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Gatorade vs. Pedialyte

In a message dated 4/24/1999 8:41:30 PM Eastern Daylight Time,
hidden@email-address writes:

> The subject of Gatorade vs. Pedialyte came up on a "Mom's" list that I am
> on.
> After a day's worth of discussion on this topic, we found that there were
> many different
> opinion's coming from pediatricians on which is better.

I'm surprised that there is a difference of opinion from pediatricians about
the use of pedialyte vs. gatorade. Gatorade is made to replace sweat losses
in athletes. The concentrations of sodium and sugar are not correct for kids
with vomiting and diarrhea. Pedialyte is best for either of those. Gatorade
tastes better, but it's really not the right thing to use. I often tell moms
to flavor the pedialyte with a little (emphasize LITTLE) gatorade, or
something else the child likes, to improve the taste. Or try Kao-Lectrolyte,
which tastes better, and the pedialyte freezer pops, which are also better
than the liquid.

Moshe Adler, MD

Gatorade vs. Pedialyte

In practical terms, Gatorade is a reasonable maintenance fluid for the
non-dehydrated older child (2yrs+) with GE. These are the kids who will
refuse to take Pedialyte anyway, even with flavouring. (Pedialyte popsicles
are a cute idea but just don't provide enough volume.) Gatorade is a
compromise solution and not ideal (see Harriet Lane for composition),
especially for smaller kids and for rehydration purposes, but is infinitely
better than pop, ginger ale and especially apple juice, which is what kids
will get otherwise. The kidneys should be trusted to do their work if the
child's perfusion is maintained and the fluid is not totally unphysiologic.
My own impression, sadly, is that lip service is paid to oral rehydration
(excuse the pun) and iv fluids are instituted far to quickly.
Steve Wainer MD FRCPC
Calgary
----- Original Message -----
From:
To:
Sent: April 25, 1999 6:19 AM
Subject: Re: Gatorade vs. Pedialyte

>
> In a message dated 4/24/1999 8:41:30 PM Eastern Daylight Time,
> hidden@email-address writes:
>
> > The subject of Gatorade vs. Pedialyte came up on a "Mom's" list that I
am
> > on.
> > After a day's worth of discussion on this topic, we found that there
were
> > many different
> > opinion's coming from pediatricians on which is better.
>
> I'm surprised that there is a difference of opinion from pediatricians
about
> the use of pedialyte vs. gatorade. Gatorade is made to replace sweat
losses
> in athletes. The concentrations of sodium and sugar are not correct for
kids
> with vomiting and diarrhea. Pedialyte is best for either of those.
Gatorade
> tastes better, but it's really not the right thing to use. I often tell
moms
> to flavor the pedialyte with a little (emphasize LITTLE) gatorade, or
> something else the child likes, to improve the taste. Or try
Kao-Lectrolyte,
> which tastes better, and the pedialyte freezer pops, which are also better
> than the liquid.
>
> Moshe Adler, MD
>
>

> This message is from PEDTALK - a Pediatric Focused email discussion
group.

>
>

Gatorade vs. Pedialyte

Steve Wainer wrote:

> In practical terms, Gatorade is a reasonable maintenance fluid for the
> non-dehydrated older child (2yrs+) with GE.

I add my vote to Steve, for all the reasons he discussed. The problem with IV
vs. Oral seems often to be that orals were not instituted early enough or
vigorusly enough, and by the time we see them they are too sick to take orals
very well. I little IV and they feel better enough to drink. Any body have
experience with breif IV tx in the office? I'd like to consider doing it, but
like most things I've never tried, I am a bit apprehensive.Herb Ruhs, MD

Gatorade vs. Pedialyte

>As far as the taste of pedialyte---if you flaver plain pediallyte with just a
>touch of DRY jello powder----works wonders in improving the taste!!!(and
>acceptability!) Mary Kay

I received this message privately and thought I'd share it with the list.
It reminds me that when I was a med student I did an externship in a peds
E.R. which used "jello water" as an ORS. I don't know what exact recipe
they used, but the kids apparently took it reasonably well.

