Rehydration strategies yield similar mortality outcome in kids with malnutrition, gastroenteritis

In the treatment of children with severe acute malnutrition and gastroenteritis, those who undergo oral rehydration therapy have similar mortality rates as those who receive intravenous rehydration therapy, according to a study.

The study included 272 children aged 6 months to 12 years of age who had severe acute malnutrition with gastroenteritis and dehydration. They were randomly assigned to receive one of the following rehydration strategies: oral rehydration, plus intravenous boluses for shock (n=138); a rapid intravenous strategy that consisted of lactated Ringer’s solution (100 ml per kg of body weight) administered over a period of 3–6 hrs, with boluses for shock (n=67); or a slow intravenous strategy that consisted of the same solution administered over a period of 8 hrs, with no boluses (n=67). All participants were followed for 28 days.

A nasogastric tube was used for oral rehydration in 93 percent of participants in the oral group and in 65 percent of those in the combined intravenous groups. Intravenous boluses were administered at admission in 9 percent of participants in the oral group, 10 percent in the rapid intravenous group, and none in the slow intravenous group.

The primary endpoint of death at 96 hrs occurred in 8 percent of participants in the oral group and in 7 percent in the combined intravenous groups. The difference was not statistically significant (risk ratio, 1.02, 95 percent confidence interval [CI], 0.41–2.52; p=0.69).

At day 28, a total of 12 percent and 10 percent of participants in the oral and combined intravenous groups, respectively, had died (hazard ratio, 0.85, 95 percent CI, 0.41–1.78).

As for safety, serious adverse events were documented in 23 percent of participants in the oral group, 21 percent in the rapid intravenous group, and 15 percent in the slow intravenous group. There were no reports of pulmonary edema, heart failure, or fluid overload occurring during the study.