• Stephen B Freedman, Elizabeth Powell, and Roopa Seshadri.
• Division of Pediatric Emergency Medicine, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada. stephen.freedman@sickkids.ca
• Pediatrics. 2009 Jan 1;123(1):e9-16.

ObjectivesOral rehydration therapy is underused by physicians treating children with acute infectious enteritis. To guide management, we hypothesized that clinical variables available at the initial assessment could be identified that will predict the need for intravenous fluid administration.Patients And MethodsClinical data were prospectively collected on a cohort of 214 children, aged 6 months to 10 years, treated in an emergency department for dehydration secondary to acute enteritis. All of the children performed supervised oral rehydration therapy for a minimum of 60 minutes according to protocol.Outcomes assessed were intravenous rehydration, return visits after discharge, and successful oral rehydration therapy. The latter variable was defined as the consumption of > or = 12.5 mL/kg per hour of oral rehydration solution. Variables individually associated with outcomes of interest were evaluated by using multiple logistic regression analysis.ResultsForty-eight (22%) of 214 children received intravenous rehydration. In multivariate analysis, the 2 clinical predictors of intravenous rehydration were large urinary ketones and altered mental status. Significant predictors of repeat emergency department visits within 3 days included > or = 10 episodes of vomiting over the 24 hours before presentation and a higher heart rate at discharge from the emergency department.ConclusionsAmong children with enteritis and mild-to-moderate dehydration, the presence of large urine ketones or an altered mental status is associated with intravenous rehydration after a 60-minute oral rehydration therapy period. Caution should be exercised before discharging children with either tachycardia or a history of significant vomiting before presentation, because they are more likely to require future emergency department care.

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