×
EMPOWERING PHYSICIANS WITH EVIDENCE-BASED CONTENT
 

Home > Browse Topics

<< Gastroenteritis: An Evidence-Based Approach To Typical Vomiting, Diarrhea, And Dehydration

Controversies/Cutting Edge

One area of controversy involves the use of a "PO challenge" before discharging patients from the ED. There is no literature to support the practice of trials of drinking fluids prior to discharge to home. This "time-honored" approach is wide open for study and cannot be recommended based on the available evidence.

Although oral rehydration has been well supported and has very good supporting evidence, the routine use of oral rehydration therapy in the ED remains controversial. These perceived barriers have been discussed above. (See Treatment, Oral Rehydration) Most clinicians agree that more emphasis should be placed on oral rehydration and the prevention of dehydration, rather than on intravenous rehydration. In many ways, this may just be "lip service." Although multiple experts have been advocating for the increased use of enteral rehydration for over 30 years as the preferred treatment for the acute replacement of fluid and electrolyte losses, the widespread use of this simple technology still seems to elude most practitioners.

Racecadotril, an enkephalinase inhibitor with antisecretory and antidiarrheal properties, has been tested
for use in children. Data suggest that when compared to placebo, racecadotril lowers stool output by up to 50% in patients with profuse, watery diarrhea.96,97 Racecadotril appears to be well tolerated and may prove to be a useful adjuvant to standard oral rehydration therapy in infants and children with acute gastroenteritis, particularly those with severe diarrheal illnesses, such as those caused by rotavirus. Currently, however, it has not gained widespread use in the United States.

There are some limited data to suggest that lactobacillus therapy may have some usefulness in acute infectious diarrhea in children; however, its effect seems to be fairly small, and it has failed to gain any widespread acceptance in the United States.98,99
 

 
Get More Content Like This!
Enter your email below to get evidence-based updates delivered to your inbox once a month.

 

 

Purchase a
subscription
$319
Pediatric Emergency Medicine Practice
 
Sign up for a free trial
Free 48-hour trial
Pediatric Emergency Medicine Practice
 

2018 LLSA Prep Study Guides, 35 CME Credits

 
About EB Medicine:
Products:
Accredited By:
ACCME ACCME
AMA AMA
ACEP ACEP
AAFP AAFP
AOA AOA
AAP AAP
Endorsed By:
AEMAA AEMAA
HONcode HONcode
STM STM

 

Last Modified: 01/17/2019
© EB Medicine