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A series of new techniques for pediatric rehydration, ondansetron, subcutaneous fluids with hyaluronidase, IO lines and fast IV fluids.
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.ThanksDaryl PudneyJunior Medical OfficerJohn Hunter HospitalAustralia
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
Aap grand rounds reviewed Feast in their last issue...
Can you recommend a good article on this technique. Does injection of the hyaluronidase hurt? Wait time after injection?Thanks.
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.
What you do matters.