01 May Dilute Apple Juice May Be More Palatable For Rehydration In Children with Mild Gastroenteritis
MedicalResearch.com Interview with:
Stephen B. Freedman MDCM, MSc,
Department of Paediatrics, Sections of Emergency Medicine and Gastroenterology;
ACHRI Healthy Outcomes Theme Group Leader
Alberta Children’s Hospital, and Alberta Children’s Hospital Research Institute
University of Calgary,
MedicalResearch.com: What is the background for this study?
Dr. Freedman: As a pediatric emergency medicine physician I continue to see large numbers of children who are brought for emergency care because of vomiting and diarrhea. In speaking with their caregivers it is clear that many of them try to administer electrolyte maintenance solutions at home but the children either refuse to drink them or they continue to vomit. As a researcher I have noticed that many children continue to receive intravenous rehydration despite not being significantly dehydrated and it appeared that this was often a physician’s response to a failed oral rehydration challenge in the emergency department, either due to refusal to consume the electrolyte maintenance solution supplied or because the children became more nauseous due to the poor palatability of the solution. It appeared that perhaps a less dogmatic approach aimed at providing fluids that children actually like, might overcome these problems leading to improved outcomes.
MedicalResearch.com: What are the main findings?
Dr. Freedman: Children with mild gastroenteritis and minimal dehydration experienced fewer treatment failures when offered dilute apple juice followed by their preferred fluid choice compared with those instructed to drink electrolyte maintenance solution to replace fluid losses. We found the benefit was greatest in those 24 to 60 months of age. The group provided and instructed to take their preferred fluids were administered intravenous rehydration less frequently.
MedicalResearch.com: What should clinicians and patients take away from your report?
Dr. Freedman: In many high-income countries, the use of dilute apple juice and preferred fluids may be an appropriate alternative to electrolyte maintenance solution use in children with mild gastroenteritis and minimal dehydration.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Dr. Freedman: It would be very interesting and important to monitor how the integration of our proposed approach to oral rehydration affects intravenous rehydration rates, hospitalizations and revisits in children across Canada and the United States. I also think it will also be important, if this approach becomes widely adopted, to conduct large scale database studies to monitor clinical outcomes and adverse events.
MedicalResearch.com: Is there anything else you would like to add?
Dr. Freedman: This study demonstrates the importance of working with patients to provide pragmatic, patient-centered approaches to care that is tailored to the affected individuals. Rigid, one-size fits all approaches, can result in sub-optimal outcomes despite the best intentions.
MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.
Stephen B. Freedman, Andrew R. Willan, Kathy Boutis, Suzanne Schuh. Effect of Dilute Apple Juice and Preferred Fluids vs Electrolyte Maintenance Solution on Treatment Failure Among Children With Mild Gastroenteritis. JAMA, 2016;
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Last Updated on May 1, 2016 by Marie Benz MD FAAD