Acute gastroenteritis in Europe and the use of oral rehydration therapy

1994 ◽  
Vol 72 (3) ◽  
Author(s):  
J.H. Hoekstra
Keyword(s):  
Acute Gastroenteritis ◽  
Oral Rehydration Therapy ◽  
Oral Rehydration

scholarly journals An Audit on the implementation of administering Ondansetron in children with acute gastroenteritis and its effect on admission rate

2021 ◽  
Vol 4 (1) ◽  
pp. 023-026
Author(s):  
D’Sa Saskia ◽  
Hussain Ahad ◽  
Hussain Mushtaq ◽  
Afridi Zahir ◽  
Twomey John ◽  
...  
Keyword(s):  
Acute Gastroenteritis ◽  
Oral Intake ◽  
Admission Rate ◽  
Cost Effective ◽  
Oral Rehydration Therapy ◽  
University Hospital ◽  
Oral Hydration ◽  
Effective Measure ◽  
Oral Rehydration ◽  
Admission Rates

Acute gastroenteritis (AGE) is a common presenting complaint in paediatrics. Most often, the reason for admission into hospital is to initiate intravenous rehydration in patients with severe dehydration and inability to tolerate oral intake. We found that Ondansetron acts as a potent antiemetic to support an increased number of children receiving oral hydration, and subsequently leading to decreased rates of admission. This study aims to audit the use of Ondansetron to Oral Rehydration Therapy (ORT) on children with acute gastroenteritis, and its effect on admission rates from the emergency department in University Hospital, Limerick (UHL). Data collected over a 3-month period from June to August 2017 in which Ondansetron was not used was compared to another 3-month period when Ondansetron was used. Several outcomes were measured including admission to hospital. The rate of admission decreased by 15% [26/74 (35%) in 2017 to 16/81 (20%) in 2019 p = 0.22]. 81 patients received Ondansetron, of which 79% were successfully rehydrated orally. The administration of Ondansetron reduced the need for intravenous fluids and hospital admission overall in these children with AGE. This reduction ultimately accounted for lower costs incurred by the Health Services Executive per patient, and also suggested the anti-emetic use as a cost effective measure for managing and treating patients with AGE.

scholarly journals LO80: Ondansetron administration to non-dehydrated children with acute gastroenteritis-associated vomiting, in emergency departments in Pakistan: a randomized, blinded, phase 3, superiority trial

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S35-S35
Author(s):  
S. Freedman ◽  
S. Soofi ◽  
A. Willan ◽  
S. Williamson-Urquhart ◽  
N. Ali ◽  
...  
Keyword(s):  
Treatment Group ◽  
Acute Gastroenteritis ◽  
Oral Rehydration Therapy ◽  
Fluid Administration ◽  
Double Blind ◽  
Oral Rehydration ◽  
Intravenous Rehydration ◽  
Intravenous Fluid Administration ◽  
Superiority Trial ◽  
Randomization Scheme

Introduction: In high-income countries, vomiting often impedes oral rehydration therapy, leading to intravenous rehydration fluid administration to children with acute gastroenteritis. Ondansetron administration reduces vomiting and intravenous fluid administration in this population. We evaluated whether ondansetron is similarly effective when employed in Pakistan. Methods: In this 2-hospital, double-blind, placebo-controlled, emergency department-based, randomized trial, we recruited children aged 0·5 to 5·0 years, without dehydration, who had diarrhea and 1 episode of vomiting within 4 hours of arrival. Patients were randomly assigned (1:1), via an internet-based randomization service, using a stratified, variable block randomization scheme, to receive a single dose of oral ondansetron or placebo. The primary endpoint was intravenous rehydration (administration of 20 ml/kg over 4 hours of an isotonic fluid) within 72 hours of randomization. All randomized children were analysed. Results: From July 3, 2014, to January 12, 2017, 626 children were randomized. Intravenous rehydration was provided to 10.8% (34/314) and 10.3% (27/312) of children administered placebo and ondansetron, respectively (OR: 0.946; 95% CI: 0.564, 1.587; P=0.834). A regression model fitted with treatment group and adjusted for antiemetic administration and vomiting frequency in the preceding 24 hours, yielded similar results; OR=0.952; 95% CI: 0.570, 1.589; P=0.850. There was no evidence of interaction between treatment group and age (P=0.974), 3 diarrheal stools in the preceding 24 hours (P=0.983) or 3 vomits in the preceding 24 hours (P=0.554). During the 4-hour study observation period, 24.0% (75/314) and 19.6% (61/312) of children in the placebo and ondansetron groups vomited, respectively; OR: 0.774; 95%CI: 0.528, 1.133; P=0.187. Conclusion: Ondansetron administration did not significantly reduce intravenous rehydration use, suggesting that in children without dehydration, ondansetron administration does not significantly alter the disease course and should not be administered to this group of children.

