Oral Rehydration Works As Well As Intravenous Rehydration For Diarrhoea

Main Category: GastroIntestinal / Gastroenterology
Article Date: 22 Jul 2006 - 3:00 PDT

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In wealthy countries it is fashionable to prefer intravenous therapy (IVT) over oral rehydration therapy (ORT). A Cochrane Review however, shows that ORT is just as effective as IVT.

The World Health Organization estimates that in low-income and middle-income countries about 1.8 million children below the age of five years die of diarrhoea each year. Almost 50% of these deaths are due to dehydration and most affect children less than one year of age. Children in high-income countries are not exempt. In the USA, for example, each year roughly 22 to 38 million episodes of diarrhoea occur among the 16.5 million children under the age of five years. Diarrhoea accounts for an estimated 2.1 to 3.7 million physician visits per year and 9% to 10% of all hospital admissions.

The issue is how best to provide these children with fluids and salts - IVT or ORT?

Despite the fact that the American Academy of Pediatrics and the Centers for Disease Control recommend ORT, pediatricians in North America tend to use IVT.

By studying the data from 18 trials, nine of which took place in high income countries, a group of Cochrane researchers found that for every 25 children treated with ORT, only one would need to move on to IVT. If the low osmolarity solution recommended by the WHO is used, then this drops to one in a hundred.

The Review Authors also point out that IVT is much more technically demanding, as the clinicians need to calculate flow rates, whereas with ORT the child's thirst mechanisms will help to regulate intake.

"It seems reasonable that children presenting for medical care with mild to moderate dehydration secondary to acute gastroenteritis should initially be treated with ORT. Should treatment fail, then IVT may be used," says senior Review Author, Dr William Craig who works at University of Alberta, in Edmonton, Canada

Review Title: Hartling L et al. Oral versus intravenous rehydration for treating dehydration due to gastroenteritis in children. Cochrane Database of Systematic Reviews 2006, Issue 3. Art. No.: CD004390.

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There are also several programs, such as the Health InterNetwork Access to Research Initiative (HINARI) that provide access in developing countries. To find out whether your country is included in any of these programmes/provisions, or to learn how to get access if you don't already have it, please visit: http://www.thecochranelibrary.com/.

Jadad AR, Cook DJ, Jones A, Klassen TP, Tugwell P, Moher M, et al. Methodology and reports of systematic Reviews and meta-analysies: a comparison of Cochrane Reviews with articles published in paper-based journal.

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