Written by Amanda Mathews
Spoon Feed
Higher IV glucose administration is associated with lower rates of hospitalization and return visits to the ED for pediatric patients presenting with acute gastroenteritis (AGE).
Sugar and spice and everything nice
This was a retrospective cohort study of children at a single tertiary care pediatric hospital in Canada who received IV rehydration for acute gastroenteritis. Children with suspected bacterial/parasitic infections, chronic diseases affecting management, hypotension or hypoglycemia during triage were excluded. 250 children were identified who fit the study with a median age of 28 months.
Primary outcome was hospitalization and secondary outcome was return ED visits within one week. Of note, the protocol at this institution is 4 hours of IV rehydration therapy in the ED and then reassessment for admission. 96% of children received some sort of dextrose 5% containing fluid, and the dose of dextrose over the first hour of rehydration ranged from 0 up to 1141mg/kg. Forty-five (18%) children were hospitalized. A lower amount of dextrose infused during the first hour and very low serum bicarbonate score were both associated with greater odds of hospitalization. Twenty-one (10.4%) children returned to the ED within one week with the amount of dextrose provided in the first and fourth hour related to risk of bounceback.
How will this change my practice?
This is hard to generalize to my practice, especially an institutional protocol of 4 hours of ED rehydration before consideration of admission, which seems long. Mechanistically, giving dextrose-containing fluids to a child in moderate to severe dehydration when they have shifted into ketosis makes sense to me, although optimal amount and dosing is not clear. I will likely continue to use a 20 cc/kg crystalloid bolus for initial management of the moderately dehydrated child who my gestalt tells me will go home, but will consider dextrose fluids up front in populations who seem on the fence between discharge and admission.
Editor’s note: They were not bolusing D5NS. One third were bolused with NS. Most got D5NS infusions for 4 hours. ~Clay Smith
Source
Impact of the Amount of Intravenous Glucose Administration on Hospitalization for Acute Gastroenteritis in a Pediatric Emergency Department. Pediatr Emerg Care. 2025 Mar 1;41(3):176-182. doi: 10.1097/PEC.0000000000003308. Epub 2025 Feb 4. PMID: 39652003
