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Outpatient Oral Rehydration in the United States FREE

Robert Listernick, MD; Edward Zieserl, MD; A Todd Davis, MD
[+] Author Affiliations

Accepted for publication Oct 29, 1985.

Presented in part at the Annual Meeting of the Ambulatory Pediatrics Association, Washington, DC, May 9, 1985.

Reprint requests to Division of General and Emergency Pediatrics, The Children's Memorial Hospital, 2300 Children's Plaza, Chicago, IL 60614 (Dr Listernick).


Am J Dis Child. 1986;140(3):211-215. doi:10.1001/archpedi.1986.02140170037024.
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• Twenty-nine dehydrated, well-nourished infants, who were 3 to 24 months of age and had acute gastroenteritis, were enrolled in a prospective randomized study that compared the safety, efficacy, and costs of oral vs intravenous rehydration. The study was designed to assess the use of a holding room in the emergency room for the outpatient rehydration of dehydrated infants. The oral solution that was used contained 60 mEq/L of sodium, 20 mEq/L of potassium, 50 mEq/L of chloride, 30 mEq/L of citrate, 20 g/L of glucose, and 5 g/L of fructose. Thirteen of 15 patients were successfully rehydrated orally as outpatients; two patients, who were subsequently discovered to have urinary tract infections, required hospitalization due to persistent vomiting. Orally rehydrated outpatients spent a mean of 10.7 hours in the holding room, as compared with intravenously rehydrated inpatients, who were hospitalized for a mean of 103.2 hours. Outpatient oral rehydration therapy was significantly less costly than inpatient intravenous therapy ($272.78 vs $2,299.50). Our results indicate that oral rehydration is a safe and cost-effective means of treating dehydrated children in an outpatient setting in the United States. The use of a holding room for observation in the emergency room can markedly decrease health care costs and unnecessary hospitalizations.

(AJDC 1986;140:211-215)

REFERENCES

Hirschhorn N:  The treatment of acute diarrhea in children: An historical and physiological perspective . Am J Clin Nutr 1980;;33:637-663.
Sack RB, Pierce NF, Hirschhorn N:  The current status of oral therapy in the treatment of acute diarrheal illness . Am J Clin Nutr 1978;;31: 2252-2257.
Hirschhorn N, Kinzie JL, Sachar DB, et al:  Decrease in net stool output in cholera during intestinal perfusion with glucose-containing solutions . N Engl J Med 1968;;279:176-180.
Sack DA, Chowdhury AMAK, Eusof A, et al:  Oral hydration in rotavirus diarrhoea: A double blind comparison of sucrose with glucose electrolyte solution . Lancet 1978;;2:280-283.
Nalin DR, Levine MM, Mata L, et al:  Oral rehydration and maintenance of children with rotavirus and bacterial diarrhoeas . Bull WHO 1979;;57:453-459.
Hirschhorn N, McCarthy BJ, Ranney B, et al:  Ad libitum oral glucose-electrolyte therapy for acute diarrhea in Apache children . J Pediatr 1973;;83:562-570.
Pierce NF, Hirschhorn N:  Oral fluid: A simple weapon against dehydration in diarrhoea . WHO Chron 1977;;31:87-93.
Tamer AM, Friedman LB, Maxwell SRW, et al:  Oral rehydration of infants in a large urban US medical center . J Pediatr 1985;;107:14-19.
Santosham M, Daum RS, Dillman L, et al:  Oral rehydration therapy of infantile diarrhea: A controlled study of well-nourished children hospitalized in the United States and Panama . N Engl J Med 1982;;306:1070-1076.
Hirschhorn N, Cash RA, Woodward WE, et al:  Oral fluid therapy of Apache children with acute infectious diarrhea . Lancet 1972;;2:15-17.
Tripp JH, Harries JT:  UNICEF/WHO glucose-electrolyte solution not always appropriate . Lancet 1980;;2:793.
Schultz SG, Zalusky R:  Transport of sodium and sugar in rabbit ileum—the interaction between active sodium and active sugar transport . J Gen Physiol 1964;;47:1043-1054.
Nalin DR, Cash RA:  Oral or nasogastric maintenance therapy in pediatric cholera patients . J Pediatr 1971;;78:355-358.
Pizarro D, Posada G, Mata L:  Treatment of 242 neonates with dehydrating diarrhea with an oral glucose-electrolyte solution . J Pediatr 1983;;102:153-156.
 Oral therapy for acute diarrhoea , editorial. Lancet 1981;;2:615.
Palmer DL, Koster FT, Islam AFMR, et al:  Comparison of sucrose and glucose in the oral electrolyte therapy of cholera and other severe diarrheas . N Engl J Med 1977;;297:1107-1110.
Sack DA, Islam S, Brown KH, et al:  Oral therapy in children with cholera: A comparison of sucrose and glucose electrolyte solutions . J Pediatr 1980;;96:20-25.
Molla AM, Hossain M, Sarker SA, et al:  Rice-powder electrolyte solutions oral therapy in diarrhea due to Vibrio cholerae and Escherichia coli . Lancet 1982;;1:1317-1319.
Nalin DR, Cash RA, Rahman M, et al:  Effect of glycine and glucose on sodium and water absorption in patients with cholera . Gut 1970;;11: 768-772.
Molla MA, Rahman M, Sarker SA, et al:  Stool electrolyte content and purging rates in diarrhea caused by rotavirus, enteropathogenic Escherichia coli and Vibrio cholerae in children . J Pediatr 1981;;96:835-838.
Bhargava SK, Sachdev HPS, DasGupta B, et al:  Oral rehydration of neonates and young infants with dehydrating diarrhea: Comparison of low and standard sodium content in oral rehydration solutions . J Pediatr Gastroenterol Nutr 1984;;3:500-505.
Committee on Nutrition, American Academy of Pediatrics:  Use of oral fluid therapy and posttreatment feeding following enteritis in children in a developed country . Pediatrics 1985;;2: 358-361.
Willert C, Davis AT, Herman JJ, et al:  Short-term holding room treatment of asthmatic children . J Pediatr 1985;;106:707-711.

