Meeting News Coverage

Diluted apple juice superior to electrolyte maintenance in children with mild gastroenteritis

BALTIMORE — Children with mild gastroenteritis and minimal dehydration experienced fewer treatment failures when given diluted apple juice followed by their preferred fluids compared with electrolyte maintenance solution, according to new research published in JAMA.

This study was also presented at the Pediatric Academic Societies meeting.

Routine administration of electrolyte maintenance solution may not be as beneficial an approach to managing mild gastroenteritis in children in areas where significant dehydration is uncommon, Stephen B. Freedman, MDCM, MSc, of the University of Calgary in Canada, and colleagues wrote. Moreover, electrolyte maintenance solution is relatively expensive and its taste can limit its use, and “thus, there remains a need to improve oral rehydration success in children with minimal dehydration.”

Freedman and colleagues performed a single-center, randomized, single blind noninferiority trial at a tertiary care pediatric ED in Toronto from October 2010 to April 2015. They randomly assigned 647 children aged 6 to 60 months with gastroenteritis and minimal dehydration (mean age, 28.3 months; 68.2% without evidence of dehydration) to receive either color-matched half-strength apple juice followed by their preferred fluids (intervention group; n = 323) or apple-flavored electrolyte maintenance solution (control group; n = 324). The intervention group was given fluids as desired after discharge, while the control group replaced losses with electrolyte maintenance solution.

A composite measure of treatment failure within 1 week of enrollment served as the primary outcome, which was defined as hospitalization or IV rehydration, subsequent unscheduled physician encounter for the same episode of vomiting or diarrhea, protracted symptoms, crossover, and/or at least 3% weight loss or significant dehydration at in-person follow-up. IV rehydration, hospitalization and frequency of diarrhea and vomiting served as secondary endpoints.

Among the 99.5% of children who completed follow-up, those in the intervention group experienced fewer treatment failures (16.7%; 95% CI, 12.8-21.2) vs. controls (25%; 95% CI, 20.4-30.1; P < .001 for inferiority and P = .006 for superiority). Those in the intervention group also received IV rehydration less often (2.5% vs. 9%). Comparable rates of hospitalization, diarrhea and vomiting frequency occurred between groups.

“These results challenge the recommendation to routinely administer electrolyte maintenance solution when diarrhea begins,” which is largely based on a smaller, unblinded study, the researchers wrote. “The present study findings, derived from a larger and more heterogeneous population, confirmed via provincial registries, and conducted in an era when complicated episodes of gastroenteritis have become uncommon, may more accurately reflect the effect rehydration fluid choice has on unscheduled medical visits.”

Thus, diluted apple juice and preferred fluids may be an appropriate alternative to electrolyte maintenance solution for treating children with mild gastroenteritis and minimal dehydration in many high-income countries, they concluded. – by Adam Leitenberger

Disclosure: The researchers report no relevant financial disclosures.

Reference:

Freedman SB, et al. Electrolyte Maintenance Solution Versus Usual Fluids in Children With Acute Gastroenteritis: A Randomized Clinical Trial. Presented at: Pediatric Academic Societies meeting; April 30 to May 3, 2016; Baltimore.

BALTIMORE — Children with mild gastroenteritis and minimal dehydration experienced fewer treatment failures when given diluted apple juice followed by their preferred fluids compared with electrolyte maintenance solution, according to new research published in JAMA.

This study was also presented at the Pediatric Academic Societies meeting.

Routine administration of electrolyte maintenance solution may not be as beneficial an approach to managing mild gastroenteritis in children in areas where significant dehydration is uncommon, Stephen B. Freedman, MDCM, MSc, of the University of Calgary in Canada, and colleagues wrote. Moreover, electrolyte maintenance solution is relatively expensive and its taste can limit its use, and “thus, there remains a need to improve oral rehydration success in children with minimal dehydration.”

Freedman and colleagues performed a single-center, randomized, single blind noninferiority trial at a tertiary care pediatric ED in Toronto from October 2010 to April 2015. They randomly assigned 647 children aged 6 to 60 months with gastroenteritis and minimal dehydration (mean age, 28.3 months; 68.2% without evidence of dehydration) to receive either color-matched half-strength apple juice followed by their preferred fluids (intervention group; n = 323) or apple-flavored electrolyte maintenance solution (control group; n = 324). The intervention group was given fluids as desired after discharge, while the control group replaced losses with electrolyte maintenance solution.

A composite measure of treatment failure within 1 week of enrollment served as the primary outcome, which was defined as hospitalization or IV rehydration, subsequent unscheduled physician encounter for the same episode of vomiting or diarrhea, protracted symptoms, crossover, and/or at least 3% weight loss or significant dehydration at in-person follow-up. IV rehydration, hospitalization and frequency of diarrhea and vomiting served as secondary endpoints.

Among the 99.5% of children who completed follow-up, those in the intervention group experienced fewer treatment failures (16.7%; 95% CI, 12.8-21.2) vs. controls (25%; 95% CI, 20.4-30.1; P < .001 for inferiority and P = .006 for superiority). Those in the intervention group also received IV rehydration less often (2.5% vs. 9%). Comparable rates of hospitalization, diarrhea and vomiting frequency occurred between groups.

“These results challenge the recommendation to routinely administer electrolyte maintenance solution when diarrhea begins,” which is largely based on a smaller, unblinded study, the researchers wrote. “The present study findings, derived from a larger and more heterogeneous population, confirmed via provincial registries, and conducted in an era when complicated episodes of gastroenteritis have become uncommon, may more accurately reflect the effect rehydration fluid choice has on unscheduled medical visits.”

Thus, diluted apple juice and preferred fluids may be an appropriate alternative to electrolyte maintenance solution for treating children with mild gastroenteritis and minimal dehydration in many high-income countries, they concluded. – by Adam Leitenberger

Disclosure: The researchers report no relevant financial disclosures.

Reference:

Freedman SB, et al. Electrolyte Maintenance Solution Versus Usual Fluids in Children With Acute Gastroenteritis: A Randomized Clinical Trial. Presented at: Pediatric Academic Societies meeting; April 30 to May 3, 2016; Baltimore.

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