[Intravenous rehydration for diarrheal dehydration of eutrophic children: survey of protocols provided at Colombian medical schools].
BACKGROUND
In all cases of severe dehydration from diarrhea, WHO recommends rapid rehydration. If oral rehydration in children is contraindicated, intravenous rehydration is recommended for immediate administration. However, methods of intravenous rehydration appear to be inadequately addressed in the medical schools of Colombia.


OBJECTIVE
Current approaches to oral rehydration were summarized, and instructors were informed concerning current WHO recommendations.


METHODS
A survey was designed for pediatric instructors in Colombian medical schools. Direct questions about rehydration methods were included as well as presentation of theoretical clinical situations with dehydrated children. The survey also asked for the conditions necessary for intravenous rehydration and method of administration (volume, solution, concentration and speed of infusion).


RESULTS
Forty-one surveys were included (82% of medical schools in Colombia). Inadequate contraindications for oral rehydration therapy were made in 41%. Rapid and slow intravenous rehydration was recommended in 71% and 29%, respectively; 57% recommended fluid bolus to rehydrate. Adequate volumes were recommended by less than half of the respondents and adequate sodium concentration was recommended by 85%. In 56% of medical schools, glucose was not included in solutions and 66% use Ringer lactate. Normal saline solution, dextrose solution with electrolytes and polyelectrolytes solutions are also used.


CONCLUSIONS
Misconceptions are common concerning the contraindications to oral rehydration therapy. One-third of medical schools promote a slow therapy despite the superiority of the rapid therapy. Uniformity for rapid therapy schemes is lacking. Bolus rehydration is commonly advocated despite the fact that this method is unsupported by the literature. Concepts about rehydration must be updated in medical schools and a national guide for intravenous rehydration is recommended.
Grupo de Investigación en Enfermedades del Niño y el Adolescente, Departamento de Pediatría y Puericultura, Universidad de Antioquia, Medellín, Colombia. ivoflorez@gmail.com
Iván Darío
ID
Flórez
Esteban
E
Ramos
Carlos
C
Bernal
Olga Juliana
OJ
Cuéllar
José William
JW
Cornejo
D002985:Clinical Protocols; D003105:Colombia; D000075202:Contraindications; D003479:Curriculum; D003625:Data Collection; D003681:Dehydration / Q000209:etiology / Q000628:therapy*; D003967:Diarrhea / Q000150:complications*; D004501:Education, Medical; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006801:Humans; D007262:Infusions, Intravenous / Q000379:methods; D008297:Male; D009752:Nutritional Status; D010372:Pediatrics / Q000193:education*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D015532:Rehydration Solutions / Q000008:administration & dosage* / Q000737:chemistry; D012577:Schools, Medical / Q000706:statistics & numerical data
D015532:Rehydration Solutions