Rapid IV Rehydration Not Recommended

The increased risks that accompany a rapid intravenous rehydration (RIVR) protocol do not warrant its recommended use, according to a new study.

Researchers from the Hospital for Sick Children (Toronto, Canada) conducted a blinded and randomized trial that compared RIVR with standard intravenous (IV) rehydration in 226 children between December 2006 and April 2010; various baseline characteristics were similar between the two groups. Both groups subsequently received IV fluids for another three hours and standard oral rehydration therapy. The primary outcome was clinical evidence of rehydration within two hours of starting the IV drip; secondary outcomes included the need for longer-term therapy, clinical rehydration scores, time to discharge, and return visits to the hospital.

The results showed that clinical rehydration was not significantly different between the RIVR group and the standard group. Even after adjustment for weight, dehydration score at baseline, and pH at baseline, RIVR did not influence the primary outcome. The proportion of patients requiring prolonged therapy was similar in the RIVR and standard groups. Although the clinical dehydration scores were consistently similar between the RIVR and standard groups, as were revisits, those treated with RIVR remained in the hospital longer. The findings were presented at the Pediatric Academic Societies (PAS) and Asian Society for Pediatric Research (ASPR) annual meeting, held during April 2001 in Denver (CO, USA).

"Oral rehydration therapy for children is appropriate but is underused. In particular, rapid intravenous rehydration lacks a standard definition and evidence of efficacy,” said lead author and study presenter Stephen Freedman, MDCM. "Given the potential risks associated with this approach, our data indicate that its use should be reconsidered.”

A basic IV rehydration solution consists of sterile water with small amounts of sodium chloride (NaCl) and dextrose added to it. Additional electrolytes such as potassium, calcium, bicarbonate, phosphate, magnesium, chloride, vitamins, or drugs can be added as needed, either in a separate minibag or via an injection into the IV line. The researchers speculated that the RIVR approach might have failed because of the possibility of hyperchloremic metabolic acidosis resulting from the administration of a larger volume of fluid, lag time in initiating treatment, and altered dehydration scores by undefined factors.

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Hospital for Sick Children