Another flavoring idea I've heard is to use a sugar-free powder drink mix
such as "Crystal Light" and put a pinch of powder in the plain ORS. The
problem is these powders have artificial sweeteners like Aspartame and some
parents prefer their kids not ingest artificial sweeteners.

Michael Sachs, M.D.
General Pediatrician

Gatorade vs. Pedialyte

Mike-Kaolectrolyte and if I'm not mistaken the Pedialyte pops have
Nutrasweet. You can also make Jello using the plain Pedialyte as if it were
water with the sugar free Jello. I just ask parents to choose a color that
matches their rug. I've found that no one thing works well, and usually it
works to have a little bit of all the rehydrating choices available. I
liberally let the parents feed the children- just asking them to stay away
from really sweet stuff like sodas and juices and really greasy stuff and I
calculate stool replacement at 10 cc per kg. per stool. This gives the
parents an objective goal. In kids that are dehydrated I calculate the 50
cc per kg of ORT over 4 to 6 hrs. I figure that the kids that are running
around playing but refuse the oral hydrating flavored liquids are not all
that dehydrated and will probably be fine. The vomiters are another thing-
the pedialyte pops are nice because it gives small volumes at a time as the
kids suck on them. It's probably a placebo effect but when I feel a
little queasy Pedialyte makes me feel better- I've often wondered why adults
aren't advised to use it- other than for the obvious that we don't dehydrate
as fast- physiologically it's beneficial isn't it? Regards- Kim Burlingham,
MD
-----Original Message-----
From: Michael Sachs
To: hidden@email-address
Date: Sunday, April 25, 1999 11:12 AM
Subject: Re: Gatorade vs. Pedialyte

>
>>As far as the taste of pedialyte---if you flaver plain pediallyte with
just a
>>touch of DRY jello powder----works wonders in improving the taste!!!(and
>>acceptability!) Mary Kay
>
>I received this message privately and thought I'd share it with the list.
>It reminds me that when I was a med student I did an externship in a peds
>E.R. which used "jello water" as an ORS. I don't know what exact recipe
>they used, but the kids apparently took it reasonably well.
>
>Another flavoring idea I've heard is to use a sugar-free powder drink mix
>such as "Crystal Light" and put a pinch of powder in the plain ORS. The
>problem is these powders have artificial sweeteners like Aspartame and some
>parents prefer their kids not ingest artificial sweeteners.
>
>
>Michael Sachs, M.D.
>General Pediatrician
>

> To unsubscribe: mail "hidden@email-address" with with "unsubscribe"

>
>

RE: Gatorade vs. Pedialyte

A big misconception in general about ORS in diarrhea is that the ORS is a
*curative* solution. A lot of parents will give only an ORS and nothing
else for days on end expecting the ORS to make the diarrhea *go away*.
They don't understand that it's merely a method of replenishing
electrolytes lost in diarrheal stools (or vomitus).

Palatability is always a big issue in any form of pediatric treatment.
Kao-electrolyte really does taste a LOT better than Pedialyte. I
personally think Gatorade also tastes better than Pedialyte but, of course,
Pedialyte and Kao-electrolyte are better choices for oral rehydration.
Don't know about everyone else, though.....Kao-electrolyte is not easy to
find in the stores. Neither are Palsicles which I think taste better than
Pedialyte popsicles.

Eve Switzer, MD

One of the really
frustrating things is to have a kid come in with 6 days of diarrhea and
it turns out they have been getting nothing but Pedialyte for the whole
6 days. Or, even worse, Gatorade or juice where the excess sugar is
exacerbating the diarrhea. They need the solids to make poop, I tell
the moms.

Gatorade vs. Pedialyte

Seth and Eve Switzer wrote:
>
> Neither are Palsicles which I think taste better than
> Pedialyte popsicles.

Are those the equivalent of the Pedialyte pops?