scholarly journals LO34: Predictors of intravenous rehydration in children with acute gastroenteritis in the United States and Canada

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S19
Author(s):  
N. Poonai ◽  
E. Powell ◽  
D. Schnadower ◽  
T. Casper ◽  
C. Roskind ◽  
...  
Keyword(s):  
Knowledge Translation ◽  
Acute Gastroenteritis ◽  
A Priori ◽  
Secondary Analysis ◽  
Oral Rehydration Therapy ◽  
The United States ◽  
Pediatric Emergency ◽  
Research Network ◽  
Oral Rehydration ◽  
Knowledge Translation Strategies

Introduction: Although oral rehydration therapy is recommended for children with acute gastroenteritis (AGE) with none to some dehydration, intravenous (IV) rehydration is still commonly administered to these children in high-income countries. IV rehydration is associated with pain, anxiety, and emergency department (ED) revisits in children with AGE. A better understanding of the factors associated with IV rehydration is needed to inform knowledge translation strategies. Methods: This was a planned secondary analysis of the Pediatric Emergency Research Canada (PERC) and Pediatric Emergency Care Applied Research Network (PECARN) randomized, controlled trials of oral probiotics in children with AGE-associated diarrhea. Eligible children were aged 3-48 months and reported > 3 watery stools in a 24-hour period. The primary outcome was administration of IV rehydration at the index ED visit. We used mixed-effects logistic regression model to explore univariable and multivariable relationships between IV rehydration and a priori risk factors. Results: From the parent study sample of 1848 participants, 1846 had data available for analysis: mean (SD) age of 19.1 ± 11.4 months, 45.4% females. 70.2% (1292/1840) vomited within 24 hours of the index ED visit and 34.1% (629/1846) received ondansetron in the ED. 13.0% (240/1846) were administered IV rehydration at the index ED visit, and 3.6% (67/1842) were hospitalized. Multivariable predictors of IV rehydration were Clinical Dehydration Scale (CDS) score [compared to none: mild to moderate (OR: 8.1, CI: 5.5-11.8); severe (OR: 45.9, 95% CI: 20.1-104.7), P < 0.001], ondansetron in the ED (OR: 1.8, CI: 1.2-2.6, P = 0.003), previous healthcare visit for the same illness [compared to no prior visit: prior visit with no IV (OR: 1.9, 95% CI: 1.3-2.9); prior visit with IV (OR: 10.5, 95% CI: 3.2-34.8), P < 0.001], and country [compared to Canada: US (OR: 4.1, CI: 2.3-7.4, P < 0.001]. Significantly more participants returned to the ED with symptoms of AGE within 3 days if IV fluids were administered at the index visit [30/224 (13.4%) versus 88/1453 (6.1%), P < 0.001]. Conclusion: Higher CDS scores, antiemetic use, previous healthcare visits and country were independent predictors of IV rehydration which was also associated with increased ED revisits. Knowledge translation focused on optimizing the use of antiemetics (i.e. for those with dehydration) and reducing the geographic variation in IV rehydration use may improve the ED experience and reduce ED-revisits.

scholarly journals 118 Predictors of intravenous rehydration in children with acute gastroenteritis in the United States and Canada

2019 ◽  
Vol 24 (Supplement_2) ◽  
pp. e45-e45
Author(s):  
Naveen Poonai ◽  
Elizabeth C Powell ◽  
David Schnadower ◽  
Charlie Casper ◽  
Cindy Roskind ◽  
...  
Keyword(s):  
Knowledge Translation ◽  
Acute Gastroenteritis ◽  
Secondary Analysis ◽  
Oral Rehydration Therapy ◽  
The United States ◽  
Pediatric Emergency ◽  
Research Network ◽  
Oral Rehydration ◽  
Intravenous Rehydration ◽  
Knowledge Translation Strategies

