Oral rehydration versus intravenous therapy for treating dehydration due to gastroenteritis in children: a meta-analysis of randomised controlled trials

BACKGROUND: Despite treatment recommendations from various organizations, oral rehydration therapy (ORT) continues to be underused, particularly by physicians in high-income countries. We conducted a systematic review of randomised controlled trials (RCTs) to compare ORT and intravenous therapy (IVT) for the treatment of dehydration secondary to acute gastroenteritis in children. METHODS: RCTs were identified through MEDLINE, EMBASE, CENTRAL, authors and references of included trials, pharmaceutical companies, and relevant organizations. Screening and inclusion were performed independently by two reviewers in order to identify randomised or quasi-randomised controlled trials comparing ORT and IVT in children with acute diarrhea and dehydration. Two reviewers independently assessed study quality using the Jadad scale and allocation concealment. Data were extracted by one reviewer and checked by a second. The primary outcome measure was failure of rehydration. We analyzed data using standard meta-analytic techniques. RESULTS: The quality of the 14 included trials ranged from 0 to 3 (Jadad score); allocation concealment was unclear in all but one study. Using a random effects model, there was no significant difference in treatment failures (risk difference [RD] 3%; 95% confidence intervals [CI]: 0, 6). The Mantel-Haenzsel fixed effects model gave a significant difference between treatment groups (RD 4%; 95% CI: 2, 5) favoring IVT. Based on the four studies that reported deaths, there were six in the IVT groups and two in ORT. There were no significant differences in total fluid intake at six and 24 hours, weight gain, duration of diarrhea, or hypo/hypernatremia. Length of stay was significantly shorter for the ORT group (weighted mean difference [WMD] -1.2 days; 95% CI: -2.4,-0.02). Phlebitis occurred significantly more often with IVT (number needed to treat [NNT] 33; 95% CI: 25,100); paralytic ileus occurred more often with ORT (NNT 33; 95% CI: 20,100). These results may not be generalizable to children with persistent vomiting. CONCLUSION: There were no clinically important differences between ORT and IVT in terms of efficacy and safety. For every 25 children (95% CI: 20, 50) treated with ORT, one would fail and require IVT. The results support existing practice guidelines recommending ORT as the first course of treatment in appropriate children with dehydration secondary to gastroenteritis

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

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The Unquantified Risk of Post-Fire Metal Concentration in Soil: a Review

Forest fire is a natural disturbance that occurs in many terrestrial ecosystems specifically in the semi-arid environments and is considered to be an important cause of environmental change. Though many causes of fire are identified, including lightning, volcanic eruption, power line sparks, etc., human involvement is the most significant factor. Fire events are able to alter the physical, chemical and biogeochemical properties of the soil and surface materials and are able to release major and trace metals into the environment. This may be more significant in mining-affected and industrial landscapes, where elevated concentrations of metals present in the soil. After the fire event, metals become more mobile due to the increase in soil surface exposure and the mobility associated with ash dispersal. This mobility may increase the bioavailability of the metals, which may generate water quality issues and may contribute to human and environmental health concerns. Even though, the influences of fire on many soil properties are well established, the behaviour of metals with respect to fire is not well investigated. However, a few studies report that major and trace metals include Cd, Cr, Co, Cu, Hg, Mn, Ni, Pb, Zn and As are mobilized after fire with increased concentrations in soil and water resources and this might pose a risk to human health and ecosystems. Climate change may increase the intensity, frequency and areal extend of fire events and hence increase the metal concentrations and their potential health impacts. This paper reviews post-fire (wild fire) mobility of metals in soil common in contaminated forest ecosystems. The human and ecological health risks of these metals are also considered. © 2017, Springer International Publishing Switzerland