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Letter to the Editor Letter to the Editor DKK Ng, YY Lam, WF Lau Dear Editor, We read with interest the article "Use of intravenous therapy in the management of acute gastroenteritis in young children: a retrospective analysis" by Ip et al.1 We would like to point out that their comment of 'dehydration was based on the weight loss classification of <5% (mild), 5-10% (moderate) and >10% (severe)' requires clarification. As total body water and extracellular fluid volume as percentage of body weight decreases with increasing age (Table 1), a lesser decrease in body weight would result in similar clinical dehydration in older children.2 Hence, for children older than 1-year, a 3%, 6% and 10% weight loss correspond to mild, moderate and severe dehydration respectively.2,3 However, one should realise that the clinical features would not change much between 5% and 9% dehydration. Because of this threshold effect, distinguishing between mild and moderate dehydration on the basis of clinical signs alone might be difficult. Therefore, the updated recommendations group together patients with mild to moderate dehydration (Table 2). It is important for paediatricians to appreciate the differences as the accurate change in body weight is often not available and the rehydration regime would then be governed by the clinical assessment. In our experience in Kwong Wah Hospital, a significant proportion of children did not have an accurate body weight before the presenting episodes of gastroenteritis. This was further complicated by the fact that difference in the weighing scales used would also make interpretation of change in body weight difficult. DKK Ng Department of Paediatrics
References1. Ip KS, Ma YM, Chan JSH, Young BWY. Use of intravenous therapy in the management of acute gastroenteritis in young children: a retrospective analysis. HK J Paediatr (new series) 2005;10:10-4. 2. Greenbaum LA. Pathophysiology of body fluids and fluid therapy. In: Behrman RE, Kliegman RM, Jenson HB, Editors. Nelson textbook of pediatrics. 17th ed. Philadelphia: WB Saunders, 2004:191-252. 3. King CK, Glass R, Bresee JS, Duggan C; Centers for Disease Control and Prevention. Managing acute gastroenteritis among children: oral rehydration, maintenance, and nutritional therapy. MMWR Recomm Rep 2003;52(RR-16):1-16. |
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