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Evidence summaries

Oral Versus Intravenous Rehydration for Treating Dehydration Due to Gastroenteritis in Children

There appear to be no clinically important differences in the effectiveness or safety between ORT and IVT. The ORT group did have a higher risk of paralytic ileus, and the IVT group was exposed to risks of intravenous therapy. Level of evidence: "B"

A Cochrane review [Abstract] 1 included 17 studies with a total of 1811 subjects. There were more treatment failures (requiring IVT) with ORT (RD 4%, 95% CI 1 to 7, NNT = 25). Six deaths occurred in the IVT group and two in the ORT groups (4 trials). There were no significant differences in weight gain (369 participants, 6 trials), hyponatremia (248 participants, 2 trials) or hypernatremia (1062 participants, 10 trials), duration of diarrhea (960 participants, 8 trials), or total fluid intake at six hours (985 participants, 8 trials) and 24 hours (835 participants, 7 trials). Shorter hospital stays were reported for the ORT group (WMD -1.20 days, 95% CI -2.38 to -0.02 days; 526 participants, 6 trials). Phlebitis occurred more often in the IVT group (NNT 50, 95% CI 25 to 100) and paralytic ileus more often in the ORT group (NNT 33, 95% CI 20 to 100), but there was no significant difference between ORT using the low osmolarity solutions recommended by the World Health Organization and IVT (729 participants, 6 trials).

Comment: The quality of evidence is downgraded by only modest quality of the trials.

    References

    • Hartling L, Bellemare S, Wiebe N, Russell K, Klassen TP, Craig W. Oral versus intravenous rehydration for treating dehydration due to gastroenteritis in children. Cochrane Database Syst Rev 2006 Jul 19;3:CD004390. [PubMed]

Primary/Secondary Keywords