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     Overall, this is not a "new" therapy.  Hypodermoclysis (infusion of subcutaneous fluids) has been used since the US Civil War.  The "twist" on this old therapy has been the addition of hyaluronic acid prior to the administration of fluids which allows larger amounts to be infused--I found references from the 1950's suggesting this use.
     The fluid can be infused into the thigh, but initial swelling there makes it unpalatable to many parents.  It can also be used in the back, between the shoulder blades (the way it was done in the 1860's).  This has the added advantage of infusing into an area where the child can't reach the catheter or tubing.
                                 Niel

 
> Date: Wed, 19 Aug 2009 14:06:42 -0500
> From: [log in to unmask]
> Subject: Re: hylenex
> To: [log in to unmask]
> 
> I've seen this product promoted at some medical meetings, but am very skeptical ..... has anyone done a cost/benefit comparison with NS? My guess is that this product is vastly more expensive than NS or oral rehydration. If this product is supposed to be used for mild/moderate dehydration why would anyone consider using this (very expensive) alternative to ZOFRAN AND PEDIALYTE?
> 
> The country is going through major debates about the cost of healthcare.... we all need to look in our own "backyards" of how to use limited healthcare dollars appropriately.
> 
> Bev Bauman MD FAAP FACEP
> 
> -----Original Message-----
> >From: don zweig <[log in to unmask]>
> >Sent: Aug 19, 2009 12:58 PM
> >To: [log in to unmask]
> >Subject: Re: hylenex
> >
> >what is hylenex?
> >On Aug 19, 2009, at 10:07 AM, Jason Foland wrote:
> >
> >> This is very interesting. Can someone forward me some articles, 
> >> references, and/ or protocols so I can look at the possibility of 
> >> using this at our institution.
> >>
> >>
> >>
> >> Jason
> >>
> >>
> >>
> >>
> >> Jason A. Foland, MD
> >> Pediatric Critical Care Physician
> >> Nemours Children's Clinic
> >> www.nemours.org
> >> Medical Director, Pediatric Respiratory Therapy
> >> Sacred Heart Women & Children's Hospital
> >> www.sacred-heart.org
> >> Pensacola, Florida
> >> [log in to unmask]
> >>
> >>
> >>
> >>
> >>
> >>> Date: Wed, 19 Aug 2009 10:39:35 -0500
> >>> From: [log in to unmask]
> >>> Subject: Re: hylenex
> >>> To: [log in to unmask]
> >>>
> >>> How about Amphadase? It is cheaper.
> >>> Bovine vs Hamster...
> >>> Any comments?
> >>>
> >>>
> >>> -----Original Message-----
> >>> From: Pediatric Emergency Medicine Discussion List
> >>> [mailto:[log in to unmask]] On Behalf Of Peter Antevy
> >>> Sent: Tuesday, August 18, 2009 12:08 PM
> >>> To: [log in to unmask]
> >>> Subject: Re: hylenex
> >>>
> >>> Bob, we've created a hylenex protocol and have started using it in 
> >>> our
> >>> ED. It's simple and easy and a great alternative to have. You can
> >>> infuse the usual 20 per kg NS bolus rapidly just the same as via IV.
> >>> Also it takes 3 minutes and one person to start rather than 2-3 
> >>> nurses
> >>> and 30 minutes.
> >>>
> >>> Peter
> >>>
> >>> -----Original Message-----
> >>>
> >>> From: BOB BELFER <[log in to unmask]>
> >>> Subj: hylenex
> >>> Date: Tue Aug 18, 2009 12:28 pm
> >>> Size: 1K
> >>> To: [log in to unmask]
> >>>
> >>> Anyone with any experience with below?
> >>> thanks,
> >>>
> >>>
> >>>
> >>> Bob Belfer
> >>>
> >>>
> >>>
> >>>
> >>> Clinical Trial*
> >>> INFUSE-Pediatric Rehydration Study: Phase IV Study of Subcutaneous
> >>> Rehydration With Recombinant Human Hyaluronidase (hylenex 
> >>> recombinant)
> >>> for Infants and Children
> >>> Purpose: The aim of the study is to evaluate the safety, 
> >>> effectiveness
> >>> and ease of use of subcutaneous rehydration using hylenex
> >>> recombinant-augmented subcutaneous infusion of fluids and 
> >>> electrolytes
> >>> for the rehydration of pediatric patients with mild to moderate
> >>> dehydration.
> >>> Study Type: Interventional
> >>> Enrollment: 51
> >>>
> >>> Study Design: Treatment, non-randomized, open label, uncontrolled,
> >>> single group assignment, safety/efficacy study Primary Outcome 
> >>> Measures:
> >>>
> >>>
> >>> Rehydration success rate (effectiveness) in children treated with
> >>> hylenex recombinant-augmented fluid infusion
> >>> Secondary Outcome Measures:
> >>>
> >>>
> >>> Safety of hylenex recombinant-augmented fluid infusion in children
> >>> For more information, send mail to [log in to unmask] with 
> >>> the
> >>> message: info PED-EM-L
> >>> The URL for the PED-EM-L Web Page is:
> >>> http://listserv.brown.edu/ped-em-l.html
> >>>
> >>> For more information, send mail to [log in to unmask] with 
> >>> the
> >>> message: info PED-EM-L
> >>> The URL for the PED-EM-L Web Page is:
> >>> http://listserv.brown.edu/ped-em-l.html
> >>>
> >>> For more information, send mail to [log in to unmask] with 
> >>> the message: info PED-EM-L
> >>> The URL for the PED-EM-L Web Page is:
> >>> http://listserv.brown.edu/ped-em-l.html
> >>
> >> _________________________________________________________________
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> >> http://windowslive.com/online/hotmail?ocid=PID23391::T:WLMTAGL:ON:WL:en-US:WM_HYGN_faster:082009
> >> For more information, send mail to [log in to unmask] with 
> >> the message: info PED-EM-L
> >> The URL for the PED-EM-L Web Page is:
> >> http://listserv.brown.edu/ped-em-l.html
> >
> >For more information, send mail to [log in to unmask] with the message: info PED-EM-L
> >The URL for the PED-EM-L Web Page is:
> > http://listserv.brown.edu/ped-em-l.html
> 
> For more information, send mail to [log in to unmask] with the message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
> http://listserv.brown.edu/ped-em-l.html

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