title: Pediatric rapid fluid resuscitation.
abstract: OBJECTIVE
  Intravenous and enteral fluid resuscitation are frequently used therapies in the management of pediatric patients in emergency departments and critical care settings. Any state of intravascular fluid deficit, ranging from mild dehydration due to gastroenteritis to fulminant septic shock, requires careful assessment and early restoration of hemodynamic stability. Rapid fluid resuscitation has gained increased recognition since the most recent pediatric shock management guidelines. We sought to review the evidence for rapid fluid resuscitation and to outline its clinical indications, implementation, and potential associated risks.
  
  
  RESULTS
  Rapid fluid resuscitation benefits pediatric patients with severe dehydration or signs of shock. Studies have proven the modality to be safe and efficacious and to reduce morbidity and mortality. Initial and frequent clinical assessments are key in reducing potential complications of overhydration or clinically significant electrolyte disturbances. Rapid enteral rehydration may be used in the uncomplicated, mildly to moderately dehydrated patient. Antiemetics may facilitate rehydration efforts by limiting further fluid losses.
  
  
  CONCLUSIONS
  Rapid fluid resuscitation is most commonly used for children with moderate-to-severe dehydration, or for patients in shock to restore circulation. Concerns regarding potential for fluid overload and electrolyte disturbances and regarding the method of rehydration (i.e., enteral versus parenteral) raise some debate about the safety and efficacy of rapid fluid resuscitation in the pediatric patient. Recent studies show that early, aggressive fluid resuscitation of up to 60 ml/kg within 1-2 h may be necessary to replenish circulating intravascular fluid volume. Complications of severe electrolyte disturbances, cerebral edema, or uncontrolled hemorrhage are uncommon and can often be avoided with early clinical assessment and reassessments throughout the resuscitation. In the mildly to moderately dehydrated child, enteral fluid resuscitation with the aid of an antiemetic such as ondansetron can be as effective and efficient as intravenous fluid resuscitation.
authors.affiliation: Division of Emergency Medicine, Children's National Medical Center, Department of Pediatrics and Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA.
authors.forename: Joelle N
authors.initials: JN
authors.lastname: Simpson
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Teach
mesh_terms: D000932:Antiemetics / Q000627:therapeutic use; D002648:Child; D003131:Combined Modality Therapy; D003681:Dehydration / Q000209:etiology / Q000628:therapy*; D005440:Fluid Therapy / Q000009:adverse effects / Q000379:methods; D005759:Gastroenteritis / Q000150:complications; D006801:Humans; D012769:Shock / Q000628:therapy*; D014882:Water-Electrolyte Balance
chemical_list: D000932:Antiemetics