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Oral Rehydration Solutions versus Drink of Choice in Children with Dehydration: A Review of Clinical EffectivenessFreige C; Spry COral Rehydration Solutions versus Drink of Choice in Children with Dehydration: A Review of Clinical Effectiveness-/-CADTH Rapid Response Reports 2020[Mar]; ä (ä): äChildren generally have a higher body water content (60-75%) compared to adults (55-60%). Dehydration in children is a concern as their higher body water content makes them more prone to water, sodium and potassium loss during acute illnesses. Vomiting, diarrhea, or other causes of excessive fluid loss can lead to varying degrees of dehydration from mild (3-5% weight loss) to moderate (6-10% weight loss) and severe (10-15% weight loss). Symptoms of dehydration in children differ according to the degree of dehydration, but can include hyperirritability, lethargy, intense thirst, mottled or cyanotic skin, a rapid pulse, hypotension and shock in more severe cases. Three types of dehydration can occur: isonatremic, hypernatremic, and hyponatremic. Isonatremic dehydration is the most common presentation (80% of cases) and is characterized by equal loss of water and salt. Hypernatremic dehydration represents a smaller fraction of cases (15%) and is characterized by a greater water loss. Hyponatremic dehydration is the rarest presentation (5% of cases) and is characterized by either excessive water intake, sodium depletion or an artificial lowering of serum sodium concentration secondary to an increase in glucose, electrolytes, lipids and proteins. The treatments of the different types of dehydration vary, but all involve replacing fluid deficits. Oral rehydration therapy is the first line treatment for children with mild to moderate dehydration. Commercially available oral rehydration solutions contain specific concentrations of sodium, potassium and glucose with the aim of optimizing fluid absorption through the gastrointestinal tract via the sodium-glucose cotransporter pump.(,) Oral rehydration solutions can thus be used for all types of dehydration as long as the serum sodium concentrations are not at the extreme ends of the spectrum in hyponatremic or hypernatremic dehydration. However, oral rehydration solutions are considered to be prohibitively expensive for some patients (or their guardians) and often have an unpleasant taste. This may lead to dehydrated children being treated with other beverages which may not contain the optimal carbohydrate and electrolyte concentrations needed for rehydration. Other, often more palatable, oral rehydration options include water, clear broths, ice pops, and juice or sports drinks. This report aims to summarize the evidence regarding the comparative clinical effectiveness of oral rehydration solution versus other fluids of choice for pediatric patients with, or at risk of, dehydration.ä |
