Extracellular fluid restoration in dehydration: a critique of rapid versus slow

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Abstract
We compared current recommendations for treatment of severe dehydration by World Health Organization physicians and by the American Academy of Pediatrics Committee on Pediatric Gastroenterology with those in general textbooks of pediatrics, written mostly by pediatric nephrologists. The former recommend rapid (1- to 2-h) and generous intravenous restoration of extracellular fluid (ECF) volume followed by oral rehydration therapy (ORT) to replace potassium, current maintenance, and diarrheal losses – the rapid rehydration regimen. Oral feedings usually are resumed in 8–24 h. General textbooks of pediatrics usually recommend giving 20 ml/kg saline ”to restore circulation,” followed by the deficit therapy regimen to correct serum electrolyte abnormalities and replace remaining deficits of water, sodium, chloride, and potassium over 1–2 days. Mortality for hospitalized patients with dehydration treated with rapid rehydration was severe dehydration and instead teach the rapid rehydration regimen.

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