Things We Do For No Reason: Electrolyte Testing in Pediatric Acute Gastroenteritis

WHAT WE SHOULD DO INSTEAD

A thorough history and PE can mitigate the need for electrolyte testing in patients with uncomplicated AGE.¹⁴ ORT with repeated clinical assessments, including PE, can assist in monitoring clinical improvement and, in rare cases, identify alternative causes of vomiting and diarrhea.²⁴ We have included 1 validated and simple-to-use CDS (sensitivity of 0.85 [95% confidence interval, 0.73-0.97] for an abnormal score; Table).^25,26 A standardized use of a CDS, obtained with vital signs, from patient presentation through discharge can help determine initial dehydration status and clinical progression. If typical clinical improvement does not take place, it may be time to evaluate for rarer causes of vomiting and diarrhea. Once a patient is clinically rehydrated or if a patient is tolerating oral fluids so that rehydration is expected, the patient should be ready for discharge, and no further laboratory testing should be necessary.

RECOMMENDATIONS

• Perform a thorough history and PE to diagnose AGE.⁸
• Clinical assessment of dehydration should be performed upon initial presentation and repeatedly with vital signs throughout the stay using a validated CDS to classify the patient’s initial dehydration severity and monitor improvement. Obtain a current patient weight and compare with previously recorded weights, if available.^25,26
• Laboratory testing in patients with AGE should not be performed unless a patient is classified as severely dehydrated, is toxic appearing, has a comorbidity that increases the likelihood of complications, or is not improving as expected.
• Rehydration via ORT is preferred to an IV in mild and moderate dehydration.¹⁵
• If initial testing is performed and indicates an expected value indicative of dehydration, do not repeat testing to demonstrate normalization as long as the child is clinically improving as expected.

CONCLUSION

Children presenting with mild-to-moderate dehydration should be treated with supportive measures in accordance with current guidelines. Electrolyte panels very rarely provide clinical information that cannot be garnered through a thorough history and PE. As in our clinical scenario, the laboratory values obtained may have led to potential harm, including overdiagnosis, painful procedures, and psychological distress. Without testing, the patient likely could have been appropriately treated with ORT and discharged from the ED.

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Disclosure

The authors have nothing to disclose.