Dear Ilene, I really enjoy your segment of EM:RAP. Your calm and considered approach to the topics covered which, as Mel says, 'freak us out' in the early hours of the morning is really appreciated. I am sure you have read the FEAST trial on peadiatric fluid resuss in Africa and it would be great if you could comment on any implications that arise from it in a later episode. Thanks Daryl Pudney Junior Medical Officer John Hunter Hospital Australia
Another commment, maybe followed by a RANT! I tend to treat the more significantly dehydrated child with NS boluses followed by a glucose containing solution. Not based on any data I am aware of but these kids tend to act more like a starvation ketoacidosis than pure dehydration. It has been my experience that using glucose to clear the ketones reduces recidivism and makes them more likely to tolerate oral rehydration.
Mike J., There's a *little* bit of evidence to support your (and my) experience that a little bit of dextrose makes kids feel muuuuch better. There's an article by Levy and Bachur from a few years back - kids who bounced back were less likely to have gotten dextrose in their initial visit.
To join the conversation, you need to subscribe.
Sign up today for full access to all episodes and to join the conversation.
Daryl P. - October 9, 2011 6:02 PM
Dear Ilene,
I really enjoy your segment of EM:RAP. Your calm and considered approach to the topics covered which, as Mel says, 'freak us out' in the early hours of the morning is really appreciated.
I am sure you have read the FEAST trial on peadiatric fluid resuss in Africa and it would be great if you could comment on any implications that arise from it in a later episode.
Thanks
Daryl Pudney
Junior Medical Officer
John Hunter Hospital
Australia
Mike J., M.D. - October 13, 2011 3:35 PM
Another commment, maybe followed by a RANT! I tend to treat the more significantly dehydrated child with NS boluses followed by a glucose containing solution. Not based on any data I am aware of but these kids tend to act more like a starvation ketoacidosis than pure dehydration. It has been my experience that using glucose to clear the ketones reduces recidivism and makes them more likely to tolerate oral rehydration.
Any thoughts, data???/
Michael A. Jasumback, MD
Michael D., M.D. - October 15, 2011 5:29 PM
Aap grand rounds reviewed Feast in their last issue...
Fredric L., M.D. - October 15, 2011 8:55 PM
Can you recommend a good article on this technique. Does injection of the hyaluronidase hurt? Wait time after injection?
Thanks.
Christopher M. - December 12, 2011 11:48 AM
Mike J., There's a *little* bit of evidence to support your (and my) experience that a little bit of dextrose makes kids feel muuuuch better. There's an article by Levy and Bachur from a few years back - kids who bounced back were less likely to have gotten dextrose in their initial visit.