33 Efficacy of sucrose administration in addition to oral rehydration at triage for paediatric gastroenteritis: A randomized controlled trial

Abstract Background Acute gastroenteritis is a common infection among children presenting to emergency departments (EDs). Fasting-induced ketosis has been proposed as a factor exacerbating nausea/vomiting in paediatric gastroenteritis. Objectives We aimed to evaluate whether administering a concentrated sucrose solution at triage improves oral intake of rehydration solution within the first two hours in children with suspected gastroenteritis. Design/Methods We conducted a double-blind, randomized controlled trial in a paediatric tertiary care ED from 2022 to 2024. Participants were children aged 6 months to 7 years who presented with three or more episodes of vomiting in the prior 24 hours, most likely due to gastroenteritis at triage. Exclusion criteria included severe dehydration, hypoglycemia, bilious vomiting, or the presence of a chronic condition. Participants were randomly assigned to receive either 1.5 ml/kg of a sucrose solution, composed of diluted juice with added table sugar (3.5g of sucrose/10 ml), or diluted juice alone (0.5g of sucrose/10 mL). Thirty minutes after the intervention, parents were instructed to progressively offer oral rehydration solution. The primary outcome was the rehydration solution volume ingested in the first two hours following intervention, while the number of vomiting episodes, need for intravenous rehydration, and ondansetron administration were secondary outcomes. Results Among 1,819 patients screened for acute gastroenteritis, 223 (12.2%) eligible children agreed to participate and were randomized to sucrose (n=112) or placebo (n=111). The median age was 37 months (IQR:19-58). Two hundred thirteen (86 %) provided data for the primary outcome and were included in the analysis. There was no difference in the amount of rehydration solution ingested in the two groups, with 83 mL for the sucrose group, compared to 93 mL for the control (mean difference: -10 mL; 95%CI: -25 to 6 mL). We found no significant differences in the mean number of vomiting episodes (0.37 vs. 0.44; difference: -0.06; 95% CI: -0.31 to 0.18), intravenous rehydration (13% vs 11%; difference: 2%; 95%CI: -8 to 12%), ondansetron administration (57% vs 56%; difference: 1%; 95%CI: -13 to 14%), and return visits (6% vs 5%; difference: 1%; 95%CI: -6 to 8%) between the sucrose and control groups respectively. Conclusion Administering a concentrated sucrose solution does not improve the oral rehydration taken in children presenting to the ED with symptoms of acute gastroenteritis. Moreover, it had no impact on vomiting episodes, need for intravenous rehydration, ondansetron administration, or hospitalizations.

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