Intravenous Rehydration for Severe Acute Malnutrition with Gastroenteritis

This multicenter, open-label, randomized controlled trial investigated whether intravenous (IV) rehydration strategies are safe and beneficial in children aged 6 months to 12 years with severe acute malnutrition and gastroenteritis a population traditionally treated with caution due to concerns about fluid overload. Conducted across four African countries, 272 children were randomized to one of three arms: WHO-recommended oral rehydration therapy (ORT), a rapid IV strategy (100 mL/kg lactated Ringer’s over 3–6 hours), or a slow IV strategy (same volume over 8 hours). Mortality at 96 hours the primary endpoint was similar across all groups: 8% in the ORT group and 7% in the combined IV groups. Importantly, no cases of pulmonary edema or fluid overload were reported, challenging long-standing guidelines that discourage IV rehydration in malnourished children. IV arms showed quicker correction of severe hyponatremia, reduced need for nasogastric tubes, and were easier to administer in under-resourced settings. The authors call for a reevaluation of WHO guidelines to consider simpler, unified rehydration protocols for all children with severe dehydration, irrespective of nutritional status.

This multicenter, open-label, randomized controlled trial investigated whether intravenous (IV) rehydration strategies are safe and beneficial in children aged 6 months to 12 years with severe acute malnutrition and gastroenteritis a population traditionally treated with caution due to concerns about fluid overload. Conducted across four African countries, 272 children were randomized to one of three arms: WHO-recommended oral rehydration therapy (ORT), a rapid IV strategy (100 mL/kg lactated Ringer’s over 3–6 hours), or a slow IV strategy (same volume over 8 hours). Mortality at 96 hours the primary endpoint was similar across all groups: 8% in the ORT group and 7% in the combined IV groups. Importantly, no cases of pulmonary edema or fluid overload were reported, challenging long-standing guidelines that discourage IV rehydration in malnourished children. IV arms showed quicker correction of severe hyponatremia, reduced need for nasogastric tubes, and were easier to administer in under-resourced settings. The authors call for a reevaluation of WHO guidelines to consider simpler, unified rehydration protocols for all children with severe dehydration, irrespective of nutritional status.