title: Successful discharge of children with gastroenteritis requiring intravenous rehydration.
abstract: BACKGROUND
  Emergency Department (ED) revisits are very common in children with gastroenteritis administered intravenous rehydration.
  
  
  OBJECTIVE
  To determine if bicarbonate values are associated with ED revisits in children with gastroenteritis.
  
  
  METHODS
  We conducted a secondary analysis of prospectively collected data, which included children >3 months of age with gastroenteritis treated with intravenous rehydration. Regression analysis was employed to determine whether, among discharged children, bicarbonate independently predicts revisits within 7 days (primary outcome) and successful discharge (secondary outcome). The latter composite outcome measure was defined as discharge at the index visit and the absence of a revisit requiring intravenous rehydration.
  
  
  RESULTS
  Of 226 potentially eligible children, 174 were discharged and were included in the primary outcome analysis. Of the eligible children, 18% (30/174) had a revisit that was predicted by a higher baseline bicarbonate (odds ratio [OR] 1.1; 95% confidence interval [CI] 1.0-1.3; p = 0.03), absence of a primary care provider (OR 7.8; 95% CI 1.2-51.0; p = 0.03), and ondansetron administration (OR 2.4; 95% CI 1.0-5.5; p = 0.05). Bicarbonate was not associated with successful discharge. Negatively associated independent predictors of successful discharge were volume of intravenous fluids administered (OR 0.84/10 mL/kg increase; 95% CI 0.76-0.93; p < 0.001), and baseline clinical dehydration score (OR 0.75/unit increase; 95% CI 0.58-0.97; p < 0.001). Revisits requiring intravenous rehydration and hospitalization were associated with higher bicarbonate values (21.2 ± 4.6 mEq, p = 0.001, and 22.3 ± 5.0 mEq/L, p < 0.001, respectively).
  
  
  CONCLUSIONS
  Lower serum bicarbonate values at the time of intravenous rehydration are not associated with unfavorable outcomes after discharge.
authors.affiliation: Division of Paediatric Emergency Medicine and Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada; Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Freedman
authors.affiliation: Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; The Paediatric Outcomes Research Team, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada.
authors.forename: Julie M
authors.initials: JM
authors.lastname: DeGroot
authors.affiliation: Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; The Paediatric Outcomes Research Team, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada; Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Paediatrics, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Patricia C
authors.initials: PC
authors.lastname: Parkin
mesh_terms: D061605:Administration, Intravenous; D000932:Antiemetics / Q000627:therapeutic use; D001639:Bicarbonates / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D002648:Child; D002675:Child, Preschool; D003681:Dehydration / Q000097:blood* / Q000209:etiology / Q000628:therapy*; D004636:Emergency Service, Hospital; D005440:Fluid Therapy; D005759:Gastroenteritis / Q000150:complications*; D006801:Humans; D007223:Infant; D017294:Ondansetron / Q000627:therapeutic use; D010351:Patient Discharge; D011237:Predictive Value of Tests; D011320:Primary Health Care; D012008:Recurrence; D012720:Severity of Illness Index
chemical_list: D000932:Antiemetics; D001639:Bicarbonates; D015415:Biomarkers; D017294:Ondansetron
keywords: acidosis; ambulatory care facilities; emergencies; gastroenteritis; intravenous infusions