Abstract Background Although oral rehydration therapy is recommended for children with acute gastroenteritis (AGE) with none to some dehydration, intravenous (IV) rehydration is still commonly administered to these children in high-income countries. IV rehydration is associated with pain, anxiety, and emergency department (ED) revisits in children with AGE. Objectives We sought to better understand the factors associated with IV rehydration in children with AGE in order to inform knowledge translation strategies. Design/Methods This was a planned secondary analysis of the Pediatric Emergency Research Canada (PERC) and Pediatric Emergency Care Applied Research Network (PECARN) randomized, controlled trials of oral probiotics in children with AGE-associated diarrhea. Eligible children were aged 3–48 months and reported >3 watery stools in a 24-hour period. The primary outcome was administration of IV rehydration at the index ED visit. We used mixed-effects logistic regression model to explore univariable and multivariable relationships between IV rehydration and a prioririsk factors. Results From the parent study sample of 1848 participants, 1846 had data available for analysis: mean (SD) age of 19.1 ± 11.4 months, 45.4% females. 70.2% (1292/1840) vomited within 24 hours of the index ED visit and 34.1% (629/1846) received ondansetron in the ED. 13.0% (240/1846) were administered IV rehydration at the index ED visit, and 3.6% (67/1842) were hospitalized. Multivariable predictors of IV rehydration were Clinical Dehydration Scale (CDS) score [compared to none: mild to moderate (OR: 8.1, CI: 5.5–11.8); severe (OR: 45.9, 95% CI: 20.1–104.7), P<0.001], ondansetron in the ED (OR: 1.8, CI: 1.2–2.6, P=0.003), previous healthcare visit for the same illness [compared to no prior visit: prior visit with no IV (OR: 1.9, 95% CI: 1.3–2.9); prior visit with IV (OR: 10.5, 95% CI: 3.2–34.8), P<0.001], and country [compared to Canada: US (OR: 4.1, CI: 2.3–7.4, P<0.001]. Significantly more participants returned to the ED with symptoms of AGE within 3 days if IV fluids were administered at the index visit [30/224 (13.4%) versus 88/1453 (6.1%), P<0.001]. Conclusion Higher CDS scores, antiemetic use, previous healthcare visits and country were independent predictors of IV rehydration which was also associated with increased ED revisits. Knowledge translation focused on optimizing the use of antiemetics (i.e. for those with dehydration) and reducing the geographic variation in IV rehydration use may improve the ED experience and reduce ED-revisits.

Preliminary Results on the Use of Oral Rehydration Fluid in the Form of Gelato for Rehydration of Patients at the Children’s Clinical University Hospital’s Emergency and Infectiology Units

2019 ◽  
Vol 800 ◽  
pp. 65-69
Author(s):  
Gunda Zvigule-Neidere ◽  
Arta Barzdina ◽  
Gunta Laizane ◽  
Inese Sviestina ◽  
Karlis Agris Gross
Keyword(s):  
Small Intestine ◽  
Acute Gastroenteritis ◽  
Oral Rehydration Solution ◽  
Oral Rehydration Therapy ◽  
Sweet Taste ◽  
Sodium Ions ◽  
Fluid Absorption ◽  
Oral Rehydration ◽  
Rehydration Solution ◽  
Further Development

Oral rehydration fluids (ORS) are used to reverse dehydration that, in case of children, mostly is due to acute gastroenteritis. The key of successful dehydration treatment is to replenish the lost water and electrolytes. This is best done by consuming oral rehydration solution, containing both salt and sugar. ORS enhances fluid absorption because sodium and glucose transport in the small intestine are coupled, and glucose promotes absorption of both sodium ions and water. Studies show that children refuse ORS due to its salty-sweet taste and unpalatability. To improve oral rehydration therapy, we hypothesized that freezing ORS containing a fruit/berry juice to a likeable texture in “gelato” form could promote oral rehydration. The results provide a basis for further development of the ORS gelato with attention to flavor, sweetness and texture.

