28 March 2011

Nasogastric Rehydration for Children with Diarrhea in Resource-Limited Countries

Each year an estimated 1.7 million children die from dehydration caused by acute diarrhea. The vast majority of deaths occur in resource-limited countries, where incidence of gastroenteritis is higher, and access to therapy is limited. In the past several decades, Oral Rehydration Solution (ORS), has been widely used, both in developed and in resource-limited countries, and has markedly reduced the death rate. If ORS therapy fails, or dehydration is severe, the alternative in developed countries is hospitalization and intravenous therapy. This IV option is expensive and often logistically difficult in resource-limited countries. What viable treatment options are available then for the child who fails ORS therapy? A recent review article by Rouhani et. al.(1) evaluates a number of studies that compare several alternative therapies. A number of randomized controlled trials show that administration of fluids by nasogastric tube is as effective as intravenous therapy in patients who fail ORS. Another large study of over 4000 patients showed that nasogastric administration of fluids had an 88% success rate in moderate and severe dehydration, and a low incidence of side effects, mainly persistent vomiting. Only one case of aspiration occurred. The fluids are given at the same rate as for intravenous replacement, 20-25 cc/kilo per hour. This approach greatly reduced the need for intravenous fluids in this large study.
Nasogastric fluid replacement should be considered as a viable, safe alternative to IV therapy for dehydration, particularly in the field, where IV fluids may not be available or easily administered.

Ref 1. Rouhani, S, et al: Alternative Rehydration Methods: A Systematic Review and lessons for Resource-Limited Care. Pediatrics 127, March 2011, pp e 748-e757.

Submitted by Roger Boe MD.

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