recommend rapid (1- to 2-h) and generous intravenous restoration of extracellular fluid (ECF) volume followed by oral rehydration therapy (ORT) to replace potassium, current maintenance, and diarrheal losses--the rapid rehydration regimen. Oral feedings usually are resumed in 8-24 h. General textbooks of pediatrics usually recommend giving 20 ml/kg saline "to restore circulation," followed by the deficit therapy regimen to correct serum electrolyte abnormalities and replace remaining deficits of water, sodium, chloride, and potassium over 1-2 days. Mortality for hospitalized patients with dehydration treated with rapid rehydration was <3 per 1,000; no recent results are reported for patients treated by deficit therapy. The rapid rehydration regimen improves patient well being and restores perfusion, so that oral feedings are readily tolerated and renal function corrects serum electrolyte abnormalities in 6 h. Amounts of saline given correspond to amounts given for treating various forms of shock. Deficit therapy regimens provide less ECF restoration and are slower at restoring perfusion; tolerance for oral feedings is delayed. Two hundred pediatric nephrologists were surveyed, asking how they would treat a patient with severe dehydration and a patient with 40% burns. Only 30 of 200 responded; 29 used a deficit therapy regimen, with 20-40 ml/kg ECF replacement, while a majority rapidly and generously restored ECF volume in burn shock. We recommend that fluid therapy chapters should stop teaching deficit therapy for treating severe dehydration and instead teach the rapid rehydration regimen. |
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Authors:
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M A Holliday; A L Friedman; S J Wassner |
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Publication Detail:
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Type: Journal Article; Review |
Journal Detail:
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Title: Pediatric nephrology (Berlin, Germany) Volume: 13 ISSN: 0931-041X ISO Abbreviation: Pediatr. Nephrol. Publication Date: 1999 May |
Date Detail:
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Created Date: 1999-08-17 Completed Date: 1999-08-17 Revised Date: 2005-11-16 |
Medline Journal Info:
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Nlm Unique ID: 8708728 Medline TA: Pediatr Nephrol Country: GERMANY |
Other Details:
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Languages: eng Pagination: 292-7 Citation Subset: IM |
Affiliation:
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Department of Pediatrics, University of California, San Francisco, USA. mah@itsa.ucsf.edu |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Child Child, Preschool Dehydration / physiopathology, therapy* Extracellular Space / physiology Fluid Therapy* Food Humans |
| Comments/Corrections | |
Comment In:
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Pediatr Nephrol. 2000 Apr;14(4):352-53
[PMID:
10775084
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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