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Treatment of Children with Mild Gastroenteritis

JAMA; 2016 May 10; Freedman, Willan, et al

Initial oral hydration with dilute apple juice followed by their preferred fluids, compared with electrolyte maintenance solution, resulted in fewer treatment failures among children with mild gastroenteritis. This according to a study of 647 children (mean age 28.3 months, 68.2% without evidence of dehydration) randomly assigned to receive color-matched half-strength apple juice/preferred fluid (n=323) or apple-flavored electrolyte maintenance solution (n=324). Oral rehydration therapy followed institutional protocols. Researchers found:

• Children who were administered dilute apple juice experienced treatment failure less often than those given electrolyte maintenance solution (16.7% vs 25.0%).

• Fewer children administered apple juice/preferred fluids received intravenous rehydration (2.5% vs 9.0%).

• Hospitalization rates and diarrhea and vomiting frequency were not significantly different between the groups.

Citation: Freedman SB, Willan AR, Boutis K, Schuh S. Effect of dilute apple juice and preferred fluids vs electrolyte maintenance solution on treatment failure among children with mild gastroenteritis. JAMA. 2016;315(18):1966-1974. doi:10.1001/jama.2016.5352.

Commentary: This study challenges the current standard that children with diarrhea and dehydration do best when they receive an oral rehydrating solution (ORS). The idea behind using an ORS is that while diarrhea causes an increase in the amount of fluid lost in the gut, the Na-coupled solute co-transport mechanism pulls salt and water through the intestine back into the body, allowing efficient reabsorption of salt and water. ORS have been primarily studied in third-world nations in children with cholera and other forms of severe diarrhea.1 In developed countries though, such severe diarrhea is rare, and a more common issue in children refusing to drink the ORS. This study shows that in children over 6 months of age with mild gastroenteritis, likely due to the tolerability of dilute apple juice followed by their choice of liquid, the need for IVF was less in the dilute apple juice group than in the ORS group. It is important to remember that this study was in children with mild diarrhea, and that for children under 6 months of age or children with moderate to severe dehydration, a formal ORS may still be preferable. —Neil Skolnik, MD

1. King CK, Glass R, Bresee JS, Duggan C. Managing acute gastroenteritis among children. MMWR. 2003; 52(RR16):1-16.