Does bicarbonate concentration predict hospitalization among children with gastroenteritis?

ABSTRACT

To determine the relationship between bicarbonate concentration and hospitalization among children with gastroenteritis. This study was conducted at Prince Ali Bin Al-Hussein Hospital over a period of 6 months between August 2008 and February 2009. A total of 84 children aged 6 months to 5 years were included in the study. All patients included in this study were evaluated in our Pediatric Outpatient Clinic and they had acute gastroenteritis with mild to moderate dehydration, associated with vomiting at least 5 times per day for less than 48 hours duration. Blood gases either arterial or venous and serum electrolytes were measured for all patients as ordered by an attended pediatric physician after initial evaluation. Each patient was given 20-30 ml / kg dextrose 5% saline over a period of two hours, followed by the oral administration of small and frequent amount of clear fluids [about 30-50 ml / 30 minutes for two hours]. Patients who developed vomiting during or after oral rehydration were hospitalized for prolonged intravenous fluid therapy while patients who tolerated oral fluids were discharged and their caregivers were advised to come back to hospital if vomiting persisted, diarrhea increased or any new complaint was noticed by the family. We extend the period of observation for patients with bicarbonate measurements bicarbonate measurements didn't contribute to the decision of hospitalization. The patients were divided into three groups according to the bicarbonate measurements 13 mmol/l or less, between 13 mmol/l and 18 mmol/l, and 18 mmol/l or more. A total of 84 children aged 6 months to 5 years were included in the study. The mean age was 17.94 months; thirty- seven [44.0%] were males and 47 [56.0%] were female. Twenty- nine [34.5%] patients were hospitalized; thirteen [44.8%] males and 16 [55.2%] females. In group I; sixteen patients [94%] out of 17 were hospitalized. In group II; 11 patients [26.2%] out of 42 were hospitalized, while in group III; 2 patients [8.0%] out of 25 were hospitalized. Twenty-six [36.1%] patients out of 72 with moderate dehydration were hospitalized while; 3 [25.0%] patients out of 12 with mild dehydration were hospitalized. Dehydration was improved in all patients after intravenous rehydration. The frequency of serum bicarbonate concentration of 13 mmol/L or less on presentation was significantly greater [P= 0.001] in patients requiring hospitalization than in those discharged from the Emergency Department to home. Most children who had bicarbonate measurements less or equal to 13mmol/L didn't tolerate oral fluids after rapid intravenous rehydration and required hospitalization for prolonged intravenous rehydration. Bicarbonate concentrations above 13 mmol/L are associated with less hospitalization for intravenous fluids in acute gastroenteritis