Juice Is Best for Treating Mild Gastroenteritis with Minimal Dehydration

Summary and Comment |
April 30, 2016

Juice Is Best for Treating Mild Gastroenteritis with Minimal Dehydration

  1. John D. Cowden, MD, MPH

Dilute apple juice for initial hydration followed by fluids of the child's choice was superior to electrolyte maintenance solution for treating children with mild gastroenteritis and minimal dehydration.

  1. John D. Cowden, MD, MPH

Oral rehydration with electrolyte maintenance solutions has become a mainstay in treating moderate to severe dehydration, but could less-expensive, better-tasting fluids such as diluted juice be just as effective in milder cases?

In a single-blind noninferiority trial, researchers randomized 647 children (aged 6−60 months) presenting to a Canadian pediatric emergency department with gastroenteritis and minimal dehydration to receive either 1) half-strength apple juice for initial hydration followed by fluids of the child's choice or 2) apple-flavored electrolyte maintenance solution. The primary outcome was treatment failure, defined as occurrence of any of the following within 7 days: intravenous rehydration, hospitalization, unscheduled visit to a physician, treating physician's request to cross over to other study arm, weight loss ≥3% or Clinical Dehydration Scale score ≥5 at follow-up.

Treatment failure was significantly lower in the juice/preferred fluids group (16.7% vs. 25.0%); the difference met the study's criteria for noninferiority and superiority. Significantly fewer children in the juice/preferred fluids group received intravenous rehydration at the index visit (0.9% vs. 6.8%) and within 7 days (2.5% vs. 9.0%). Juice/preferred fluids was most beneficial in children ≥24 months of age (treatment failure rate, 9.8% vs. 25.9%).

Comment

Use of special oral rehydration solution in cases of mild gastroenteritis may not only be unnecessary but also could lead to worse outcomes than use of more readily available and cheaper fluids, such as apple juice. Juices and energy drinks with high glucose content have not been shown to harm children, and their palatability may lead to higher overall fluid intake. Evidence supporting a less-restrictive approach to rehydrating mildly dehydrated children should be welcomed by clinicians and parents alike.

Editor Disclosures at Time of Publication

  • Disclosures for John D. Cowden, MD, MPH at time of publication Leadership positions in professional societies Co-Chair, Culture, Ethnicity, and Health Care Special Interest Group, Academic Pediatric Association

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