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Re: IV rehydration in the office?

	Our group has been doing office rehydration for at least 5 years.
 Many times, a mere push of 20cc/kg normal saline or lactated Ringer's
will get a child "over the hump", especially one who has become acidotic
from protracted vomiting.  Careful reassessment after the initial 20cc/kg
can permit the additional administration of 10-20 cc/kg.  Due to the use
of bolus fluids, prolonged periods of IV infusion and observation can be
avoided.  If the patient needs prolonged infusion, we do admit to the
hospital.  Most of the time, however, hospitalization can be completely
avoided, benefiting the patient, parent, doctor, and even the insurance
company.
	Rehydration is usually done in our "treatment room", although
once the IV line is in, the patient can be moved to an examination room
if  necessary.  IV lines are usually placed by either an MD or RN.  Bear
in mind, as we all know, that little veins become littler when they
reside within a dehydrated infant--we have found the topical application
of small amounts of nitroglycerin paste to be of immense help (references
available upon request); the nitroglycerin causes venodilatation and
inhibits the reflex venoconstriction caused by the needle puncturing the
vein.
	Dave Arkin
	Richmond, VA