Family doctor

Diluted apple juice has proven to be more successful in treating mild dehydration in children with gastroenteritis than electrolyte solution, a recent randomised study published in the JAMA has found.

Gastroenteritis is a very common illness in young children. It is usually caused by a viral infection in the stomach and bowel lining leading to severe diarrhoea. The most important treatment for viral gastroenteritis is rehydration. This is usually achieved by an oral electrolyte solution that hospitals and GPs commonly prescribe. It is a relatively expensive solution and its unfamiliar taste can often be off-putting. If oral rehydration doesn’t adequately replace the fluids lost through diarrhoea, children may need to receive fluids through an intravenous drip in their arm with admission to hospital. This is undoubtedly an unpleasant experience for children and avoidance of this through early intervention and hydration is very important.

The study tested whether allowing mildly dehydrated children to rehydrate with dilute half-strength apple juice followed by their fluids of choice was as effective as rehydration with an electrolyte solution. The study randomised children with minimal dehydration who presented to the emergency department in Canada to receive either one of the two treatment options. The children in the study were between 6 and 60 months and had had 3 or more episodes of diarrhoea or vomiting. Children who were severely dehydrated were excluded from the study. All participants received 2 litres of either solution for treatment within the emergency department and also to take home with them.

Children who were assigned to the apple-juice group were advised to continue rehydrating any fluid losses with fluid of their choice and this usually included juices and milk. Among the 647 randomised children, the group receiving apple juice had fewer treatment failures than those drinking electrolyte solution. In particular, they had a reduced need for intravenous rehydration therapy. The greatest benefit of this was seen in children older than 24 months. The study’s results are only applicable in a high-income country setting because children in low-middle income countries are at a higher risk of complications from gastroenteritis.

Traditionally, rehydration with sugary drinks was commonly discouraged because it was thought to worsen diarrhoea. However, this is no longer the currently accepted theory. Despite apple juice being higher in sugar than the electrolyte solution, the study did not find that there was a difference in the frequency of diarrheal episodes between the two groups. The findings suggest that the overall fluid consumption is more important than the amount of sugar consumed.

One other concern that doctors may have had in the past with apple juice compared to electrolyte solution is that there is a lower concentration of salt in apple juice than in typical body fluids. This may theoretically cause water retention and potential water intoxication, however no significant episodes of this occurred during the study and the risk of this in mild dehydration is very low.

The main reason it is thought that dilute apple juice resulted in lower rates of treatment failure is because children seemed more willing to drink apple-juice than the electrolyte solution. Because electrolyte solution was not significantly better at hydrating children than apple juice, this increased fluid consumption lead to more effective hydration. This may seem glaringly obvious at first look but it is reassuring to know that hydration can be just as effectively achieved through common household drinks as electrolyte solution.

Reference:

1. Freedman, Stephen B. et al. "Effect Of Dilute Apple Juice And Preferred Fluids Vs Electrolyte Maintenance Solution On Treatment Failure Among Children With Mild Gastroenteritis". JAMA (2016): n. pag. Web. 3 May 2016.