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Three Part Question

[In adults with gastroenterits] are [IV fluids better than oral fluids] at [reducing length of stay in the Accident and Emergency department].

Clinical Scenario

An adult is brought into the Accident and Emergency Department with vomiting, diarrhoea. They are diagnosed with gastroenteritis. Will IV or oral fluids be faster at rehydrating this patient to a point where discharge will be possible?

Search Strategy

Cochrane database
EMBASE 1996 to May 13t 2005
Medline 1951 to May 13th 2005
Cochrane database
(MeSH descriptor Gastroentertis, this term only) AND (MeSH descriptor Fluid Therapy, this term only).
EMBASE 1996 to May 13t 2005
(Gastroenteritis or Diarrhea or Vomiting) AND (Fluid-therapy OR Rehydration) limited to Human AND Adult.
Medline 1951 to May 13th 2005
(Gastroenterits or Diarrhea or Vomiting) AND (Rehydration OR Rehydration Solutions OR Fluid Therapy) limited to Human AND Adult.

Search Outcome

Altogether 113 papers were found in Medline, 103 in EMBASE and 36 in Cochrane of which all were irrelevant.

Comment(s)

There is no available literature which directly compares the use of IV fluid and oral fluid for rehydration of adults with gastroenteritis. There is a study, A Randomized Trial of Oral vs Intravenous Rehydration in a Pediatric Emergency department. Atherly-John YC, Cunningham SJ, Crain EF. Archives of Pediatrics and Adolescent Medicine, Dec 2002. VOl156, Iss12;pg1240 that answers this question for paediatric patients. Oral fluids were found to reduce patient stay, decrease staffing times and thus costs with a decreased potential for side effects encountered with venous cannulation. Parental satisfaction was greater with oral fluids and there was no increase in relapse rate. Such evidence may be partly transferable to an adult population.

Clinical Bottom Line

There is no proof for adults with gastroenteritis that IV fluids are any better than oral fluids at reducing length of stay in the Accident and Emergency department. In view of the evidence found for paediatric patients, the additional costs, staffing times and potential complications involved with IV fluid use there is support for trials of oral fluid rehydration prior to considering IV fluids.