In Reply We thank Guarino et al for highlighting the fact that acute gastroenteritis is a devastating disease in developing countries and that treatment with oral rehydration solution made from clean drinking water, salt, and sugar is life saving and inexpensive.
Our review1 presented a trial by Freedman et al,2 which found that children with gastroenteritis and minimal dehydration presenting to a tertiary care Canadian emergency department who were randomized to treatment with dilute apple juice and preferred fluids were less likely to experience treatment failure compared with children treated with commercial oral rehydration solution. These findings should not be extrapolated to situations of severe dehydration in the developing world. Rather, the Freedman et al trial2 applies to children in more economically developed countries who present to emergency departments with minimal dehydration.
Coon ER, Quinonez RA, Schroeder AR. Oral Rehydration Solution—An Essential Therapy for Childhood Gastroenteritis—Reply. JAMA Pediatr. 2018;172(10):991–992. doi:10.1001/jamapediatrics.2018.2627
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