pem pearl: dextrose in IVF
Here is a retrospective cohort study out of a single PED in Canada evaluating whether or not there is an association between the amount of dextrose given in the first 4 hours of IVF rehydration in kids with acute gastroenteritis and return visits/hospitalizations.
This makes theoretical since given that, as the study points out, "in AGE, dehydration and ketosis lead to metabolic acidosis, which increases nausea and vomiting; however, when provided with glucose, insulin production increases and ketosis is inhibited, which corrects the metabolic acidosis."
While this makes sense, only 1 study previously had shown an actual benefit and several others couldn't replicate similar findings.
This study enrolled 250 children diagnosed with acute gastroenteritis who got IVF rehydration. Only 9 total had no dextrose. The vast majority (95%) got D5NS; there was a negative association between hospitalization and dextrose administration (OR of 0.6 for each 100mg/kg increment in dextrose). There was a similar decreased likelihood of return visit in those receiving dextrose with an OR of 0.52 for each 100mg/kg of dextrose. This means that "for every additional 100 mg/kg of IV dextrose provided to children during the first hour of rehydration, the odd of hospitalization decreased by a factor of 0.60."
This gets mathy, read on if you dare... So, the median weight of kids in this study was 13kg. In D5NS, 100mls contains 5g (5000mg) of dextrose. So a 10ml/kg D5NS bolus is 130mls which contains 6500mg dextrose = 500mg/kg. In this study, the median amount of dextrose in hour 1 was about 217mg/kg (probably a 5ml/kg bolus?), and the median amount of dextrose at 4 hours was 909mg/kg.
If this sounds like a lot of sugar, consider that 1g of sugar gives 4kcal. So the 6.5g of sugar in the above 130ml bolus gives 26kcal, the equivalent of less than 6 of everyone's favorite peanut M&Ms (thank you Dr. Trautwein!).
What does this study not go into? Too much of a good thing is a bad thing. Certainly, there is a limit to how much dextrose you should give.
Bottom Line: in this retrospective cohort study, for every 100mg/kg increase of dextrose given in the patients' IVF rehydration, there was a decrease in the likelihood of hospitalization and return visit.
This makes theoretical since given that, as the study points out, "in AGE, dehydration and ketosis lead to metabolic acidosis, which increases nausea and vomiting; however, when provided with glucose, insulin production increases and ketosis is inhibited, which corrects the metabolic acidosis."
While this makes sense, only 1 study previously had shown an actual benefit and several others couldn't replicate similar findings.
This study enrolled 250 children diagnosed with acute gastroenteritis who got IVF rehydration. Only 9 total had no dextrose. The vast majority (95%) got D5NS; there was a negative association between hospitalization and dextrose administration (OR of 0.6 for each 100mg/kg increment in dextrose). There was a similar decreased likelihood of return visit in those receiving dextrose with an OR of 0.52 for each 100mg/kg of dextrose. This means that "for every additional 100 mg/kg of IV dextrose provided to children during the first hour of rehydration, the odd of hospitalization decreased by a factor of 0.60."
This gets mathy, read on if you dare... So, the median weight of kids in this study was 13kg. In D5NS, 100mls contains 5g (5000mg) of dextrose. So a 10ml/kg D5NS bolus is 130mls which contains 6500mg dextrose = 500mg/kg. In this study, the median amount of dextrose in hour 1 was about 217mg/kg (probably a 5ml/kg bolus?), and the median amount of dextrose at 4 hours was 909mg/kg.
If this sounds like a lot of sugar, consider that 1g of sugar gives 4kcal. So the 6.5g of sugar in the above 130ml bolus gives 26kcal, the equivalent of less than 6 of everyone's favorite peanut M&Ms (thank you Dr. Trautwein!).
What does this study not go into? Too much of a good thing is a bad thing. Certainly, there is a limit to how much dextrose you should give.
Bottom Line: in this retrospective cohort study, for every 100mg/kg increase of dextrose given in the patients' IVF rehydration, there was a decrease in the likelihood of hospitalization and return visit.
