Good questions...I hope you are designing a prospective study(ies)
to answer them. My non-evidence based biases follow FWIW...
On 3/4/98, Doobinin, Kathy wrote:
>A few questions for the list:
>1. When hydrating otherwise healthy children with dehydration, in which
>cases to you obtain serum electrolytes?
Almost always, though I find they don't help much in otherwise well
older children. More often than not a "normal" bicarb leads housestaff to
falsely conclude that 'this child isn't dehydrated'.
>2. Do you get electrolytes in all kids or just when the history or physical
>exam make you suspicious for a clinically relevant abnormality?
We have talked about a study at our place to identify risk factors
for hyper- and hypo-natremia. Severe developmental delay, breast feeding
neonates, G-tube feeds with fever, large amounts of water are obvious
historical variables. Do you see water intoxication in Norfolk in young
babies? It was common in West Philadelphia, and surprisingly rare in
>3. If child who has a low bicarb (rest of lytes are normal) looks well after
>rehydration and has proven they can tolerate oral fluids , will you admit
>them based on a low bicarb. If so, how low?
I think of the bicarb as the area under the stool curve. Steve
Poole (Denver)tried to look at this issue in a retrospective cohort by
looking at bounce-back rates to the ED. I think the ref is (Poole
SR.Criteria for measurement of dehydration. Ann Emerg Med. 1990 Jun; 19(6):
730-731). My personal number for nearly automatic admission has decreased
over time from 13 or less to 10 or less in older infants and toddlers with
diarrhea. I take diarrhea in young infants (less than 4-6 weeks) very
seriously and order electrolytes more liberally. My bicarb number of
concern would be higher in this setting as I've been burned in the past by
"well appearing neonates" with diarrhea.
Dale W. Steele M.D. | Assistant Prof. of Pediatrics
Pediatric Emergency Medicine | Brown University
Potter 212, Rhode Island Hospital | VOICE: [work] (401) 444-6236
593 Eddy St | Office FAX (401) 444-4569
Providence, RI 02903 | E-Mail: [log in to unmask]>
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