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You are the registrar on duty in the children's emergency department. A registered children's nurse asks you about an 18-month-old child who came in with his parents. He has been vomiting for the last 24 h and has today developed loose watery diarrhoea. His mother is concerned that his oral intake is poor and his nappies are not as wet as normal. The GP prescribed some oral rehydration solution yesterday, but the child is refusing to drink it. A neighbour told the mother that allowing the child to drink "flat" cola was a good way to prevent him from getting dehydrated. The nurse asks you if this is a safe and acceptable treatment to recommend for children. You have heard it mentioned by parents of children with gastroenteritis before but feel unsure whether any evidence supports it.
Structured clinical question
In children with viral gastroenteritis [subject] do "flat" fizzy drinks such as Coca-Cola [intervention] compared with oral rehydration solution [comparison] offer adequate rehydration?
Search Strategy and Outcome
Primary searching used the dialog DataStar interface Medline 1950 to date, CINAHL(R) 1982 to date and EMBASE 1974 to date (search date: 18 April 2007).
Two search strategies were run, firstly [gastroenteritis (textword) or gastroenteritis.w.de (MeSH term)] AND [coca cola or carbonated-beverages.de or cola or fizzy drink$] yielding 25 records and secondly [coca cola or carbonated-beverages.de or cola or fizzy drink$] AND [dehydrat$] OR [rehydrat$] yielding nine records, all of which were found by the first strategy. From these, nine papers were relevant and reviewed. 1 - 9 A further five relevant papers not picked up by initial searching were found from the articles reviewed. 10 - 14
A secondary search was performed on The Cochrane Library (Issue 2, 2007) using the following terms: [gastroenteritis AND treatment], [gastroenteritis AND carbonated drink$], [gastroenteritis AND cola] and [gastroenteritis AND flat cola]. Three articles were found but none was relevant to this question.
Although it is difficult to know what terms to choose in order to find all possible literature relating to such drinks, the terms used were felt to be exhaustive. Repeated searches using alternative terms yielded no new papers and all the papers found by the initial search.
Papers were...