Don’t assume dehydrated children always need IVs

When a child is vomiting and has diarrhea, is your first thought to give intravenous (IV) fluids?

"The literature shows that for a mildly to moderately dehydrated child, giving fluids orally works just as well," says Lynn Daum, RN, BSN, special projects coordinator for emergency services nursing at Cincinnati Children’s Hospital Medical Center.1

Instead of starting IV fluids, nurses offer children a Popsicle. "That way, we can see how they do with a fluid challenge before jumping to IV fluids," she says. IVs are only given to children if their primary care physician has ordered fluids, can’t keep Popsicles down, are severely dehydrated, or have not had sufficient urine output in the past 12 hours, Daum explains.

This means that about half as many children are getting IV fluids for mild/moderate dehydration, says Daum. "At this institution, at $109 a pop, that is quite a savings when you look at our numbers," she says.

Daum’s ED treats more than 2,676 patients with gastroenteritis each year. Since an evidence-based guideline was implemented, ED visits for this complaint decreased approximately 22%. The guidelines state, "In children with moderate to severe dehydration, oral dehydration therapy is an effective and proven alternative to IV therapy. IV therapy is always recommended in the child with severe dehydration and obtunded mental status."

To reduce ED visits, instruct patients to give children enough fluids to keep up with fluid losses from vomiting or diarrhea, Daum recommends. "This can be tricky, but if the parents force fluid in any way the patient will take it, they will be able to manage the potential dehydration at home," she says.

Reference

1. Atherly-John YC, et al. Oral vs. intravenous rehydration in the pediatric emergency department. Acad Emerg Med 2001; 18:436.

Source

For more information on dehydration and pediatric patients, contact:

  • Lynn Daum, RN, BSN, Special Projects Coordinator, Emergency Services Nursing, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229-3039. Telephone: (513) 636-1831. E-mail: lynn.daum@cchmc.org.