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References

Hirschhorn N:  The treatment of acute diarrhea in children: An historical and physiological perspective . Am J Clin Nutr 1980;;33:637-663.
Sack RB, Pierce NF, Hirschhorn N:  The current status of oral therapy in the treatment of acute diarrheal illness . Am J Clin Nutr 1978;;31: 2252-2257.
Hirschhorn N, Kinzie JL, Sachar DB, et al:  Decrease in net stool output in cholera during intestinal perfusion with glucose-containing solutions . N Engl J Med 1968;;279:176-180.
Sack DA, Chowdhury AMAK, Eusof A, et al:  Oral hydration in rotavirus diarrhoea: A double blind comparison of sucrose with glucose electrolyte solution . Lancet 1978;;2:280-283.
Nalin DR, Levine MM, Mata L, et al:  Oral rehydration and maintenance of children with rotavirus and bacterial diarrhoeas . Bull WHO 1979;;57:453-459.
Hirschhorn N, McCarthy BJ, Ranney B, et al:  Ad libitum oral glucose-electrolyte therapy for acute diarrhea in Apache children . J Pediatr 1973;;83:562-570.
Pierce NF, Hirschhorn N:  Oral fluid: A simple weapon against dehydration in diarrhoea . WHO Chron 1977;;31:87-93.
Tamer AM, Friedman LB, Maxwell SRW, et al:  Oral rehydration of infants in a large urban US medical center . J Pediatr 1985;;107:14-19.
Santosham M, Daum RS, Dillman L, et al:  Oral rehydration therapy of infantile diarrhea: A controlled study of well-nourished children hospitalized in the United States and Panama . N Engl J Med 1982;;306:1070-1076.
Hirschhorn N, Cash RA, Woodward WE, et al:  Oral fluid therapy of Apache children with acute infectious diarrhea . Lancet 1972;;2:15-17.
Tripp JH, Harries JT:  UNICEF/WHO glucose-electrolyte solution not always appropriate . Lancet 1980;;2:793.
Schultz SG, Zalusky R:  Transport of sodium and sugar in rabbit ileum—the interaction between active sodium and active sugar transport . J Gen Physiol 1964;;47:1043-1054.
Nalin DR, Cash RA:  Oral or nasogastric maintenance therapy in pediatric cholera patients . J Pediatr 1971;;78:355-358.
Pizarro D, Posada G, Mata L:  Treatment of 242 neonates with dehydrating diarrhea with an oral glucose-electrolyte solution . J Pediatr 1983;;102:153-156.
 Oral therapy for acute diarrhoea , editorial. Lancet 1981;;2:615.
Palmer DL, Koster FT, Islam AFMR, et al:  Comparison of sucrose and glucose in the oral electrolyte therapy of cholera and other severe diarrheas . N Engl J Med 1977;;297:1107-1110.
Sack DA, Islam S, Brown KH, et al:  Oral therapy in children with cholera: A comparison of sucrose and glucose electrolyte solutions . J Pediatr 1980;;96:20-25.
Molla AM, Hossain M, Sarker SA, et al:  Rice-powder electrolyte solutions oral therapy in diarrhea due to Vibrio cholerae and Escherichia coli . Lancet 1982;;1:1317-1319.
Nalin DR, Cash RA, Rahman M, et al:  Effect of glycine and glucose on sodium and water absorption in patients with cholera . Gut 1970;;11: 768-772.
Molla MA, Rahman M, Sarker SA, et al:  Stool electrolyte content and purging rates in diarrhea caused by rotavirus, enteropathogenic Escherichia coli and Vibrio cholerae in children . J Pediatr 1981;;96:835-838.
Bhargava SK, Sachdev HPS, DasGupta B, et al:  Oral rehydration of neonates and young infants with dehydrating diarrhea: Comparison of low and standard sodium content in oral rehydration solutions . J Pediatr Gastroenterol Nutr 1984;;3:500-505.
Committee on Nutrition, American Academy of Pediatrics:  Use of oral fluid therapy and posttreatment feeding following enteritis in children in a developed country . Pediatrics 1985;;2: 358-361.
Willert C, Davis AT, Herman JJ, et al:  Short-term holding room treatment of asthmatic children . J Pediatr 1985;;106:707-711.

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