Half-strength apple juice relieves mild dehydration in children

Last Updated: 2016-05-02

By Will Boggs MD

NEW YORK (Reuters Health) - For children with mild dehydration from gastroenteritis, half-strength apple juice - and whatever fluid the child prefers - is as effective as expensive electrolyte solutions, researchers say.

"In many high-income countries, the use of dilute apple juice and preferred fluids may be an appropriate alternative to electrolyte maintenance solution use in children with mild gastroenteritis and minimal dehydration," Dr. Steven D. Freedman from University of Calgary in Alberta, Canada told Reuters Health by email.

Dr. Freedman's team studied 647 children aged six months to five years who came to the emergency department with mild dehydration from stomach flu.

Half the children were given half-strength apple juice followed by their favorite drink, and half received an apple-flavored electrolyte maintenance solution, the researchers reported April 30 online in JAMA.

Twenty-five percent of the kids who drank the electrolyte solution still needed intravenous fluids or other additional treatment, compared to 16.7% of the kids who drank apple juice and their favorite drink.

Two-year-olds and older children responded best to apple juice, but even the younger group fared slightly better with apple juice than with the electrolyte solution.

In addition, children treated with apple juice required fewer IV fluids and had lower hospitalization rates than children treated with the electrolyte solution.

"These results challenge the recommendation to routinely administer electrolyte maintenance solution when diarrhea begins," the researchers say.

But this doesn't mean that apple juice is the best treatment for all children with stomach flu.

"Our study specifically excluded high-risk children, and such children should continue to receive electrolyte maintenance solution," Dr. Freedman said. "This would include children younger than six months of age, those with moderate to severe dehydration, children receiving care in a region where severe disease and dehydration are common, and those at risk for electrolyte abnormalities."

He also favors electrolyte solutions for children with other significant medical conditions.

Dr. Francois Angoulvant from Hopital Necker-Enfants Malades in Villejuif, France recently looked at how stomach flu is treated in emergency departments in Belgium, France, and The Netherlands. He told Reuters Health by email, "If a child more than two years of age with mild dehydration refuses to drink electrolyte maintenance solution, the use of half-strength apple juice/preferred fluids therapy is legitimate."

He would not use half-strength apple juice in younger children, however.

Dr. Ivan D. Florez from Universidad de Antioguia, Medellin, Colombia told Reuters Health by email that more information is needed, especially regarding the composition of these fluids, before switching from electrolyte solution to apple juice.

"Physicians should think of apple juice as a promising intervention that needs further studies," he said, adding that "these results are not applicable in low- and middle-income settings."

SOURCE: http://bit.ly/1SV1GGi

JAMA 2016.