--
Gary M. on LI
Clinton 8/17/98 GJ at 59:
"depends on what the meaning of the word 'is' is"

Gatorade vs. Pedialyte

In a message dated 4/25/1999 10:41:27 AM Eastern Daylight Time,
hidden@email-address writes:

> They need the solids to make poop, I tell
> the moms.

My standard line is that if there is only liquid going in, there will only be
liquid coming out. Most people seem to understand that.

Moshe Adler, MD

Gatorade vs. Pedialyte

>In a message dated 4/25/1999 10:41:27 AM Eastern Daylight Time,
>hidden@email-address writes:
>
>> They need the solids to make poop, I tell
>> the moms.

>At 06:47 PM 4/25/99 -0400, hidden@email-address wrote:
>My standard line is that if there is only liquid going in, there will only be
>liquid coming out. Most people seem to understand that.
>
>Moshe Adler, MD
>

And to add to the thought about parents who expect Pedialyte to "cure" the
diarrhea, my standard line with a parent's first call regarding diarrhea in
the winter (usually it will be the first of many calls):

"We can't really do much which will make the diarrhea 'better'. The
*wrong* diet might make it worse but the *right* diet won't necessarily
make it better. We can't really reduce the number of poops or change the
consistency and make it any better than it's destined to be at each
particular stage of the illness."

Letting parents know it might be one to two weeks before the stools are
"normal" and giving them the warning signs of dehydration also helps to
prevent the panic when the kid who's drinking fine with normal activity and
urination still has a large number of liquid poops five or six days into
the illness. Also, keeping the limited dairy/juice - high starch diet
going helps to prevent the rebound I often see when the kid's getting
better after four or five days so they go out and give the him/her a
pepperoni pizza, a dish of ice cream, and a big glass of milk. Then they
call the next day and wonder why it's
gotten worse again!
Michael Sachs, M.D.
General Pediatrician

Gatorade vs. Pedialyte

In a message dated 4/25/1999 1:03:43 PM Eastern Daylight Time,
hidden@email-address writes:

> I just ask parents to choose a color that
> matches their rug.

Which reminds me of another important point: Probably the most common cause
of "bloody" diarrhea (or at least the most common cause of phone calls about
bloody diarrhea) is red jello or red kool-aid. When the mom calls in a
panic, my first question is "what has he/she been drinking?"

Moshe Adler, MD

Gatorade vs. Pedialyte

At 06:47 PM 4/25/99 -0400, hidden@email-address wrote:
>In a message dated 4/25/1999 1:03:43 PM Eastern Daylight Time,
>hidden@email-address writes:
>
>> I just ask parents to choose a color that
>> matches their rug.
>
>Which reminds me of another important point: Probably the most common cause
>of "bloody" diarrhea (or at least the most common cause of phone calls about
>bloody diarrhea) is red jello or red kool-aid. When the mom calls in a
>panic, my first question is "what has he/she been drinking?"
>
>Moshe Adler, MD

When I was a resident we worked up a kid for two hours for documented heme
positive diarrhea. The kid looked so good that the whole story didn't add
up. Finally the mother said the kid had eaten half a watermelon the day
before, my senior tested the stool himself, and it was heme negative. We
asked the nurse who'd documented a heme positive stool on the E.R. sheet
and she said, "Well it was so obviously red I just marked it down as being
due to blood!!!"
Michael Sachs, M.D.
General Pediatrician

Gatorade vs. Pedialyte

hidden@email-address wrote:

> In a message dated 4/25/1999 1:03:43 PM Eastern Daylight Time,
> hidden@email-address writes:
>
> > I just ask parents to choose a color that
> > matches their rug.
>
> Which reminds me of another important point: Probably the most common cause
> of "bloody" diarrhea (or at least the most common cause of phone calls about
> bloody diarrhea) is red jello or red kool-aid. When the mom calls in a
> panic, my first question is "what has he/she been drinking?"
>
> Moshe Adler, MD
>

And in the healthy kids, don't forget to ask about beet and/or spaghetti
sauce/pizza sauce.