scholarly journals Cost-effectiveness of oral ondansetron for children with acute gastroenteritis in primary care: a randomised controlled trial

2021 ◽  
pp. BJGP.2020.1093
Author(s):  
Anouk AH Weghorst ◽  
Gea A Holtman ◽  
Irma J Bonvanie ◽  
Pien I Wolters ◽  
Boudewijn J Kollen ◽  
...  
Keyword(s):  
Primary Care ◽  
Cost Effectiveness ◽  
Randomised Controlled Trial ◽  
Acute Gastroenteritis ◽  
Controlled Trial ◽  
Oral Rehydration Therapy ◽  
Out Of Hours ◽  
Oral Rehydration ◽  
Randomised Controlled ◽  
Oral Ondansetron

Background: Acute gastroenteritis is a common childhood disease with substantial medical and indirect costs, mostly because of referral, hospitalization and parental absence from work. Aim: To determine the cost-effectiveness of adding oral ondansetron to care-as-usual for children with acute gastroenteritis in out-of-hours primary care. Design and setting: A pragmatic randomised controlled trial at three out-of-hours primary care centres, with a follow-up of 7 days. Method: Inclusion criteria were: 1) age 6 months to 6 years; 2) diagnosis of acute gastroenteritis; 3) at least four reported episodes of vomiting 24 hours before presentation, whereof; 4) at least one in the 4 hours before presentation; and 5) written informed consent from both parents. Children were randomly allocated in a 1:1 ratio to either care-as-usual (oral rehydration therapy) or care-as-usual plus one dose of 0.1 mg/kg oral ondansetron. Results: In total, 194 children were included for randomisation. One dose of oral ondansetron decreased the proportion of children who continued vomiting within the first 4 hours from 42.9% to 19.5%, with an odds ratio of 0.4 (95% CI = 0.2–0.7, NNT 4). Total mean costs in the ondansetron group were 31.2% lower (€488 vs €709), and the total incremental mean costs for an additional child free of vomiting in the first 4 hours was −€9 (95% confidence interval, −€41 to €3). Conclusion: A single oral dose of ondansetron for children with acute gastroenteritis, given in out-of-hours primary care settings, is both clinically beneficial and cost-effective.

Evaluation of mothers' knowledge about oral rehydration therapy and sodium concentration in homemade sugar salt solutions

2001 ◽  
Vol 77 (6) ◽  
pp. 481-6
Author(s):  
Lauro Virgílio de Sena ◽  
Helcio de S. Maranhão ◽  
Mauro B. Morais
Keyword(s):  
Oral Rehydration Therapy ◽  
Sodium Concentration ◽  
Salt Solutions ◽  
Oral Rehydration

scholarly journals Issues and Controversies in the Evolution of Oral Rehydration Therapy (ORT)

2021 ◽  
Vol 6 (1) ◽  
pp. 34
Author(s):  
David Nalin
Keyword(s):  
Pediatric Patients ◽  
Oral Rehydration Therapy ◽  
Sodium Balance ◽  
Plain Water ◽  
Oral Glucose ◽  
Oral Rehydration ◽  
Low Sodium ◽  
Current Review ◽  
The Subject ◽  
Rehydration Solution

The original studies demonstrating the efficacy of oral glucose-electrolytes solutions in reducing or eliminating the need for intravenous therapy to correct dehydration caused by acute watery diarrheas (AWD) were focused chiefly on cholera patients. Later research adapted the oral therapy (ORT) methodology for treatment of non-cholera AWDs including for pediatric patients. These adaptations included the 2:1 regimen using 2 parts of the original WHO oral rehydration solution (ORS) formulation followed by 1 part additional plain water, and a “low sodium” packet formulation with similar average electrolyte and glucose concentrations when dissolved in the recommended volume of water. The programmatic desire for a single ORS packet formulation has led to controversy over use of the “low sodium” formulations to treat cholera patients. This is the subject of the current review, with the conclusion that use of the low-sodium ORS to treat cholera patients leads to negative sodium balance, leading to hyponatremia and, in severe cases, particularly in pediatric cholera, to seizures and other complications of sodium depletion. Therefore it is recommended that two separate ORS packet formulations be used, one for cholera therapy and the other for non-cholera pediatric AWD.

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