Levy, Jason A, Richard G Bachur, Michael C Monuteaux, and Mark Waltzman. “Intravenous Dextrose for Children with Gastroenteritis and Dehydration: a Double-Blind Randomized Controlled Trial..” Annals of Emergency Medicine. PMID 22959318
METHODS
- RCT of kids with relatively severe gastro (nearly half got admitted)
- randomised to either initial 20ml/kg saline or D5NS
- fluid use beyond that was up to the doc
- everyone got blinded ketone and sugars taken by the researchers; though they don’t mention how often they got unblinded BSLs as part of usual care which may confuse things
- outcomes were rate of admission (which is a surrogate for what the kid looked like as that’s what usually determines admission)
RESULTS
- n = 188
- 44% admitted in saline group, 35% in D5NS group (non-sig)
- half of kids got glucose at some point of their care
- it improved the ketones
THOUGHTS
- i imagine they’re a fairly glucose heavy institution given that they were studying this which might not be immediately comparable to most places
- 20% of kids were hypoglycemic at initial BSL suggesting that any benefit here might be down to simply treating hypos – if the kids hypo he’s gonna look a bit shitty – it doesn’t mean much beyond symptomatic care but still nice to know.
Just as a reminder – we know that ORS needs glucose to allow the gut to absorb fluid and electrolytes though when you’re giving fluids IV you should be able to avoid this.
Hi Andy,
Interesting paper. I’ve seen a few (non-diabetic) ketotic / ketoacidotic kids with D&V lately, and I’m starting to wonder if its something that we are under-diagnosing…. Sure, we always check the sugar; but should we routinely check the ketones too.
My understanding was that ‘ketones begets more ketones’, with the subsequent epigastric pain and vomiting (created by ketosis) further perpetuates the lack of substrate and hence the development of more ketones.
It would be interesting to see the study breakdown between ketotic & non-ketotic kids ?
Obviously those who get dextrose will clear ketones quicker (less pain, nausea & vomiting) ! Possibly leading to a quicker tolerance of oral fluids, & hence discharge.
Chris.
do we need to measure the ketones to do that? Why not give them all D5NS and skip the test. That’s if we’re gonna give IVs at all.
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