Vicki

Gatorade vs. Pedialyte

In a message dated 4/25/99 11:22:46 AM US Mountain Standard Time,
hidden@email-address writes:

<< A big misconception in general about ORS in diarrhea is that the ORS is a
*curative* solution. >>
How true. I think a lot of parents think that the ORS is like Kaopectate. If
I see a child with just diarrhea I do not put them on just clear liquids
anymore. I keep them on small bites of starchy foods.
Maureen

Gatorade vs. Pedialyte

In a message dated 4/25/99 2:43:50 PM US Mountain Standard Time,
hidden@email-address writes:

<< Any body have
experience with breif IV tx in the office? >>

In a former practice we did it all the time and with great success. In my
current practice we are planning on doing it as soon as we build our new
offce with more room. It is satisfying to see a child "bounce" back so
quickly-after some IV fluids.
Maureen CPNP

Gatorade vs. Pedialyte

hidden@email-address wrote:

> In a message dated 4/25/99 2:43:50 PM US Mountain Standard Time,
> hidden@email-address writes:
>
> << Any body have
> experience with breif IV tx in the office? >>
>
> In a former practice we did it all the time and with great success. In my
> current practice we are planning on doing it as soon as we build our new
> offce with more room. It is satisfying to see a child "bounce" back so
> quickly-after some IV fluids.
> Maureen CPNP
>
> How do you bill for it? And do you get paid?

Vicki

Gatorade vs. Pedialyte

While we're discussing gastroenteritis, does anyone have a good treatment for
the cramping pain that comes with it? I just got a call from a mom about a
child I saw this morning, who was also in the ER on Friday, with diarrhea,
fever and pain. The ER did a CBC, lytes, and U/A--all normal except for some
ketones in the urine, and a rotavirus, which was negative. She still has
some liquid stool every time she eats, but she is voiding some, and acting ok
between episodes of fever and pain. She is getting ibuprofen for the fever,
and the pain does get a little better with each dose, but comes back about 5
hours later. Any suggestions?

Moshe Adler, MD

Gatorade vs. Pedialyte

It's the blue dye in the koolaid mixing with the bile in the stool. And
it is pretty fluorescent, too.

"Michael L. Webster" wrote:

> But why should grape Kool-aid turn their poop green?
>
> Mike Webster, MD

Fw: Gatorade vs. Pedialyte

 
-----Original Message-----From:
Dr. Javier Viniegra <hidden@email-address>To:
Vicki L Soloniuk <hidden@email-address>Date:
Wednesday, April 28, 1999 11:26 AMSubject: Re: Gatorade vs.
Pedialyte
all this nice line of concepts with oral
solutions brings me back to the days where I was in a Pediatric residence back
in Mexico City, those were the days. It was 1978. A great change in Pediatric
thinking was about to take place. My first two years of residence I was teached
to treat dehydration with IV's, great results, if managed well there were no
complications, outcomes were always OK, no matter what. Then suddenly the
treatment commite in the big hospital said: no more IV's from today all
dehydrated kid is going to be oral dehydrated. Hell broke loose. Big coky
figures started emanating with their own educated thoughts: is it going to be
pedyalite (the one that then existed) or is it going to be Gatorade (or whatever
similar), or is it going to be homemade, with flavor or without flavor.
Experimental work begun,  3 years later results were convincing. It was
oral rehydration: by far less money was needed, hospital stay was also lessened,
kids loved the treatment suddenly instead of rooms filled with tears there were
rooms filled with laughter and giggles,
 
Being more scientific:
 
1) Oral rehydration produced at the beginning
more liquid in the stools, but don't worry no problema
2) No matter which solution outcome was
Ok
3) With the proper words moms and kids were
happy and obedient to take the solution
4) Antibiotics, bicarbonate and all that became
each time less needed.
 
all this is properly documented with a
respective paper, published and all the works.
 
Nowadays seldomly I
need to install an IV in a kid for dehydration, I am talking probably 2 or 3
times a year, my practice having 30-40 patients a day.
 
theses are my 2x2 cents
 
Javier from Mexico