Samenvatting
Dehydratie bij gastro-enteritis is een veelvoorkomende reden van ziekenhuisopname bij kinderen. Er zijn sinds 1996 goed onderbouwde internationale richtlijnen voor diagnostiek en behandeling. Diagnostiek vindt plaats op basis van klinische bevindingen; slechts in geval van ernstige dehydratie of complicaties wordt aanvullende diagnostiek aanbevolen. Er wordt bij milde tot matige dehydratie gestreefd naar snelle rehydratie binnen 3-6 uur met behulp van orale rehydratietherapie met ORS (oral rehydration solution). Intraveneuze therapie is alleen geïndiceerd in geval van ernstige dehydratie of complicaties (zoals falen van de orale therapie). Uit onderzoek met behulp van een enquête onder kinderartsen in Nederland blijkt een grote discrepantie tussen de dagelijkse praktijk en hetgeen in de richtlijnen wordt geadviseerd. Slechts 18% van de kinderartsen streeft naar rehydratie binnen 3-6 uur. Bij meer dan 80% van de kinderen wordt nog laboratoriumdiagnostiek verricht; in veel gevallen is deze laboratoriumdiagnostiek niet geïndiceerd. De implementatie van richtlijnen over de behandeling van acute gastro-enteritis verdient meer prioriteit. De richtlijn van de European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN), alsook die van het National Institute for Health and Clinical Excellence (NICE) vormen een goede basis voor de ontwikkeling van een Nederlandse richtlijn.
Summary
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.
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Dankbetuiging
De auteurs danken collega dhr. J.H. Hoekstra, kinderarts MDL in het Jeroen Bosch Ziekenhuis te Den Bosch, voor zijn beoordeling van het manuscript.
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arts-assistent kindergeneeskunde (thans: huisarts in opleiding)
kinderarts EAA
kinderarts MDL
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Mast-Harwig, F., Lincke, C. & Groeneweg, M. Diagnostiek en behandeling van dehydratie bij acute gastro-enteritis op de kinderleeftijd. TIJDSCHR. KINDERGENEESKUNDE 78, 214–219 (2010). https://doi.org/10.1007/s12456-010-0054-8
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DOI: https://doi.org/10.1007/s12456-010-0054-8