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Diarrhoea and vomiting caused by gastroenteritis in children under 5 years

after a period of initial IVT in children with severe dehydration and/or shock. The different fluid
regimens have been tabulated in Table 5.4. In these studies, rapid IV fluid was given initially (for
example, 20–40 ml/kg per hour) and ORT usually introduced after about 1–2 hours to complete
the rehydration process.

Evidence summary
No direct evidence was identified on the appropriate time for switching IVT to ORT. Processes
followed in various studies indicate that children with severe dehydration and/or hypovolaemic
shock were initially rehydrated with IVT over a period of 1–2 hours or until there was improvement
in blood pressure and pulse volume, and ORT were usually introduced after this period to
complete the rehydration process.

GDG translation from evidence to recommendation
In current practice the GDG believed that once IVT is begun, children often remain in hospital for
lengthy periods, for example 24 hours or more. Although formal research trials are not available,
nevertheless clinical studies have reported success with regimens in which children with shock or
severe dehydration due to gastroenteritis received IVT for 1–2 hours, with subsequent rehydration
given as ORT. Hence there was some evidence (Table 5.4) to support early introduction of ORT
in those requiring initial IV rehydration. The GDG agreed that if a child is able to tolerate orally,
IVT should be stopped as soon as possible and further rehydration completed with ORT alone.
This was desirable in that it would reduce the risk of prolonged IV fluid administration. The GDG
also anticipated that early introduction of ORT could reduce the need for hospital admission and
facilitate early hospital discharge.

Recommendation on changing to ORT during intravenous fluid therapy

Attempt early and gradual introduction of oral rehydration therapy during intravenous fluid
therapy. If tolerated, stop intravenous fluids and complete rehydration with oral rehydration
therapy.

5.5 Fluid management following rehydration

Introduction
Following rehydration, some children may be at risk of recurrence of dehydration. In those cases,
it might be possible to prevent this by giving supplementary fluids. The GDG wished to consider
the circumstances in which this should be advised and an appropriate strategy for effective
supplementation.

Clinical questions
What is the risk of recurrence of dehydration? What interventions and/or supplementary fluid
(if any) are safe and effective in preventing recurrence?

Evidence overview

A detailed literature search failed to identify any relevant good-quality studies to answer these
questions.

GDG translation from evidence to recommendation

In the absence of clinical studies on the recurrence of dehydration, the GDG based its
recommendations on consensus. Once a child is rehydrated, whether by ORT or IVT, it is
important to ensure that they receive adequate fluids for normal maintenance and if necessary
to compensate for significant ongoing fluid loss from diarrhoea. The frequency with which
dehydration recurs following successful rehydration is not clear, but recurrence of dehydration
certainly does happen. Intuitively, it seemed probable that some children would be at increased

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