A more palatable alternative to oral rehydration therapy for kids
Parents no longer need to struggle to get their kids to drink electrolyte solutions during episodes of mild gastroenteritis; apple juice works just as well.
PRACTICE CHANGER
Recommend that parents give half-strength apple juice to children ≥24 months of age who are minimally dehydrated following a case of simple viral gastroenteritis. The juice reduces the need for further interventions better than oral hydration therapy.
Freedman SB, Willan AR, Boutis K, et al. Effect of dilute apple juice and preferred fluids vs electrolyte maintenance solution on treatment failure among children with mild gastroenteritis: a randomized clinical trial. JAMA. 2016;315:1966-1974.1
STRENGTH OF RECOMMENDATION
B: Based on a single, good quality randomized controlled trial.
WHAT’S NEW
Kids drink more of what they like
This study, in a developed country, found rehydration with diluted apple juice worked just as well as ORT. In children ≥24 months of age, there were fewer treatment failures.
CAVEATS
Infants may not benefit,and ondansetron played a role
In this study, children were only mildly dehydrated. Also, the study did not include infants younger than 6 months of age, and the greatest benefit was in children ≥24 months of age.
Also noteworthy was the role that oral ondansetron played. Most (67.4%) of the children received an oral dose of ondansetron (0.1 mg/kg). Although expensive, if one dose prevents a hospitalization, it is cost-effective. Previous studies of oral ondansetron show it reduces vomiting (NNT=5); lowers the rate of intravenous hydration in the ED (NNT=5); and reduces the hospitalization rate from the ED (NNT=17).10
Lastly, there are a variety of fluid replacement guidelines. In this study, fluid replacement was 2 mL/kg for a vomiting episode and 10 mL/kg for a diarrhea episode.
CHALLENGES TO IMPLEMENTATION
Given the ease of swapping diluted apple juice for oral rehydration therapy, we see no barriers to implementation.
ACKNOWLEDGEMENT
The PURLs Surveillance System was supported in part by Grant Number UL1RR024999 from the National Center For Research Resources, a Clinical Translational Science Award to the University of Chicago. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center For Research Resources or the National Institutes of Health.
