Diagnosis and treatment of dehydration in acute gastroenteritis in children: The situation in the Netherlands

Dehydration in the course of acute gastroenteritis is a common reason for hospital admission in children. Since the late nineties, international guidelines on the diagnosis and treatment of dehydration in acute gastroenteritis have been devised. Dehydration is a clinical diagnosis. Only in case of severe dehydration and in case of complications, laboratory investigations are advised. In mild to moderate dehydration, rapid oral rehydration in 3-6 hours with oral rehydration substance (ORS) is recommended. Intravenous therapy is only indicated in severe dehydration and shock, and in case of complications (like failure of oral rehydration therapy). In this study we issued a nation-wide survey to all pediatricians in the Netherlands on their policy regarding the diagnosis and treatment of dehydration in acute gastroenteritis. It was evident, that there is a substantial discrepancy between daily practice and the recommendations in the international guidelines. Only 18% of pediatricians starts rapid rehydration in 3-6 hours, and in more than 80% of children laboratory investigations are performed. More priority should be given to the implementation of guidelines on the diagnosis and treatment of children with dehydration in acute gastroenteritis. The guideline of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and the guideline of the National Institute of Health and Clinical Excellence (NICE) can be the basis for the development of a Dutch guideline.