title: Intravenous dextrose for children with gastroenteritis and dehydration: a double-blind randomized controlled trial.
abstract: OBJECTIVE
  We seek to determine whether an initial intravenous bolus of 5% dextrose in normal saline solution compared with normal saline solution will lead to a lower proportion of hospitalized patients and a greater reduction in serum ketone levels in children with gastroenteritis and dehydration.
  
  
  METHODS
  We enrolled children aged 6 months to 6 years in a double-blind, randomized controlled trial of patients presenting to a pediatric emergency department. Subjects were randomized to receive a 20 mL/kg infusion of either 5% dextrose in normal saline solution or normal saline solution. Serum ketone levels were measured before and at 1- and 2-hour intervals after the initial study fluid bolus administration. Primary outcome was the proportion of children hospitalized. Secondary outcome was change in serum ketone levels over time.
  
  
  RESULTS
  One hundred eighty-eight children were enrolled. The proportion of children hospitalized did not differ between groups (35% in the 5% dextrose in normal saline solution group versus 44% in the normal saline solution group; risk difference 9%; 95% confidence interval [CI] -5% to 22%). Compared with children who received normal saline solution, those who received 5% dextrose in normal saline solution had a greater reduction in mean serum ketone levels at both 1 hour (mean Δ 1.2 versus 0.1 mmol/L; mean difference 1.1 mmol/L; 95% CI 0.4 to 1.9 mmol/L) and 2 hours (mean Δ 1.9 versus 0.3 mmol/L; mean difference 1.6 mmol/L; 95% CI 0.9 to 2.3 mmol/L).
  
  
  CONCLUSIONS
  Administration of a dextrose-containing bolus compared with normal saline did not lead to a lower rate of hospitalization for children with gastroenteritis and dehydration. There was, however, a greater reduction in serum ketone levels in patients who received 5% dextrose in normal saline solution.
authors.affiliation: Division of Emergency Medicine, Children's Hospital Boston, Harvard Medical School, Department of Pediatrics, Boston, MA, USA. jason.levy@childrens.harvard.edu
authors.forename: Jason A
authors.initials: JA
authors.lastname: Levy
authors.forename: Richard G
authors.initials: RG
authors.lastname: Bachur
authors.forename: Michael C
authors.initials: MC
authors.lastname: Monuteaux
authors.forename: Mark
authors.initials: M
authors.lastname: Waltzman
mesh_terms: D002675:Child, Preschool; D003681:Dehydration / Q000209:etiology / Q000628:therapy*; D004311:Double-Blind Method; D004636:Emergency Service, Hospital; D005440:Fluid Therapy / Q000379:methods*; D005759:Gastroenteritis / Q000150:complications / Q000628:therapy*; D005947:Glucose / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D007275:Injections, Intravenous; D007659:Ketones / Q000097:blood; D012965:Sodium Chloride / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D007659:Ketones; D012965:Sodium Chloride; D005947:Glucose