Adult Oral Rehydration

The New England Journal of Medicine this month discussed a hospitals experience using an adult oral rehydration protocol in a large American metropolitan emergency department. This protocol was originally implemented as a result of IV fluid shortages. The protocol saw patients receive analgesia and antiemetics, as necessary, followed by directions to drink 30ml of the fluid of their choice every 3-5 minutes, 20 minutes after treatment.

Inclusion criteria were:

1. Acute Gastroenteritis
2. Hyperemesis Gravidum
3. Viral URTI/Pharyngitis

Exclusion Criteria were:

1. Moderate or severe dehydration
2. Contraindications to oral fluids (ex: bowel obstruction)

Reported outcomes:

1. 30% reduction in volume of IV fluids administered in the ED
2. 15% reduction in the number of physician orders for IV fluids. 

Unfortunately this protocol and accompanying data weren't published as a study, so there's limited baseline demographics, outcome measures, or comparison group information. They also unfortuantely didn't release patient specific measures such as satisfaction, need for rescue medication, or clinical outcomes - which limit the generalizability of this data.  

The hospital itself Brigham and Women's Hospital (one of the largest research hospitals in the world) may also suggest limits to the generalizability of this protocol (well funded tertiary centers); however, the practice is well established in pediatric patients (with a large systematic review) and is used in resource limited settings. 

This is a timely study, it addresses a current problem (IV fluid shortage); it also raises the question if IV fluids are superior to PO for mild dehydration, and what the impact of PO over IV rehydration strategies would have on patient satisfaction, care costs, length of stay and patient specific outcomes.

Patiño, A. M., Marsh, R. H., Nilles, E. J., Baugh, C. W., Rouhani, S. A., & Kayden, S. (2018). Facing the Shortage of IV Fluids—A Hospital-Based Oral Rehydration Strategy. New England Journal of Medicine.

Hartling, L., Bellemare, S., Wiebe, N., Russell, K. F., Klassen, T. P., & Craig, W. R. (2006). Oral versus intravenous rehydration for treating dehydration due to gastroenteritis in children. The Cochrane Library.