Gastroenteritis
Gastroenteritis is a condition that causes diarrhea, nausea, vomiting and stomach cramps. It’s sometimes referred to as “stomach flu,” though it has nothing to do with influenza (a respiratory condition).

Most cases of gastroenteritis are caused by a viral infection (such as the rotavirus). Symptoms typically appear about four hours to four days after exposure to the virus and can be severe. In most patients, the condition runs its course in one to two days, but sometimes the symptoms can persist for up to ten days. Gastroenteritis can also be caused by bacteria, food-borne illness and parasites.

Researchers say gastroenteritis is the most common illness in children in the U.S. Among children under five, it causes more than 1.5 million health care visits and 220,000 hospital admissions. Annual treatment costs for young children with gastroenteritis are more than $2 billion.

Dehydration
A potentially serious consequence of severe vomiting and diarrhea is dehydration (an abnormally low level of water in the body). Adequate fluid levels are needed to maintain the volume of blood in the body. As the body loses fluid, it also loses electrolytes, electrically charged minerals (like sodium, potassium, calcium, phosphate and magnesium), that are important for muscle action and many of the body’s processes.

In very early stages of dehydration, the signs are very subtle and may include thirst and dryness of the mouth and tongue. If fluids are not replaced, dehydration becomes more serious, leading to dizziness, facial flushing, sleepiness, irritability, headaches, weakness, and cramping in the arms and legs. A child may cry, yet produce no tears. Babies may not have wet diapers, or may pass only small amounts of very dark colored urine. The eyes, cheeks, abdomen and (in infants) soft spot on the head may appear sunken. Eventually, dehydration can lead to a serious drop in blood pressure, seizures, heart failure, shock and death.

When dehydration occurs, it’s important to restore the levels of fluids and electrolytes. Mild cases of dehydrations can sometimes be treated with oral rehydration solutions. In more severe cases, or when a child can’t keep liquids down, fluids must be restored intravenously.

Philip Spandorfer, M.D., Pediatric Emergency Medicine physician with Children’s® Healthcare of Atlanta says, inserting an IV needle into a sick child can be difficult. Even when the child is healthy, the veins are very small and can be difficult to access. When a child is dehydrated, the veins shrink and it becomes even harder to insert the IV needle, and several needle sticks may be required to get the IV line established. On top of the access difficulty, the sick child is usually very scared and often needs to be held down while the nurse is trying to start the IV.

Hylenex for Rehydrating Kids
A product, called hylenex recombinant, is easing the ability to rehydrate sick kids. Hylenex is made from hyaluronidase, an enzyme that breaks down hyaluronan (hyaluronic acid, an enzyme that holds cells together, like glue, and enables tissue to become a natural barrier). When hylenex is injected under the skin, the enzyme breaks down some of the natural glue, opening up spaces in the tissue and enabling it to become more permeable.

Instead of using an IV line, Spandorfer says hylenex is injected into the back of the child, between the shoulder blades, where the injection can’t be seen. Then, a catheter is inserted just under the skin. IV fluids are delivered through the catheter and into the skin. The fluid is then absorbed into the capillaries (the tiny blood vessels near the surface of the skin).

A parent can hold the child the entire time, from the injection of hylenex until the fluid levels are restored. The IV lines are out of reach of the child and he/she still has free hands to play or hold a toy. According to the manufacturer, the natural tissue barrier is restored within 48 hours.

Spandorfer says, with hylenex, health care providers are typically able to start rehydration treatment faster, allowing a child to go home sooner. Hylenex is not appropriate for severe dehydration. Spandorfer also says if a child needs multiple medications of other medical procedures that require an IV line, standard rehydration techniques would be used.

AUDIENCE INQUIRY
For information about hylenex, go to http://www.hylenex.com

For information about gastroenteritis or dehydration:
Centers for Disease Control and Prevention, http://www.cdc.gov
National Institute for Diabetes and Digestive and Kidney Disease, http://www.niddk.nih.gov

BIBLIOGRAPHY
DeCamp, Lisa, M.D., et al., “Use of Antiemetic Agents in Acute Gastroenteritis,” Archives of Pediatrics and Adolescent Medicine, September 2008, Vol. 162, No. 9, pp. 858-865.

Frost, G., “Recombinant Human Hyaluronidase (rHuPH20),” Expert Opinion in Drug Delivery, July 2007, Vol. 4, No. 4, pp. 427-440.

Goldman, Ran, M.D., et al., “Validation of the Clinical Dehydration Scale for Children with Acute Gastroenteritis,” Pediatrics, September 2008, Vol. 122, No. 3, pp. 545-549.

“Preventing Dehydration from Diarrhea,” Journal of the American Medical Association, January 17, 2001, Vol. 285, No. 3, p. 362.

Thomas, J., et al., “Assessing the Role of Human Recombinant Hyaluronidase in Gravity-Driven Subcutaneous Hydration,” Journal of Palliative Medicine, December 2007, Vol. 10, No 6, pp. 1312-1320.

Yocum, R., et al., “Assessment and Implication of the Allergic Sensitivity to a Single Dose of Recombinant Hyaluronidase Injection,” Journal of Infusion Nursing, September-October 2007, Vol. 30, No. 5, pp. 293-299.