IV Dextrose for Children with Acute Gastroenteritis and Dehydration
Date First Published:
May 22, 2017
Last Updated:
July 16, 2017
Report by:
Dan Chargo MD, Matthew Singh MD, Senior Emergency Medicine Resident (Chargo) and EM Faculty (Singh) (Spectrum Health/Michigan State University Emergency Medicine Residency Program)
Search checked by:
JS Jones MD, Spectrum Health/Michigan State University Emergency Medicine Residency Program
Three-Part Question:
In [pediatric ED patients who present with acute gastroenteritis and dehydration], does [dextrose added to intravenous saline solution] compared with [normal saline solution] lead to reduced hospitalization?
Clinical Scenario:
A 4 year old boy comes in to the ED with 3 days of vomiting and diarrhea. Given the history and exam, you determine this child has gastroenteritis with signs of dehydration. His fingerstick blood glucose is 80 mg/dL (4.44 mmol/L). As the treating physician, you order a rapid infusion of intravenous saline with 5% dextrose. You wonder if the dextrose is really necessary.
Search Strategy:
Medline 1966-06/17 using PubMed, Embase, and Cochrane Library (2017)
Search Details:
[(exp dextrose) AND (Diarrhea OR diarrheoa OR vomiting OR gastroenteritis OR enteritis OR dehydration)]. Limit to Children (birth-18 years) and English language.
Outcome:
66 studies were identified; three prospective trials addressed the clinical question.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Intravenous dextrose for children with gastroenteritis and dehydration: a double-blind randomized controlled trial Levy et al March, 2013 USA | 188 children 6mo-6yrs with gastroenteritis and dehydration. IV normal saline vs. IV D5NS |
Double-blind RCT | Admission rate | No significant difference in admission rates | Small sample size, convenience sample, many in NS group also received dextrose as part of practice standard |
| Change in serum ketone levels | Significant decrease in serum ketone levels for D5NS group | ||||
| Rapid intravenous rehydration by means of a single polyelectrolyte solution with or without dextrose. Rahman O, Bennish ML, Alam AN, Salam MA. October,1988 Bangledash | 67 male children with diarrhea and moderate-severe dehydration. IV crystalloid (Dhaka solution) with vs without dextrose | Blinded RCT | Glucose levels | Increased rate of hyperglycemia in dextrose group, one episode of asympomatic hypoglycemia in control group | Single center, dated study, results not clinically relevant to current US practices and population |
| Urine output | No significant difference | ||||
| Electrolyte changes | No significant difference | ||||
| Clinical Impact of Rapid Intravenous Rehydration With Dextrose Serum in Children With Acute Gastroenteritis. Sendarrubias M, Carrón M, Molina JC, Pérez MÁ, Marañón R, Mora A. November, 2017 Spain | 145 children 6mo-16y presenting to ED with acute gastroenteritis and dehydration, IV normal saline vs. IV normal saline+2.5% glucose (SGS 2.5%) | Open-label RCT | Hospital admission rates | No significant difference in admission rates | Small sample size, not blinded (open-label) |
| 72 hour ED return visit rate | 17.8% vs. 5.6% bounce-back rate, being higher in the normal saline group yet not statistically significant | ||||
| Blood ketone levels | Lower blood ketone levels at 2hrs in SGS 2.5% group |
Author Commentary:
All 3 studies are limited by small sample sizes.
One study is outdated with a different patient population compared to US practice. There does appear to be a difference in short term serum glucose and ketone levels, however the clinical relevance of these lab findings is small. Symptomatic hypoglycemia was rare in each study and hyperglycemia caused by dextrose containing solutions did not demonstrate any clinically adverse effects such as osmotic diuresis. Two studies demonstrate decreases in return visits for groups receiving dextrose (24% in NS vs 17% in D5NS, article 1) and (17.8% NS vs 5.6% in SGS, article 3). These findings were not statistically significant, but may be clinically relevant if a true difference exists. One study points out that this difference is even greater in certain (more ill?) subgroups. Given the small sample sizes for these studies, I would suggest that a larger scale blinded RCT be performed to determine if a true difference exists regarding return visits between groups.
One study is outdated with a different patient population compared to US practice. There does appear to be a difference in short term serum glucose and ketone levels, however the clinical relevance of these lab findings is small. Symptomatic hypoglycemia was rare in each study and hyperglycemia caused by dextrose containing solutions did not demonstrate any clinically adverse effects such as osmotic diuresis. Two studies demonstrate decreases in return visits for groups receiving dextrose (24% in NS vs 17% in D5NS, article 1) and (17.8% NS vs 5.6% in SGS, article 3). These findings were not statistically significant, but may be clinically relevant if a true difference exists. One study points out that this difference is even greater in certain (more ill?) subgroups. Given the small sample sizes for these studies, I would suggest that a larger scale blinded RCT be performed to determine if a true difference exists regarding return visits between groups.
Bottom Line:
Dextrose-containing IV rehydration solutions do not demonstrate a reduction in admission rates for dehydrated children with gastroenteritis when compared to normal saline or similar solutions. Dextrose containing solutions may reduce the rate of ED return visits, however further studies are needed to better analyze this relationship.
References:
- Levy et al. Intravenous dextrose for children with gastroenteritis and dehydration: a double-blind randomized controlled trial
- Rahman O, Bennish ML, Alam AN, Salam MA. . Rapid intravenous rehydration by means of a single polyelectrolyte solution with or without dextrose.
- Sendarrubias M, Carrón M, Molina JC, Pérez MÁ, Marañón R, Mora A.. Clinical Impact of Rapid Intravenous Rehydration With Dextrose Serum in Children With Acute Gastroenteritis.