It is safer to rehydrate children with D&V enterally than intravenously

I got a few blank faces on a ward round recently when I was working out volumes of diarolyte for rehydrating a child with D&V.  We tend to use “5mls every 5 minutes” in our Emergency Departments whatever the size of the child and however dehydrated they are and then, when they fall asleep and we want to move them out of our department for fear of 4-hour breaches, we put an iv line in, take bloods which we then have to act on and start iv fluids which we should then monitor more often than most of us do.  Where is the half way point?

Have a look at http://www.paediatricpearls.co.uk/wp-content/uploads/Fluid-management-in-childhood-gastroenteritis.pdf for some help with enteral rehydration (which is safer and more efficient overall than intravenous fluids).  Please let me know if you disagree with my calculations and work them all out for yourself from scratch if you happen to be dealing with a 16kg child like in the worked example…

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